HIV Vulnerability Among Female Sex Workers in Ghana: IOM Study

GENEVA, Switzerland - IOM Ghana has published a new behavioural study of HIV and population mobility: HIV Vulnerability Among Female Sex Workers Along Ghana's Tema-Paga Transport Corridor.

"The movement of people, goods and services across Ghana continues to increase including various migrant populations. It is therefore important to understand the links between HIV, migration and mobility to create effective HIV programme interventions," says Dr Aden Guliye, Head of IOM Ghana's Migration Health Unit.

The study, funded by UNAIDS and conducted by IOM in partnership with Management Strategies for Africa (MSA) and the West African Programme to Combat AIDS and STI (WAPCAS), looks specifically at the association between mobility and the risk of HIV infection among female sex workers (FSWs) in Ghana.

In November and December 2011 interviews were conducted with 559 FSWs (75% roamers and 25% seaters) in eight pre-identified locations along Ghana's Tema-Paga transport corridor. This North-South corridor traverses six of Ghana's ten regions and serves as a link to transit and trade hubs both in Ghana and neighbouring countries.

In Ghana there are two main categories of FSWs, roamers who are mobile and travel to actively seek clients and seaters who are stationary and work out of their homes or brothels.

To put the situation of FSWs in perspective, Ghana had a population of 24.6 million and an overall prevalence of HIV infection at 1.5% in 2011. The exact figure of FSWs is unknown, but their population is estimated to be between 47,780 and 58,920, with 90% categorized as roamers. The overall prevalence of HIV infection among FSWs in Ghana was estimated at 11.1% in 2011 with a prevalence of 6.6% among roamers and 21.4% among seaters.

The vast majority of FSWs interviewed were Ghanaian nationals (91%) in their late 20s who claimed to have entered into sex work due to poverty and continued this work due to economic hardship. Researchers also found that most FSWs intended to stop sex work if they received alternative financial assistance

Among the key findings was the high level of consistent condom use by FSWs with clients (90.2%), but the majority (53.3%) were inconsistent condom users with non-paying partners. Roamers were also found to have significantly more non-paying partners than seaters.

FSWs were also mobile, with 46% of respondents having travelled for sex work in the three months prior to the interview. The most popular destinations were Kumasi, Tema and Techiman along the Tema-Paga transport corridor and Accra, Sunyani and Takoradi outside the corridor.

The research team concluded that roamers are more vulnerable to HIV infection than seaters because of their frequent movements, concurrent multiple non-paying partnerships and not always having condoms while at work. Findings also indicate that seaters are older, less mobile, have more dependents and earn less income from sex work than roamers.

IOM and its research partners recommend revamping HIV prevention programmes to target not only FSWs in Ghana, but also their non-paying partners and clients with behaviour change communications (BCC) messages and income generating activities to stop sex work. The meeting and interaction points between FSWs, their clients and non-paying partners could be optimal points to deliver HIV prevention interventions.