title: Underage and underserved: reaching young women who sell sex in Zimbabwe.
abstract: Young women who sell sex (YWSS) in Southern Africa are highly vulnerable to HIV, as the risks of being young and female in a high prevalence setting coalesce with those of commercial sex. YWSS are less able to negotiate safe sex, more likely to have higher risk partners, and less likely to use available health services compared to older sex workers. In Zimbabwe's national HIV programme for sex workers, fewer than 1% of clients were 15-29. We developed monthly interactive workshops for YWSS based on an Activity Pack consisting of 21 sessions organised into six modules. The aim was to encourage YWSS' interaction with each other, build their trust, confidence and skills, and encourage uptake of clinical services. We conducted a process evaluation to assess programme strengths, identify challenges, and recommend changes. This paper presents findings synthesising programme records with qualitative data and discusses feasibility, acceptability, and outputs during the pilot phase. In total, 143 YWSS attended meetings and most were from the target 15-19-year-old age group. Participants enjoyed the sessions and reported improved cooperation, willingness to negotiate with clients, and self-reflection about their futures. Staff found facilitating sessions easy and activities clear and appropriate. Challenges included identifying appropriate referrals, initial recruitment of women in some sites, and managing participants' requests for financial compensation. The number of clients aged 15-19 increased at sex worker clinics in all sites. This programme is the first to target YWSS in Zimbabwe to address their disproportionately low service use. It proved feasible to staff and acceptable to participants over a one-year period. Given enhanced vulnerability of YWSS, this programme provides one workable model for reaching this underserved group.
authors.affiliation: a Department of Population Health , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Busza
authors.affiliation: b Centre for Sexual Health, HIV and AIDS Research (CeSHHAR) , Harare , Zimbabwe.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Mtetwa
authors.affiliation: b Centre for Sexual Health, HIV and AIDS Research (CeSHHAR) , Harare , Zimbabwe.
authors.forename: Rumbidzo
authors.initials: R
authors.lastname: Mapfumo
authors.affiliation: c United Nations Population Fund (UNFPA) , 605 3rd Avenue, New York , NY , United States.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Hanisch
authors.affiliation: d German Development Cooperation , Harare , Zimbabwe.
authors.forename: Ramona
authors.initials: R
authors.lastname: Wong-Gruenwald
authors.affiliation: b Centre for Sexual Health, HIV and AIDS Research (CeSHHAR) , Harare , Zimbabwe.|e Department of Infection & Population Health , University College London (UCL) , London , UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Cowan
mesh_terms: D000293:Adolescent; D000328:Adult; D003075:Coitus; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work; D060386:Sex Workers; D012725:Sexual Behavior; D012747:Sexual Partners; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
keywords: Key populations; Zimbabwe; adolescents; process evaluation; sex work