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Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda
  1. Margaret Erickson1,2,
  2. Shira M Goldenberg1,3,
  3. Monica Akello4,
  4. Godfrey Muzaaya4,
  5. Paul Nguyen1,
  6. Josephine Birungi5,
  7. Kate Shannon1,6
  1. 1Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
  2. 2School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  4. 4The AIDS Support Organization Gulu, Gulu, Uganda
  5. 5The AIDS Support Organization, Kampala, Uganda
  6. 6Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Kate Shannon, Department of Medicine, University of British Columbia, Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608–1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6; gshi{at}cfenet.ubc.ca

Abstract

Background While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions.

Methods Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011–2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO.

Results Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99–3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31–9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39–19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42–15.61).

Discussion and conclusions These results suggest a critical need for removal of legal and social barriers to realising the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalised and criminalised populations of FSWs.

  • Unsafe abortion
  • sex workers
  • incarceration
  • reproductive health politics
  • internal displacement

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Footnotes

  • Funding Canadian Institutes of Health Research. This research was supported through a CIHR Team Grant in Gender, Violence and Health (TVG-115616).

  • Competing interests None declared.

  • Ethics approval The study received ethical approval from the University of British Columbia Behavioural Research Ethics Board, TASO Institutional Review Board and is registered at the Ugandan National Council for Science and Technology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • http://jfprhc.bmj.com/site/about/licence.pdf

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