Increased condom use among sex workers but more education needed

With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.



Many of the women entering into sex work in Addis are rural migrants who have failed to secure formal employment, or are escaping poor-paying jobs in the city or unwanted marriages in the country, according to a 2008 article published by the UK's Royal Geographical Society.



Teguest, a 16-year-old girl from Gonder, a town 700km northwest of Addis Ababa, fled to the capital four months ago after the death of her parents and a dispute with her brothers.



The relative she contacted in the capital was already engaged in sex work, so the decision to enter the trade was an easy one. Teguest charges 10 Ethiopian Birr or $0.80 per client and has sex with as many as 20 men a day in her tiny room; she is adamant that under no circumstances would she have unprotected sex.



"No, I would not do that for any money. I need my life," she said. "They sometimes offer 200 Birr [$16] and beg me, but life is more important than money."



Teguest says in the past four months, at least 10 men have asked her for unprotected sex at a higher fee.



The good news, according to research by Wise-UP - a condom-promotion project implemented by local NGO Timret Le Hiwot and funded by social marketers DKT-Ethiopia - is that 99 percent of sex workers in 42 Ethiopian cities said they used a condom with their last paying partner, compared with 91 percent in 2002.



Shame factor



But according to health workers, not all sex workers are as fastidious about condom use as they claim. When Abeje Israel, monitoring and evaluation officer at Wise-Up, posed as a paying customer for random surveys, some women did agree to have sex without a condom for a higher fee.



A 2006 study published in the British Medical Journal found that results of sex worker studies obtained using surveys and questionnaires may be biased as they will not always reveal the truth because of "pride, fear, or shame".



"They may say that they do not have sex without a condom, but the reality may be different; they may pretend and not show the real circumstances," Abeje said.



"All these [sex] workers are very vulnerable," he added. "They are not very powerful and they receive a very small sum of money; if you offer them more money, they may be willing to have sex without a condom."



Education vital



Further investigation makes it clear that the city's sex workers still need education on protecting themselves from sexually transmitted infections.





















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Meron, 25, also says she would never have sex without a condom, but added that she took the “precaution” of insisting her clients used two condoms - a practice roundly advised against as it increases the chances of a condom tearing.



Low levels of education and alcohol use also affect the likelihood of female sex workers using condoms, according to a study by Addis Ababa University.



Wise-UP aims to achieve 100 percent condom use among sex workers in the capital, which has an HIV prevalence rate of 7.5 percent, almost four times the national average of 2.1 percent.



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