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Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice.
Sex Transm Infect. 2016 Dec; 92(8):599-604.ST

Abstract

BACKGROUND/OBJECTIVES

Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon.

METHODS

FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models.

RESULTS

Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78).

DISCUSSION

Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice.

Authors+Show Affiliations

Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Comité national de lutte contre le sida (CNLS), Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.PEPFAR DSF Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.Global Viral, Yaoundé, Cameroon. Mosaic, Yaoundé, Cameroon.Global Viral, Yaoundé, Cameroon.Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27280972

Citation

Decker, Michele R., et al. "Gender-based Violence Against Female Sex Workers in Cameroon: Prevalence and Associations With Sexual HIV Risk and Access to Health Services and Justice." Sexually Transmitted Infections, vol. 92, no. 8, 2016, pp. 599-604.
Decker MR, Lyons C, Billong SC, et al. Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice. Sex Transm Infect. 2016;92(8):599-604.
Decker, M. R., Lyons, C., Billong, S. C., Njindam, I. M., Grosso, A., Nunez, G. T., Tumasang, F., LeBreton, M., Tamoufe, U., & Baral, S. (2016). Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice. Sexually Transmitted Infections, 92(8), 599-604. https://doi.org/10.1136/sextrans-2015-052463
Decker MR, et al. Gender-based Violence Against Female Sex Workers in Cameroon: Prevalence and Associations With Sexual HIV Risk and Access to Health Services and Justice. Sex Transm Infect. 2016;92(8):599-604. PubMed PMID: 27280972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice. AU - Decker,Michele R, AU - Lyons,Carrie, AU - Billong,Serge Clotaire, AU - Njindam,Iliassou Mfochive, AU - Grosso,Ashley, AU - Nunez,Gnilane Turpin, AU - Tumasang,Florence, AU - LeBreton,Matthew, AU - Tamoufe,Ubald, AU - Baral,Stefan, Y1 - 2016/06/08/ PY - 2015/11/16/received PY - 2016/04/06/revised PY - 2016/05/10/accepted PY - 2016/6/10/pubmed PY - 2017/6/2/medline PY - 2016/6/10/entrez KW - AFRICA KW - COMMERCIAL SEX KW - HIV KW - SEXUAL ABUSE KW - WOMEN SP - 599 EP - 604 JF - Sexually transmitted infections JO - Sex Transm Infect VL - 92 IS - 8 N2 - BACKGROUND/OBJECTIVES: Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon. METHODS: FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models. RESULTS: Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78). DISCUSSION: Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice. SN - 1472-3263 UR - https://www.unboundmedicine.com/medline/citation/27280972/Gender_based_violence_against_female_sex_workers_in_Cameroon:_prevalence_and_associations_with_sexual_HIV_risk_and_access_to_health_services_and_justice_ L2 - https://sti.bmj.com/lookup/pmidlookup?view=long&pmid=27280972 DB - PRIME DP - Unbound Medicine ER -