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Sex workers in sub-Saharan Africa are vulnerable to a range of factors that ill-dispose them to poor health outcomes. Their vulnerability to HIV and other STIs are many fold greater than the non-sex worker population of the same age. Health care systems world-wide are not responsive to the special needs of sex workers, and many sex workers do not receive adequate health services, education or HIV prevention tools. While the literature on female sex work in Africa is fairly robust, troubling research gaps are evident on male and transgender sex work, and the intersections of migration and sex work. A cross-sectional descriptive study was conducted with female, male and transgender sex workers in four sites in South Africa. The research results point towards the diversity of the sex industry and the people who work in it. Sex work is an important livelihood strategy for many, and provides an income for sex workers and their extended network of dependents. Migration is a vital component in how sex worker lives and work are structured. Moreover, the article highlights the shortcomings of health care services to respond adequately to the needs of sex workers, and recommends the rolling-out of specialized, sex work-specific health care services in areas of sex work concentration, and sex work-friendly services in mainstream health care facilities in areas of low sex work concentration.

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