*Department of Global Health, Boston University School of Public Health, Boston, MA; †Center for Global Health and Development, Boston University, Boston, MA; ‡Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Kumasi, Ghana; §Ghana Health Service, Kumasi, Ghana; ‖United States Agency for International Development, Yaounde, Cameroon; and ¶FHI360, Accra, Ghana.
J Acquir Immune Defic Syndr. 2015 Mar 1;68 Suppl 2:S131-7. doi: 10.1097/QAI.0000000000000455.
This study aimed to identify social, economic, structural, and individual-level vulnerabilities of female adolescents who sell sex in Kumasi, Ghana.
Twenty-four in-depth interviews and 4 focus group discussions were conducted with female sex workers of age 18-20 years who had been involved in sex work for at least 2 years. Total sample size was 48.
One-third of participants started sex work before age 15. Knowledge of HIV was accurate and most reported having intentions to use condoms consistently with clients; however, factors such as higher payments, drug and/or alcohol use, fear of violence, and police harassment affected condom use. They perceived violence and rape at the hands of clients as their greatest risk. They also reported abuse and exploitation by police. Respondents voiced strong concerns that girls and teens involved in sex work are at higher risk of unsafe sex, exploitation, and abuse than their older and more experienced counterparts. Unprotected sex with boyfriends was also common.
The pathway to sex work followed a similar pattern for many study participants who left their rural homes for Kumasi in search of economic opportunity. While adolescents who sell sex appear to be abundant in Kumasi, they have been missed by HIV prevention and harm reduction programming. The findings from this study informed the design and implementation of a young female sex worker peer educator pilot program. Key elements of that program are presented, and recommendations for future program evaluation are made.
本研究旨在确定加纳库马西从事性交易的女性青少年在社会、经济、结构和个人层面的脆弱性。
对年龄在 18-20 岁之间、从事性工作至少 2 年的女性性工作者进行了 24 次深入访谈和 4 次焦点小组讨论。总样本量为 48 人。
三分之一的参与者在 15 岁之前就开始从事性工作。她们对艾滋病毒的认识是准确的，大多数人表示有意与客户始终使用安全套；然而，一些因素，如更高的报酬、使用毒品和/或酒精、害怕暴力和警察骚扰，影响了安全套的使用。她们认为客户的暴力和强奸是她们最大的风险。她们还报告了警察的虐待和剥削。受访者强烈担心，参与性交易的女孩和青少年比年龄更大、经验更丰富的同行面临更高的不安全性行为、剥削和虐待风险。与男友发生无保护性行为也很常见。
对于许多研究参与者来说，从事性工作的途径是相似的，她们离开农村前往库马西寻找经济机会。虽然库马西似乎有很多从事性交易的青少年，但他们却被艾滋病毒预防和减少伤害规划所忽视。本研究的结果为年轻女性性工作者同伴教育者试点计划的设计和实施提供了信息。提出了该计划的关键要素，并为未来的项目评估提出了建议。
