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Abstract：
BACKGROUND: Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients.
METHODS: We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews.
RESULTS: Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients.
CONCLUSIONS: To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.
METHODS: We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews.
RESULTS: Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients.
CONCLUSIONS: To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.
摘要：
背景：结构，人际关系和个人层面的因素可能对艾滋病毒感染高风险人群的艾滋病毒预防行为提出障碍，包括卖性的女人.在本文中，我们记录了在坎帕拉卖性服务的妇女见面并为客户提供服务的情况。
方法：我们使用半结构化访谈收集了定性数据。妇女有资格参加，如果他们是18岁或以上，自我认定为性工作者或为金钱提供性服务，会说卢甘达或英语。从诊所中随机选择了十名在场所和室外地点与客户会面的妇女，这些妇女具有艾滋病毒感染高风险。使用滚雪球抽样招募了其他十名在网上认识客户的女性。访谈包括人口统计数据，主题包括参加和离开性工作的原因，工作地点,与客户和同行的关系的性质，与当局互动，关于性工作的规定，并报告了污名。我们进行了三个多月的采访。使用框架分析方法对数据进行主题分析。编码框架基于从文献中确定的结构因素，但也对面试产生的主题进行了归纳性修改。
结果：女性在物理和虚拟空间会见客户。物理空间包括场地和室外位置，虚拟空间是社交媒体应用程序和网站等在线平台。包括20名女性,12使用在线平台来满足客户。一般来说,诊所样本中的女性受教育程度较低，主要是未婚，虽然雪球样本中的人接受了更多的教育，有专业的工作，或者是大学生。来自两个样本的女性都报告了耻辱的经历，来自客户和当局的暴力，以及由于性工作的非法性而面临的获得医疗保健服务的挑战。尽管所有参与者都在性工作非法的环境中工作，因此遭受了严厉的待遇，雪球样本中的那些人面临着网络安全攻击的额外威胁，从客户那里勒索,以及来自客户的高度暴力。
结论：为了降低性交易女性感染艾滋病毒的风险，研究人员和实施者应该考虑上下文中的这些差异，挑战,以及设计覆盖并包括所有妇女的创新干预措施和计划的风险。
方法：我们使用半结构化访谈收集了定性数据。妇女有资格参加，如果他们是18岁或以上，自我认定为性工作者或为金钱提供性服务，会说卢甘达或英语。从诊所中随机选择了十名在场所和室外地点与客户会面的妇女，这些妇女具有艾滋病毒感染高风险。使用滚雪球抽样招募了其他十名在网上认识客户的女性。访谈包括人口统计数据，主题包括参加和离开性工作的原因，工作地点,与客户和同行的关系的性质，与当局互动，关于性工作的规定，并报告了污名。我们进行了三个多月的采访。使用框架分析方法对数据进行主题分析。编码框架基于从文献中确定的结构因素，但也对面试产生的主题进行了归纳性修改。
结果：女性在物理和虚拟空间会见客户。物理空间包括场地和室外位置，虚拟空间是社交媒体应用程序和网站等在线平台。包括20名女性,12使用在线平台来满足客户。一般来说,诊所样本中的女性受教育程度较低，主要是未婚，虽然雪球样本中的人接受了更多的教育，有专业的工作，或者是大学生。来自两个样本的女性都报告了耻辱的经历，来自客户和当局的暴力，以及由于性工作的非法性而面临的获得医疗保健服务的挑战。尽管所有参与者都在性工作非法的环境中工作，因此遭受了严厉的待遇，雪球样本中的那些人面临着网络安全攻击的额外威胁，从客户那里勒索,以及来自客户的高度暴力。
结论：为了降低性交易女性感染艾滋病毒的风险，研究人员和实施者应该考虑上下文中的这些差异，挑战,以及设计覆盖并包括所有妇女的创新干预措施和计划的风险。
