MAPPING TRANSACTIONAL SEX ON THE TRANS-AFRICA

HIGHWAY

Alan Ferguson1

Chester Morris2

1 Constella-Futures and University of Manitoba

2 University of Manitoba

Vulnerable people and vulnerable places

• Even in generalized epidemics, vulnerable groups disproportionately affected

• Where epidemic has peaked, re-concentration of infection in vulnerable groups

• Increasing evidence of locations that make people vulnerable to HIV

OBJECTIVES

• Measure volume and characteristics of highway-based transactional sex on section of Trans-Africa highway

– Identification of ’Hot Spots’– Risk-avoidance practices and un-met

needs– Client characteristics– Use of GIS in visualization and planning

METHODS

1. GIS

GPS mapping of stopovers

between Mombasa and

Kampala

Mapping of aggregate

data at national /

regional level

METHODS

2. Sex Worker Diaries (n=578)

• Completed for 28 consecutive days

• Permit calculation of:– No. partners, liaisons, sexual acts– Condom use– Occupation of client– Sex during menses– Mobility

METHODS

• Truckers FGDs (6)

• Truckers surveys (4)

• Sex Worker FGDs (22)

• Truck Census (all stopovers)

• Bar census / survey (1,007)

Basic results

No. of stopovers mapped 47

Mean No. of trucks parked overnight 3,066

Estimated No. of FSWs c.8,000

Total No. bars / lodgings mapped 1,007

Average weekly No. of crates of beer sold 12,046

No. bars / lodges selling / distributing condoms 601

No. bars / lodges having condom dispensers 181

Weekly no. of condoms sold / distributed in bars / lodges

82,324

Stopover points

Mean nos. overnight trucks

Mean no. trucks / FSW estimates

Truck and sex worker volumes: Uganda sector

Malaba

Sega

Busia

TCI

Naluwerere

Idudi

Mbikko

Lugazi

Kampala (Mbuya)

3065

75

500

100

100

750

1400

0 40 8020 Kilometers

Busia / Malaba - Kampala

Example of thematic map of single hot spot

Mean levels of transactional sex

13.3

24.4

52.9

0

10

20

30

40

50

60

Mean

Different clients per month

Liaisons per month

Sexual acts per month

Variations in mean monthly # sexual acts

No. of sexual acts

192

145

134

106

96

90

84

78

72

66

60

54

48

42

36

30

24

18

12

3

% F

SW

s

3.0

2.5

2.0

1.5

1.0

.5

0.0

Transactional sex by type of partner

81.6

18.4

51.948.1 50.749.3

0102030405060708090

% all clients % allliaisons

% all sexualacts

Casual Regular

Condom use per liaison by type of client

89.9

64.5

77.7

50

55

60

65

70

75

80

85

90

%

Casual Regular All

Client occupations

21.0%

1.1%

3.9%

6.4%

11.0%

2.4%

2.2%

7.4%

14.5%

30.2%

Others

Soldier

Health Worker

Teacher

Business / sales

Bar/Lodging worker

Artisan

Police

Other driver

Trucker

HIV Transmission

• Using AVERT model, estimated that 3,200 – 4,200 new infections per annum from transactional sex on highway

• Raising condom use to 90% would avert almost 2/3 of these new infections

CONCLUSIONS

• High levels of highway-based transactional sex in E. Africa

• Despite high levels of condom use, HIV transmission significant

• Client base much wider than expected suggesting a ‘vulnerable places’ approach to programming

• Both FSWs and truckers socially marginalized

CONCLUSIONS - Methodology

• GIS proved to be effective in visualization and advocacy

• Diaries are flexible and efficient means of generating data where recall and social desirability biases are present

THANKS TO