SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
Print version ISSN 0256-9574
RICHTER, M; CHERSICH, M; TEMMERMAN, M and LUCHTERS, S. Characteristics, sexual behaviour and risk factors of female, male and transgender sex workers in South Africa. SAMJ, S. Afr. med. j. [online]. 2013, vol.103, n.4, pp.226-251. ISSN 2078-5135.
BACKGROUND: In South Africa, information on sex workers' characteristics, sexual behaviour and health needs is limited. Current social, legal and institutional factors impede a safe working environment for sex workers and their clients. OBJECTIVES: To describe characteristics and sexual behaviour of female, male and transgender sex workers, and assess their risk factors for unprotected sex. METHODS:Repeat cross-sectional surveys among sex workers were conducted in Hillbrow, Sandton, Rustenburg and Cape Town in 2010. Sex workers were interviewed once; any re-interviews were excluded from analysis. Unprotected sex was defined as any unprotected penetrative vaginal or anal sex with last two clients. RESULTS: Trained sex worker-research assistants interviewed 1 799 sex workers. Sex work was a full-time profession for most participants. About 8% (126/1 594) of women, 33% (22/75) of men, and 25% (12/50) of transgender people had unprotected sex. A quarter of anal sex was unprotected. Unprotected sex was 2.1 times (adjusted odds ratio (AOR), 95% CI 1.2 - 3.7; p=0.011) more likely in participants reporting daily or weekly binge drinking than non-binge drinkers. Male sex workers were 2.9 times (AOR, 95% CI 1.6 - 5.3; p<0.001) more likely, and transgender people 2.4 times (AOR, 95% CI 1.1 - 4.9; p=0.021) more likely, than females to have unprotected sex. Sex workers in Hillbrow, where the only sex work-specific clinic was operational, were less likely to have unprotected sex than those in other sites. CONCLUSION: Tailored sex work interventions should explicitly include male and transgender sex workers, sex work-specific clinics, focus on the risks of unprotected anal sex, and include interventions to reduce harm caused by alcohol abuse.