Policing the epidemic: High burden of workplace violence among female sex workers in conflict-affected northern Uganda

• Published in: Global public health Vol. 12; no. 1; pp. 84 - 97
• Main Authors: Muldoon, Katherine A., Akello, Monica, Muzaaya, Godfrey, Simo, Annick, Shoveller, Jean, Shannon, Kate
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-01-2017; Taylor & Francis Ltd
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Burden; Chi-Square Distribution; Clients; Condoms - utilization; Confidence intervals; Conflict; Criminal Law; criminalisation; Cross-Sectional Studies; Ecological risk assessment; Epidemics; Female; Gang rape; Harassment; Health care policy; Health risk assessment; HIV; HIV Infections - economics; HIV Infections - epidemiology; HIV Infections - transmission; HIV/AIDS; Human immunodeficiency virus; Human rights; Humans; Interest groups; Legalization; Logistic Models; Multivariate Analysis; Negotiations; northern Uganda; Police; Police - statistics & numerical data; Policing; Prevalence; Prostitutes; Prostitution; Public health; Rape; Risk; Risk factors; Sex; Sex industry; Sex work; Sex Workers - legislation & jurisprudence; Sex Workers - statistics & numerical data; Sexes; Sexual assault; Sexual violence; Social Stigma; Statistical analysis; Trust; Uganda; Uganda - epidemiology; Violence; Workplace violence; Workplace Violence - economics; Workplace Violence - legislation & jurisprudence; Workplace Violence - statistics & numerical data; Workplaces; Young Adult; Uganda; Africa; HIV/AIDS; criminalisation; northern Uganda; Sex work; violence
• ISSN: 1744-1692; 1744-1706
• DOI: 10.1080/17441692.2015.1091489

Sex workers in sub-Saharan Africa experience a high burden of HIV with a paucity of data on violence and links to HIV risk among sex workers, and even less within conflict-affected environments. Data are from a cross-sectional survey of female sex workers in Gulu, northern Uganda (n = 400). Logistic regression was used to determine the specific association between policing and recent physical/sexual violence from clients. A total of 196 (49.0%) sex workers experienced physical/sexual violence by a client. From those who experienced client violence the most common forms included physical assault (58.7%), rape (38.3%), and gang rape (15.8%) Police harassment was very common, a total of 149 (37.3%) reported rushing negotiations with clients because of police presence, a practice that was significantly associated with increased odds of client violence (adjusted odds ratio: 1.61, 95% confidence intervals: 1.03-2.52). Inconsistent condom use with clients, servicing clients in a bar, and working for a manager/pimp were also independently associated with recent client violence. Structural and community-led responses, including decriminalisation, and engagement with police and policy stakeholders, remain critical to addressing violence, both a human rights and public health imperative.