Table 3 Findings on personal-level risk factors, including behavioral, interpersonal, and psychosocial factors

Nagot 2002

Burkina Faso [9]

Median of 6 years, with wide range

Mean of 3.3 clients per week

Self-assessment of acquiring HIV in the future. Yes: 31%; No: 31%; Don’t know: 37%

12% of sex acts condomless

–

Van Blerk 2007

Ethiopia [24]

Timespan worked in bars often short

SW venue: back rooms of bars; Mean of 1 client per night most nights

High HIV risk awareness

High condom use with clients almost never with boyfriends

Alcohol consumption among FBWs lowers their control over condom negotiation

Van Blerk 2008

Ethiopia [23]

–

–

High risk awareness but feeling powerless to insist on condom use

Many afraid to test for HIV

Forced condomless sex or condom cutting common

Several reports of client violence against FBWs

Van Blerk 2011

Ethiopia [25]

–

SW venue: varies by bar: luxury hotel rooms to backrooms and corridors; Regular clients can become boyfriends

Forced condomless sex, sometimes cutting of condoms

Expected to drink alcohol; Socially isolated if friends & family know occupation

Sori 2012

Ethiopia [3]

Mean of several years; Frequent bar changes

Expectation that low/no wages supplemented by SW; SW venue: back room of bars

Condom use occasional with new clients, rare for regulars

Messersmith 2014 Ghana [6]

–

Few admitted doing transactional sex; widespread agreement that sex work is done by FBW

High HIV knowledge; 64% FBWs think they are at risk of HIV, most due to partner infidelity

64% had ever tested for HIV

–

Low levels of alcohol use reported; client alcohol use seen as risky; violence largely IPV, not at bars

Kishindo 1995a

Malawi [26]

Mean 3 years

Expected to make money from SW not BW; mean of 11 clients per week; SW venue: back rooms of bars

Low HIV risk awareness

23% lifetime condom use

Willing to not use condoms with clients if enough money paid

Stigmatized because they are perceived to spread HIV

Kishindo 1995b

Malawi [8]

All consider BW a temporary occupation;

SW venue: in back room, or elsewhere post- shift; 40% report regular clients.

High awareness that multiple partners risky; low HIV risk self-perception

30% lifetime condom use

–

Mhalu 1991

Tanzania [27]

–

–

–

Unmarried and longer term FBWs with access to counseling had condom use rates of around 65%

–

Mnyika 1995

Tanzania [28]

–

92% of FBWs are aware of the importance of condom use

–

47% lifetime condom use; 44% always have condoms available; 28% regularly insist on condom use with clients

–

Talle 1995

Tanzania [7]

–

All FBWs engage in SW; often have clients & boyfriends

High awareness, low perceived self-risk for HIV

Condom use rare

Reports of violence if refuse client’s demanded sexual practices

Asking clients to use condoms raises stigma

Talle 1998

Tanzania [10]

All working in Namanga < 1 year

Number of clients answered imprecisely & perhaps underreported

–

–

–

Mgalla 1997

Tanzania [29]

–

Almost all have both casual & regular clients

High but imperfect HIV awareness

Some condom use with casual clients, none with regulars;

Low negotiation power

Riedner 2003

Tanzania [30]

–

75% of FBWs´ relationships involve money

–

Condom use ~ 50% ever with both, regular & casual partners

–

Akarro 2009

Tanzania [1]

–

–

High HIV risk awareness

90% report more money for condomless sex

96.7% regularly drink alcohol

Beckham 2013

Tanzania [31]

–

–

High HIV risk awareness

Reports of FBWs unveiling their occupation in front of doctors to receive appropriate care

Condom decisions often left to client; condomless sex better paid

Stigmatized if reveal their profession to HCW; often assumed HIV-positive & referred to ART clinic

Ostermannn 2015

Tanzania [32]

–

FBWs have twice as many lifetime sexual partners as non-FBW peers

FBWs willing to test for HIV when tests are required by officials

–

FBWs less willing than others use home-based HIV testing, more concern re. disclosure

Gysels 2002

Uganda [2]

–

Women have both casual & regular clients

Some claim to enjoy work: can make money & avoid demands for sex from local men; some do well through SW, others still struggling

High HIV risk awareness

Condom use acceptable with casual, but taboo for regular clients

Alcohol use leads to rape; 82% have been subject to violence, 44% to forced sex. Majority of rape prior to starting bar work

Ntozi 2003

Uganda [33]

–

Both types of casual & regular clients; prefer casual because they pay higher and mostly cash

High HIV risk awareness

High stated willingness to test for HIV, but no past testing

Barriers to HIV testing: cost & no facility

Increased condom use in recent years

Alcohol claimed as reason for multiple partners & low condom use