SUBSTANCE ABUSE AND SEX WORK: PROTRACTING THE POTENTIAL OF RISKY SEXUAL BEHAVIORS AMONG COMMERCIAL SEX WORKERS IN MUSINA, LIMPOPO PROVINCE OF SOUTH AFRICA.

• Author: Svinurai, A.
• Position: Report

1. Introduction

   Substance abuse and risky sexual behaviors are common behaviors responsible for a high proportion of diseases and deaths worldwide (World Health Organization [WHO] 2005). Sexual risk behaviors account for over 90% of Human Immunodeficiency Virus (HIV) inflections in the world, with substances and sex work increasing the occurrence of such risk behaviors. UNAIDS states that more than 80 million people have been infected with HIV and other STIs, with over 58% of that population occurring in Sub-Saharan Africa. WHO (2005) argues that HIV is the leading cause of deaths in Sub-Saharan Africa and the fourth biggest cause of mortality globally. It is from such high statistics that Sub-Saharan Africa is regarded as the 'global epicentre' of the HIV pandemic ((Needle, Kroeger, Belani, and Hegle 2006), as despite containing 10% of the world's population, the region carries more than 60% of the world HIV/AIDS burden.

   High-risk population groups such as female sex workers and substance abusers are particularly vulnerable to risky sexual behaviors and HIV epidemics (Afsar, Motazedian, Sayadi, and Sabet 2014, Beduki, Unlu, and Duyan 2011). Baral et al. (2012a) note that female sex workers are 13.5 times more vulnerable to HIV/STIs infections than other women. The global prevalence of HIV among female sex workers is at 37% (UNAIDS 2013) and 56.65% in South Africa (SANAC 2014). Baral et al. (2012a) further posits that female sex workers were 13.5 times more vulnerable to HIV infections than other women.

   The high prevalence of HIV and STs Infection in the Sub-Saharan region and South Africa thus necessitated the research into the twin risks of risky sexual behaviors among substance abusing sex workers in Musina, South Africa. Musina. Musina is a border town between South Africa and Zimbabwe and is regarded as the socioeconomic hub of Southern Africa, ballooning with migrant population (Chinyakata, Raselekoane, and Gwatimba 2018). The migrants are mostly Zimbabweans, with a significant number of Malawians, Ethiopians, Mozambicans and Somalians (Anonymous, 2014). The majority of the population groups are between the ages of 20-34 (Statistics South Africa 2012).

   The main economic activities in the town are mining, plus informal employment. Many people in Musina have taken trades in transport sector, with some working as 'malayitshas' (smugglers) and 'amagumagumas' (gangsters targeting informal cross borders and money changers) (Chinyakata et al. 2018). Some, mainly women, have become sex workers.

2. Sex work and substance abuse

   Researches have estimated that there are around 130 000 to 180 000 commercial sex workers in South Africa (Konstant, Rangasami, Stacey, Stewart, and Nogoduka 2015). A quick survey by South African National Aids Council (2014) posits that Musina has at least 500 sex workers. However, SANAC admits that this number is too small for a border town, as the study was conducted in one night, targeting only clubs and other hotspots. Sisonke Gender Justice notes that the majority of sex workers in South Africa are women, constituting 90%, with 10% being males and transgender.

   It is challenging to guesstimate the number of substance abusing sex workers, but researchers have shown high prevalence of substance abuse within this population (UCSF, Anova Health Institute, and WRHI 2015, Ditmore 2013, Gilchrist et al. 2005, Cusick et al. 2003, El-Bassel, Gilbert, Wittes and Chang 2001). Studies in the United Kingdom have revealed that most women involved in street sex work were heroin or crack abusers (Spittal et al. 2003, Cusick et al. 2003).

   In South Africa, Wechsberg et al. (2009) and Gould and Fick (2008) posits that in Cape Town and Pretoria, sex workers are most likely to abuse substances than people with similar backgrounds. UCSF et al. (2015) survey on hazardous drinkers among sex workers notes that a majority of FSW in Johannesburg of 81.5% (N = 764), a simple majority of FSW in Cape Town with 51.4% (N = 650), (58.4%) while fewer FSW in Durban at 43% (N = 766) were classified as hazardous alcohol drinkers. The mostly abused substances are alcohol, cannabis, methamphetamine and ecstasy (UCSF et al. 2015, Limpopo Provincial Government 2013).

3. Substance abuse, sex work and risky sexual behaviors

   Campbell (2003) note that 'risk' is the likelihood or probability that a specific incident will happen. The term 'risk' as defined by Newcome (1992) within the substance-abuse harm reduction framework is the probability of substance abusing behavior resulting in consequences such as unprotected sexual intercourse or just 'risk' sexual behaviors. In this case, the argument is on the chances that one will engage in risk sexual behavior that he/she would ordinarily not do if not under the influence of substances. Sex work is considered a risk behavior as one would engage in sex with multiple partners, enhancing the risk.

   WHO (2005) argues that substance abuse and sexual risk behaviors are more prevalent in settings such as nightclubs, bars, low-street settings, dark houses, highway eating joints, brothels, motels etc. These substances are used as disinhibitors, sex facilitators, means of relaxation or recreation and for socializing and confidence boosting. Places where substances are found as mentioned above are also work settings of sex workers, with substances being used for the same reasons as noted earlier. Ditmore (2013) argues that the working environment of sex workers also overlaps with establishments where substances are sold.

   Cusick et al. (2003) argues that the most immediate risk that substance abusing sex workers are exposed to is an increase in risk sexual behaviors. The danger is further exacerbated by the compromising effects of substances in which under their influence, one's ability to negotiate for safe sex and use a condom correctly will be diminished. Moreover, substance abusing sex workers face the protracted risk of exchanging sex directly for substances, which can be unprotected. This is particularly so with sex workers with substance addiction as the need for a fix will overpower the rational reasoning (Gilchrist et al. 2012). Under such circumstances, a sex worker may engage in risky sexual behavior if it pays more and is in desperate need of substances (Degenhardt et al. 2007, NADC 2009, Gilchrist et al. 2012; Ditmore 2013). Gilchrist et al. (2012) quotes an HIV positive substance abusing sex worker saying:

   The truth is that (there are sexual behaviors' that put you at greater risk of getting HIV), but then if they (clients) pay...