Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland

• Published in: PloS one 2014-01, Vol.9 (1), p.e87527-e87527
• Main Authors: Fonner, Virginia A, Kerrigan, Deanna, Mnisi, Zandile, Ketende, Sosthenes, Kennedy, Caitlin E, Baral, Stefan
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Cohesion; Community participation; Condoms; Confidence intervals; Disadvantaged groups; Discrimination; Disease prevention; Employee rights; Empowerment; Epidemiology; Eswatini; Female; Health risks; Health services; HIV; HIV infections; HIV Infections - epidemiology; HIV tests; HIV-1; Human immunodeficiency virus; Humans; Infections; Medical tests; Medicine; Meetings; Participation; Police; Prostitution; Public health; Risk analysis; Risk factors; Risk-Taking; Sex; Sex industry; Sex oriented businesses; Sex Workers; Sexually transmitted diseases; Social and Behavioral Sciences; Social capital; Social Conditions; Social interactions; Social networks; Staff participation; Statistical analysis; Violence; Workers; Working women
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087527

Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30-3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36-4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13-3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33-0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.