Research shows that female sex workers are exposed to extremely high levels of violence

As the country continues to commemorate Women's Month, a recent study by the South African Medical Research Council (SAMRC) and the Perinatal HIV Research Unit (PHRU) shows that female sex workers (FSWs) are exposed to extremely high levels of violence.

Early findings of the study were published in the SSM-Mental Health, a journal that publishes scientific advances related to mental, neurological, and substance use disorders, as well as psychosocial wellbeing and resilience, broadly construed.

Aimed primarily at investigating and describing the prevalence and patterns of exposure of FSWs to violence from intimate partners and other men (clients, police and others), this was a national study of female sex workers (FSWs) linked to sex worker programs, using interviews conducted with 3005 FSWs from across all South African provinces. The study also sought to describe the factors associated with having been raped in the past year.

According to investigators, this is the first time evidence has been available from a national sample of FSWs, and it has illuminated the health and complex life experiences of these vulnerable women. The study followed a 2016 pilot conducted in Soweto amongst FSWs that showed sex workers were extremely vulnerable to violence, mental health problems, and worryingly, signs of HIV drug resistance. The latest nationwide study was conducted in 2019 and was completed before sex workers lives were disrupted by the COVID-19 pandemic.

One of the key findings of the study is that FSWs are exposed to extremely high levels of violence—in the previous year, almost three quarters (71%) had been exposed to physical violence and more than half (58%) had been raped. The study also found that sex workers were extremely vulnerable to rape by clients, men they encountered in the community, as well as from their intimate partners. "However, a particularly concerning finding was that one in seven women had been raped by a policeman," highlights the study.

The study examined the factors that made FSWs vulnerable to rape by their intimate partners or other men. Within the overarching context in which FSWs are discriminated against as poor, uneducated women and as members of a profession that is criminalized, the research showed that women were much more vulnerable to rape by male non-partners if they worked on the streets, sold sex more frequently across the months, and had begun selling sex in their childhood. They were also more likely to be vulnerable if they were homeless or felt they needed to use drugs or alcohol to cope with sex work. Sex workers who had been raped were much more likely to experience depression and post-traumatic stress disorder.

Dr. Jenny Coetzee, the Principal Investigator (PI) of the study who has been working with FSWs for much of the last two decades, explains that this study has put numbers to the very high levels of violence that she has been aware of FSWs experiencing.

"It is vital that sex worker programs are properly resourced so that they can help protect sex workers from violence," said Dr. Coetzee, adding that there is a need for bold and innovative violence prevention projects to reduce the rates of violence seen across South Africa.

She also highlights that with the economic downturn due to COVID-19, we are likely to see an increase in the number of people engaging in "survival-type" sex work, as well as the perpetration of violence against women. "There has been a lot of research showing what needs to be done to help sex workers, now we need committed resources to protect this vulnerable group of women".

Professor Rachel Jewkes, Executive Scientist for Research Strategy in the Office of the SAMRC President, co-author of the study, described these findings as clearly showing that FSWs experience levels of violence that are even higher than the very high levels found in informal settlements, and are likely the most vulnerable women to rape and physical violence in the country.

"It is essential that we leave no one behind in preventing GBV, and female sex workers must be protected" said Prof Jewkes.

She added that the SAMRC, through its Gender and Health Research Unit (GHRU) continues to reiterate its vital contribution to improving the health status and quality of life of women in South Africa by conducting high quality scientific research and leading dialog on violence against women and how we can more effectively fight against the scourge of GBV.