Commercial sex referred to an act of exchanging sexual intercourse and other sexual pleasures with something valuable in return for several purposes including generating income1. Globally, female commercial sex workers (FCSW) differ from one place to another2. Commencementreasons into that business is still personal1 but in developing countries, poverty3, lack of employment, civil war was mainly noted to be the courses4.
Worldwide there is a gargantuan number of FCSW and some are living with HIV5 with a global prevalence of 11.8% up to 30%higherthan other women of reproductive6. They are alsopresupposed to be a source of HIV andSTI’s transmission7,8 due to unprotected consummation and having many couples7,9.A study performed in Australia revealedthe increased in burden of STI’s which are bridged by involvement in commercial sex with 39% rise in chlamydia and 47% in gonorrhea infections with low HIV prevalence among FCSW which was 0.2%9. China has prevalence of 49% 8,10with an estimated of 4 up to 10 million sex workers11. Brazil has also large number of commercial sex workers 12 but with minimal number of HIV infected FCSW13 due to its maintained lower country-wise HIV prevalence14 while Uganda being the leading country in the world with the highest prevalence of HIV among FCSW, 85% followed by Lesotho with the prevalence of 72%12,15,16 same as in South Africa17.
As per data reported by UNAIDS, people who are living with HIV/AIDS in Tanzania range from 1.4 to 1.7 million with the prevalence of 4.4%. A nutshell number of female commercial sex worker in Tanzania is estimated to be 155,500 where by in their midst, the prevalence ofFCSW living with HIV is 15.4%12,16,18.
Apart from commercial sex work being attributed in escalation of HIV and other sexual transmitted infections19, it has also been associated with the great increase in unwanted pregnancies20. Most of these FCSW have children and some of them have families also21, they both in a need of structuring families despite being labeled bad22. Knowledge regarding pregnancy intention and preparedness lack to many FCSW23 as most of them are unable to access health services24 and hence predisposed to unwanted pregnancies25 and give birth to children which lead to them continue working so that to feed families16,21,26,27. Nearly quarter of all FCSW in Sub-Saharan countries have one child28.
Maternal mortality and morbidities among these FCSW have been ignored for number of years and no any consideration has been laid on it21. Most FCSW deal with infection preventions and leave aside consideration about their reproductive health concerns23. 23.7% of women in Ethiopia with cervical cancer were noted to engage themselves in commercial sex workwhich showed that, they were predisposed4. Study done in India alsorevealedpredicament in counselling FCSW on how to breast-feed as they are constant at risk of being infected, hence most of them lack prenatal services as well as breast-feeding recommendation24. 81.6% of Indian commercial sex worker initiated breast-feeding24 with no knowledge on mother to child transmission23. Community stamping towards FCSW is what made them lack important reproductive health serviceslike any other women of reproductive age23.
According to nature of work itself, leads into so many actions which put FCSW into danger1 and these violation of some human rights25. Other commercial sex-workers face heightened sexual violence, victimization8 and other social isolations9. In so many regions across the globe they receive high level of brutality from their customers, sexual riskand worse part of it, some cannot access health services24. Study performed in Guatemala revealed that most of FCSW are in danger as they are vulnerable to poor health, gender based violence and sexual exploitation2. Canada Supreme Court laid a huge protection to these sex workers23 while in Kenya they receive extreme violation of some of their common human rights25. Joint United Nation Program on HIV/AIDS launched a program in 2014 which aimed in promoting FCSW to have access to health services including family planning despite these violence29. Tanzania also protects their human rights but local government prohibit that sex work30 and the law of country criminalize the act of selling sexual activities6, being a criminal act made most of FCSW to hide their victimization, violence due to commercial sex and not even to seek medical help in a fear of being prosecuted31.
Contraception method which most of FCSW are aware of, is condom17,19. Consistent use of condom was reported in Australia9 while in China most of these workers are in low social economic status and 62.5% up to 95% are immigrant, hence become unable to negotiate with their customers about condom use8. In United Kingdom, they commonly use condom with their customers but not regularly with their intimate partners and hence increase the risk of transmission sexually transmitted infections22. Kenya implement a policy and program for FCSW to promote condom use29 to which 29% up to 74% adhere to it28. Tanzania reported inconsistent use of condom among FCSW as most put their prices regarding type of sexual pleasure a customer needs to receive including condom-less coitus6.
Little is known about FCSW in Tanzania which brought a motive for this study. Sex work is performed almost in all regions in Tanzania but mainly in the big cities. Assault has been noted to be performed to these FCSW in Tanzania as reported in several medias and these violence have been keep them in danger and lead into performing of this work incognito32. Most of these sex workers have been limited to access to several family planning services including access to contraception19,21,22,25,28,29 so most of them tend to use condom as a method of infection prevention as well as contraceptive method. Very little information has been explored in Tanzania and it is still unknown if knowledge of emergence contraception has been delivered to these FCSW in Tanzania. The main purpose of this research was to assess prevalence of sexual assault and use of emergency contraceptives among FCSW who are mainly working in Dodoma City in central Tanzania.