Characteristics, sexual behaviour and access to health care services for sex workers in South Africa and Kenya

Type Thesis or Dissertation - Doctor
Title Characteristics, sexual behaviour and access to health care services for sex workers in South Africa and Kenya
Publication (Day/Month/Year) 2013
URL thesis Marlise Richter 9 june 2013 monograph final.pdf
Throughout recent history, sex workers - and other groups marginalised under a
particular period’s political or social system - have been blamed for the spread of disease,
corruption, immorality, witchcraft and death (Bolin and Whelehan, 2009, Alcabes, 2009,
Kempadoo, 1996, Ditmore, 2006). The twentieth and twenty-first centuries have been
no different, and sex workers in particular have been held responsible for the spread of
sexually transmitted infections (STIs), with the Human Immunodeficiency Virus (HIV)
receiving particular focus in the last three decades. A number of studies have designated
sex workers, “vectors” or “sources” of disease (Open Society Institute, 2006, p.14, Delany
and Nielson, 2000, p.1), “a core reservoir of STDs and HIV” (Pettifor et al., 2000, p.36), or
“a potential hazard to society” (Wolffers and van Beelen, 2003, p.1981). Core group
theory holds that those with high rates of sexual partner change are central to the
transmission of HIV and other STIs (Watts et al., 2010). Implementation of this theory
therefore considers sex workers (and less so their clients) as the main target of
prevention activities to reduce the transmission of STIs, including HIV (Hanenberg et al.,
1994). Talbott, for example, notes the “unusual power of CSW’s *commercial sex
workers+ to spread a sexually transmitted illness like HIV/AIDS” and attributes this
“power” to the high number of annual sexual partners and high rates of STIs amongst this
population group, and considers that many sex workers are injecting drug-users (Talbott,
2007, p.1). While many sex work settings contain features that facilitate the spread of
HIV – including multiple sexual partners, the pre-existence of STIs, possible exposure to
contaminated needles and high levels of sexual violence – it does not follow that sex
workers themselves are responsible for the HIV epidemic, which is often implied by the
terminology above, and the implementation and approach of some public health
programmes. One aspect of the impact that an overriding concern with the association 11
between HIV and sex work has on sex workers, is described by Kempadoo in the following

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