Crossroads of choice: a qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda.
| Title: | Crossroads of choice: a qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda. |
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| Authors: | Nattabi J; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Sensoy Bahar O; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America. Ozge.sensoybahar@wustl.edu.; Nabayinda J; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Nabunya P; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Kiyingi J; Department of Medicine, Division of Prevention Science, University of California San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA 94158, USA.; Kizito S; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Namuwonge F; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Nsubuga E; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America.; Witte SS; School of Social Work, Columbia University, New York, United States of America.; Ssewamala FM; International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States of America. |
| Source: | BMC women's health [BMC Womens Health] 2025 Apr 19; Vol. 25 (1), pp. 196. Date of Electronic Publication: 2025 Apr 19. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088690 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6874 (Electronic) Linking ISSN: 14726874 NLM ISO Abbreviation: BMC Womens Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BioMed Central, 2001- |
| MeSH Terms: | Sex Workers*/psychology ; Sex Workers*/statistics & numerical data ; Sex Work*/psychology ; Decision Making* ; Career Choice* ; Choice Behavior*; HIV Infections/prevention & control ; Humans ; Female ; Uganda ; Adult ; Qualitative Research ; Middle Aged ; Young Adult ; Interviews as Topic ; Social Stigma |
| Abstract: | Background: Women engaged in commercial sex work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk of HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs.; Methods: Face-to-face semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within the larger Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 geographical hotspots in the Southern region of Uganda. Participants were selected based on their level of intervention attendance (high/medium/low attendance) during the 12-month follow-up (Time 2). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?" All interviews were audio-recorded, transcribed verbatim, and translated into English. Thematic analysis in Dedoose software was used to analyze the data.; Results: Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and staying in sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to transitioning out of sex work. Individual-level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the interpersonal level, physical and sexual violence was noted as a reason to leave sex work. At the structural level, stigma and discrimination (from community members) were identified as facilitators to leaving sex work. Income-related factors were identified mainly as barriers to leaving sex work.; Conclusion: Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.; (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: All study procedures were approved by the Washington University in St. Louis Institutional Review Board (#201811106), Columbia University Institutional Review Board (IRB-AAAR9804), and the in‐country local IRBs in Uganda: Uganda Virus Research Institute (UVRI—GC/127/18/10/690), and the Uganda National Council of Science and Technology (UNCST—SS4828). Informed written consent is obtained from all study participants. Any future protocol modifications will be submitted to Washington University in St. Louis IRB, Columbia IRB, and in‐country local IRBs for approval. Written consent was obtained from all study participants. Our study procedures adhered to the ethical principles outlined in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. |
| Comments: | Update of: Res Sq. 2024 Jun 07:rs.3.rs-4468785. doi: 10.21203/rs.3.rs-4468785/v1.. (PMID: 38883774) |
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| Contributed Indexing: | Keywords: Commercial sex work; Sub-Saharan Africa; Transition from sex work; Uganda; Women engaged in sex work |
| Entry Date(s): | Date Created: 20250419 Date Completed: 20250419 Latest Revision: 20250424 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12008991 |
| DOI: | 10.1186/s12905-025-03631-4 |
| PMID: | 40253351 |
| Database: | MEDLINE |
Journal Article