Formative Research with Sex Workers for Kasumbalesa Border in Chililabombwe District of the Copperbelt Province of Zambia

This 49-page research report, published by Zambia Centre for Communication Programmes (ZCCP), is part of a regional research process meant to inform the development of print materials on Sexual and Reproductive Health and Rights (SRHR) designed for sex workers, particularly in cross-border regions in Southern Africa. The research forms part of a SRHR initiative, funded by the Sweden and Norwegian Agency for Development Cooperation (Norad) and involving the Soul City Institute for Health and Development Communication's regional partners in Southern Africa. According to the survey, sex workers face a wide number of challenges in Zambia, and there is still a need for increased awareness, sensitisation, and information. The sex workers interviewed expressed various preferences for print, interpersonal, and radio channels to access information.

The report explains that formative target audience research is the process of obtaining relevant and appropriate information from audiences in order to feed into the designing of health and development communication materials. This formative target audience research is part of an information gathering process that will culminate into production for materials for sex workers across the Soul City Institute's regional country partners. The study was carried out in Kasumbalesa border post in Chililabombwe district of the Copperbelt province of Zambia among sex workers.

According to the report, most of the survey participants reported that they had been engaged in sex work for durations ranging from a few months to 10 years. The research resulted in a wide range of findings, including the following:

• Causes for Engagement in Sex Work: Generally the circumstances that lead the participants to start engaging in sex work focused on socio-conomic factors, such as poverty, lack of livelihood after divorce, being widowed or being separated from their husbands, and being orphaned. Many engaged in transactional sex as a means of survival and to raise funds to support their children and siblings, and in some cases support their families back home.
• Challenges Faced by Sex workers: Some of the challenges mentioned included security challenges - participants said that their work was risky because they did not know their clients. Sometimes they were picked up by thugs, criminals, and dangerous people who attacked them. Most prominently, the sex workers reported that they experienced rampant and rife thefts from their clients who stole their proceeds and possessions from time to time. There was a high risk perception amongst sex workers with regards to chances of contracting Sexually Transmitted Infections (STIs) and HIV infections through sex work. Generally the sex workers understood that their job was highly risky.
• SRH Related Problems:Participants reported facing various sexual reproductive health problems. They risked sexually transmitted infections like syphilis, gonorrhoea, and reinfection with different strains of HIV for those that were HIV positive. They also reported that they experienced genital pains due to having too frequent sex with different people. They also reported that they suffer some side effects from family planning medicines such as heavy and prolonged menses to not having menses at all. Others reported that they are faced with engaging in sex acts that are more risky than vaginal sex which are higher paying. Some participants reported experiencing bad services at the clinics when they went to access sexual reproductive health services. They sometimes were shouted at and scolded by the health care providers. Condom access was also reported to be restricted as most of the times the condoms were given only to those that were on ART and those that went for family planning. As a result, they are forced to buy condoms. Negative attitudes were also shown towards the sex workers by the health care providers. On the other hand the participants reported that they got better services from the Congolese side and at the Corridors of Hope project.
• Dealing with Challenges: Participants reported dealing with the challenges that they face in different ways. Some reported that they did report violence, assault, and theft cases to law enforcement officers, and that police were sometimes helpful and sometimes not. When faced with sexual reproductive challenges the participants mentioned that they sought medical attention from the clinics and Corridors of Hope centre. Participants reported getting several services such as family planning services, screening and treatment for sexually transmitted infections, accessing condoms and HIV counseling and testing services, others reported that they self medicated by buying drugs from pharmacies.
• Condom use Among Sex workers: Participants reported that condom use was good because it safeguarded one’s life; it prevented pregnancy, STIs and HIV/AIDS. They showed understanding of the importance of using condoms even if one was already HIV positive to avoid reinfection with different strains of HIV and resistance to ARVS. Some attested to using condoms and narrated their experiences in using condoms. Mostly the male condoms were used more often, were more preferred, more readily available, and accessible compared to the female condom.
• Risk perception & Condom Use: Some participants showed some understanding that they were in sexual networks because they had sex with different people who also had other sexual partners in the different places that they passed through. They echoed the need to use condoms in these relationships to avoid infection and re-infection with HIV.
• Barriers to condom use: Some men were reported not to like using condoms because they wanted to deliberately infect others. Some were said not to just like using condoms. It was also observed that people that knew their status and were not HIV positive were very careful and insisted on condom use all the time. Regular clients, who as a result had become somewhat permanent partners, were reported to resist the use of condoms because of the rapport that had been established. Some circumcised men refused to use condoms because they felt that they could not get infected with sexually transmitted diseases because they were circumcised. The participants reported accessing condoms from the hospital where they were given freely especially to those on ARV.
• Gender-Based Violence among Sex Workers: Gender-based violence was rife amongst sex workers. They reported that their rights were violated almost everywhere they went. Some of them recounted the many instances when they have been violated either by gang rapes by the clients, threats of violence with dangerous weapons, abduction, abandonment in strange places, emotional abuse such as the non payment for services provided, and being used sexually in ways that they were not comfortable with. They narrated accounts of their friends that have been killed by their unknown clients. It was noted that the police do not usually do anything about cases reported to them; the police were reported to be corrupt as they were bribed by the perpetrator of violence from time to time and the perpetrators were released. The sex workers also felt that they were condemned so even if they reported cases of abuse, no one took them seriously.
• Sex Workers Views on HIV/AIDS: The sex workers attested to knowing that HIV/AIDs was real and their need to be careful not to contract it by not engaging in unprotected sex with clients. They were also able to perceive their risk with regards to getting infected with HIV due to the nature of their jobs which exposed them daily to contracting HIV. They reported that they were always scared that one day they would contract the disease. They also reported knowing the need to live positively for those that had tested positive for HIV, and to adhere to ART as this was said to prolong life. Other participants also appealed to the organisations involved in dealing with HIV awareness programmes to target the youth because they had noticed a trend where young people such as 15 years olds were coming to engage in transactional sex with the sex workers. They also appealed to the sex workers to consider the age of the client at all times before ending in sex with the client.

In terms of information and programming, participants reported that role modelling encourages them to go for voluntary counselling and testing (VCT). They felt that if they are tested by someone who is also HIV positive, they feel motivated to do the test. They also felt this would work in reforming them; it could make sense for someone that has been a sex worker before to talk to them about changing because they would readily believe after seeing the change. Some participants felt that there were high levels of denial and limited adherence to ART amongst the Zambians, this was evidenced by the high numbers of people who have been observed to not accept that they are HIV positive, and who do not want to take their ARVs to prolong their lives. Some felt that there was need for more sensitisation and awareness campaigns to encourage people to live positively and seek treatment for STIs.

The sex workers interviewed expressed different preferences for information. Some reported that they were illiterate and did not know how to read. They preferred interpersonal ways of getting information rather than print materials. They also felt that the kind of work that they did afforded then little or no free time. Some felt that they would love radio programmes because they listened to the radio frequently. Others preferred print materials that they could read at anytime whenever they were free.