Food insecurity is driving women in Africa into sex work, increasing HIV risk

by | Nov 11, 2022 | Top Stories

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Hanna Barczyk for NPR

The first time she traded sex for food to feed her family, J was 14 years old. Her father died when she was an infant, leaving her single mother to care for her and her six siblings in her native village in eastern Uganda. She soon gave birth to a baby girl, and her family continued to struggle to eat. So at 16, lured by a relative and the prospect of earning money as a maid, J left her baby behind and traveled 101 miles to the capital to find work so she could send money back home. “We [had] nothing to eat, nothing to drink, nothing to feed the baby, to dress the baby — nothing,” she told NPR. “I thought when I was in the village that things are easy here in Kampala, that I will find peace, I will work.” Then, famine struck her village and her daughter became ill. “The pressure was too high for me,” she said. “At that time, in my mind, I could not resist anything. … I needed money to take care of my mama and the baby,” she said.

J turned to sex work to make money. J’s clients were willing to pay more for sex without a condom, which let her send more money back home. But it also put her at greater risk for contracting HIV. At age 22, J tested positive. (She asked NPR to refer to her by her first initial because of the stigma surrounding HIV and sex work.) Many women and girls living with food insecurity in sub-Saharan Africa face this dilemma. A study published in July by the International Center for AIDS Care and Treatment Program at Columbia University found that severe food insecurity approximately doubles the risk of contracting HIV among women in the region, because it often leads them to engage in transactional sex. The economic shocks of the COVID-19 pandemic and the war in Ukraine have already intensified food shortages in sub-Saharan Africa, the ICAP study pointed out. And without efforts to mitigate climate change, the researchers warned that predicted increases in extreme weather events, from droughts and high temperatures to flooding and cyclones, will likely make food insecurity worse in a region where nearly one in five people are already undernourished.

In Uganda, where three-fourths of the population lives in rural areas, about 28% of households experience some type of food insecurity, the ICAP study found. Worsening drought, flooding and heat waves have contributed to land degradation, crop failures and the loss of livestock, among other consequences. The ICAP researchers also found that giving women in sub-Saharan Africa direct food support resulted in a significant — 64% — decrease in risk of catching HIV. “Women, particularly those heading their own households, need to be specifically targeted with food assistance,” they concluded.
Now 32 and the mother of four children, J wants to tell her story to raise awareness about the risks that food shortages pose to vulnerable women and girls in her country. “I don’t want them to end up where I ended up,” J told NPR. “I know how painful it is.” How food insecurity impacts HIV outcomes With 38.4 million people currently living with HIV in the world — and 1.5 million new infections per year — the study’s findings offer new insights into how combating food insecurity can help control the virus. Women and girls experiencing food insecurity were 28% more likely to engage in transactional sex, defined as sex in exchange for material goods, including food. They are also more likely to engage in high-risk or unprotected sex, sex before the age of 15, forced sex, or sex with a man who is 10 or more years older, the study found. This increa …

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