The role of intimate partners in harm reduction for HIV positive female sex workers in Kibera, Nairobi




Sharpe, Kimberly

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While female sex workers (FSWs) are often the focus of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other sexually transmitted infections (STIs) research in Kenya, little else is known about their lives, including their intimate relationships. This thesis explores the relationships between FSWs and their intimate partners in Kibera, an urban informal settlement in Nairobi, Kenya. As part of the Kenya Free of AIDS (KeFA) project, previous field research found that FSWs with an intimate partner saw over 50% fewer clients per week and were statistically more likely to use a condom with clients. These findings suggested that FSWs' intimate relationships might act as a form of harm and/or use reduction. Sex work harm reduction aims to diminish the occupational harms associated with sex work, such as discrimination, violence and disease, through strategies such as empowerment and education. Use reduction aims to reduce FSWs' frequency of exposure to these occupational risks through a reduction in clients. Specifically, it is proposed that FSW intimate relationships promote harm and/or use reduction in three ways: 1) by reducing the number of clients on a weekly basis, 2) by reducing harm from the virus through adherence to antiretroviral drugs (ARV), and 3) by offering a supportive environment financially, emotionally, and in terms of health and/or childcare. To test these theories this thesis analyzed interviews with 27 HIV positive FSWs from Kibera. Results showed that HIV was normalized in intimate relationships, whereas sex work was stigmatized. As a result, FSWs in this study were more likely to tell their partners that they were HIV positive than disclose their involvement in sex work. Therefore, rather than genuine use reduction, client reduction was unintentional and, in reality associated with sex work stigmatization that prevents women from disclosing their occupation. Some intimate partnerships were found to be a source of emotional and health-related support for Kibera FSWs. Intimate partners provided support for participants' HIV status and adherence to ARV. They also provided emotional support in the form of advice and comfort. Overall, this study suggested it would be difficult to include intimate partners in interventions with HIV positive Kibera FSWs because of the considerable, continued stigma surrounding sex work but that intimate partners can have a positive and/or protective role to play in HIV positive Kibera FSWs’ lives.



Female sex workers, Kenya, harm reduction, HIV/AIDS, intimate partners, sex work