2020 Theses Master's

Gender, Sex, and Power: The Public Health Implications of Excluding Male Clients of Female Sex Workers in HIV Programming

Morse-Karzen, Bridget Audrey

Female sex workers (FSW) are one of the five populations identified by UNAIDS as being at highest risk for HIV. Due to this increased risk, HIV interventions targeted at FSW are common practice in national-level HIV prevention efforts. While these efforts appropriately work to provide FSW with comprehensive sexual health education, access to reproductive technologies, and social support, they fail to address a critical component of their everyday lives: male clientele. Male clients of FSW are a key bridging population, meaning that they play a crucial role in transmitting HIV from high-risk core groups to non-core groups, such as their wives, girlfriends, or other sexual partners. Despite this, male clients of FSW are rarely targeted by HIV interventions. Focusing all HIV programmatic energy on FSW and excluding male clients is a misstep that places a dual burden on female sex workers; not only are FSW expected to learn safe sex practices, they are also deemed responsible for ensuring that these safe sex practices are followed by their male clientele. These negotiations frequently occur in social environments where male clients hold more power than FSW due to gender norms that shape the policies, economic opportunities, healthcare access, and social support sex workers receive. In order to more effectively decrease the transmission of HIV, the male clients of FSW need to be targeted by HIV interventions. This is especially needed in Eastern and Southern Africa, which is home to 54% of individuals living with HIV globally, despite having only 6% of the world’s population. Overall, the most successful HIV interventions will target male clients and FSW, and will also work to support the communities that these individuals are a part of. HIV interventions should be holistic and employ a broad, multi-pronged approach that addresses the medical, financial, social and legal factors that contribute to creating an environment that heightens HIV transmission between FSW and their male clients.