Age Matters: Determinants of sexual and reproductive health vulnerabilities amongst young women who sell sex (16–24 years) in Zimbabwe

Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is...

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Published in:Social science & medicine (1982) 2021-02, Vol.270, p.113597-113597, Article 113597
Main Authors: Crankshaw, Tamaryn L., Chareka, Samantha, Zambezi, Pemberai, Poku, Nana K.
Format: Article
Language:English
Subjects:
Age differences
Clinical outcomes
Cognitive development
Exploitation
Health care industry
Health problems
Health services
Health status
HIV
Human immunodeficiency virus
Intervention
Medical personnel
Prostitution
Qualitative research
Reproductive health
Sex workers
Sexual and reproductive health
Sexual behavior
Social determinants of health
Teachers
Vulnerability
Women
Young key populations
Young women
Young women who sell sex
Zimbabwe
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Summary:Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16–24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16–24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16–24 year age band. In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16–19 years) and older YWSS (20–24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a “sex worker” identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes. •Young women who sell sex have unique sexual and reproductive health needs.•Elusive identities within the economies of sex pose a challenge to related interventions.•Substance use as a coping mechanism amongst young women who sell sex.•Subordinate social status of young women who sell sex in sex worker hierarchies.•Younger and older sex workers differ in characteristics and vulnerability.
ISSN:0277-9536
1873-5347
DOI:10.1016/j.socscimed.2020.113597