Violence against female sex workers in Cameroon: accounts of violence, harm reduction, and potential solutions.
BACKGROUND
Female sex workers (FSWs) in Cameroon, and West Africa generally, suffer a disproportionate burden of HIV. Although violence against FSWs has been documented extensively in other parts of the world, data on violence from West African countries are lacking. The aim of this study was to qualitatively document violence and harm reduction strategies from the perspective of FSWs in Cameroon as well as to understand how experiences of violence may increase FSWs' HIV risk.


METHODS
FSWs from 7 major cities in Cameroon (Douala, Yaounde, Bamenda, Bertoua, Nagoundere, Kribi, and Bafoussam) were purposively recruited. Data from 31 in-depth interviews and 7 focus groups (n = 70; with some overlapping participants from in-depth interviews) conducted with these FSWs in 6 of these 7 cities (excluding Kribi) were analyzed using a grounded theory approach.


RESULTS
Transcripts revealed 3 primary themes related to violence: (1) sources and types of violence, including sexual, physical, and financial violence perpetrated by clients and police, (2) harm reduction strategies, including screening clients and safe work locations, receipt of payment before sexual act, and formation of an informal security network, and (3) recommendations on structural changes to reduce violence that emphasized sex work decriminalization and increased police accountability.


CONCLUSIONS
As in other parts of the world, violence against FSWs is pervasive in Cameroon. Interventions targeting violence and HIV must address the forms of violence cited locally by FSWs and can build on FSWs' existing strengths and harm reduction strategies. Structural changes are needed to ensure access to justice for this population.
*Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Global Viral Cameroon, Yaoundé, Cameroon; §Comité national de lutte contre le sida (CNLS), Ministère de la Santé Publique (MINSANTE), Yaoundé, Cameroon; ‖Cameroon Medical Women Association, Bamenda, Cameroon; and ¶Department of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Sahnah
S
Lim
Sarah
S
Peitzmeier
Charles
C
Cange
Erin
E
Papworth
Matthew
M
LeBreton
Ubald
U
Tamoufe
Aristide
A
Kamla
Serge
S
Billong
Pamella
P
Fokam
Iliassou
I
Njindam
Michele R
MR
Decker
Susan G
SG
Sherman
Stefan
S
Baral
D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016495:Police; D011902:Rape; D055500:Resilience, Psychological; D060386:Sex Workers; D014754:Violence