"It's all about making a life": poverty, HIV, violence, and other vulnerabilities faced by young female sex workers in Kumasi, Ghana.
OBJECTIVE
This study aimed to identify social, economic, structural, and individual-level vulnerabilities of female adolescents who sell sex in Kumasi, Ghana.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
*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.
Monica Adhiambo
MA
Onyango
Yaw
Y
Adu-Sarkodie
Thomas
T
Agyarko-Poku
Mabel Kissiwah
MK
Asafo
Joy
J
Sylvester
Peter
P
Wondergem
Kimberly
K
Green
Samuel
S
Wambugu
Alana T
AT
Brennan
Jennifer
J
Beard
D000293:Adolescent; D005260:Female; D017144:Focus Groups; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011203:Poverty; D011902:Rape; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012747:Sexual Partners; D047568:Unsafe Sex; D014754:Violence; D055815:Young Adult