A life of fear: Sex workers and the threat of HIV in Uganda Schoemaker J, Twikirize J. A life of fear: sex workers and the threat of HIV in Uganda The way individuals perceive their risk to certain threats influ- ences their adoption of preventive behaviour. This study explored sex workers’ perception of risk of HIV infection within the context of other serious threats. The study was carried out in Kampala, Uganda, using peer ethnography. Sex workers were well aware of their risk of HIV infection but this risk was eclipsed by other more immediate and frightening threats. Sex workers’ willingness to gamble with HIV is explained by the fact that their existence is already very dan- gerous, and taking risks is an inherent part of their trade. Decriminalising sex work could make their lives somewhat safer, motivating them to better protect themselves, but this is unlikely to happen in Uganda. Attempting to enforce some coercive control mechanisms would not work, given the per- vasive corruption in law enforcement and the judiciary, the institutions that would be responsible for implementing such control. Juan Schoemaker 1 , Janestic Twikirize 2 1 Johns Hopkins University, Maryland, USA 2 Makerere University, Faculty of Social Sciences, Kampala, Uganda Key words: sex workers, HIV/AIDS, risk perception, Uganda, sexual violence Juan Schoemaker, Johns Hopkins University, School of Public Health, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA E-mail: JSchoemaker@icfi.com Accepted for publication October 22, 2010 Background It is a well-established fact that heterosexual transmis- sion has been the principal driving force of the AIDS pandemic in Sub-Saharan Africa, and sex workers have taken a major part in it, both as victims and as ‘drivers’ in its spread. In sub-Saharan Africa, HIV prevalence among sex workers ranges from 30 per cent in Cameroon to 75 per cent in Kenya (World Health Organization, 2005). Given their multiple partners, their frequent instances of unprotected sex and the fact that a size- able proportion of their partners are likely to be HIV infected, there is little doubt that sex workers live under constant risk of being infected and infecting others. Changing high-risk behaviour is a key means of mini- mising the incidence of HIV infection among this vul- nerable group. Risk is the likelihood or probability of a hazardous event happening, whereas a threat is that potentially dangerous event or hazard. It has been suggested that a high-risk perception level be regarded as a pro- tection factor against the threat of HIV infection (Serpelloni et al., 1992). How individuals perceive the risk in relation to particular events is related to the preventive behaviours they adopt. If people are unreal- istically optimistic, they tend to feel less vulnerable and, hence, are expected to be less likely to change their behaviour to reduce risk (Van derVelde, Hooykaas & Plight, 1992). Weistein (in Van der Velde etal., 1992) related risk perception to defensive denial, a situation where people believe they are already vulnerable, which in turn diminishes their feelings of vulnerability. Interventions focusing on sex workers often call attention to the threat of HIV and attempt to promote consistent condom use to minimise the risk of infection. But HIV is only one of the many threats sex workers face, for sex work is an occupation full of grievous occupational hazards. For example, there appears to be an intersection between violence and HIV among sex workers (WHO, 2005) and this violence is not uncommon. Romero-Daza, Weeks and Singer (2003) observed that street sex workers in Hartford, Connecticut were almost continuously exposed to vio- lence, both as victims and as witnesses. A study in San Francisco found that 82 per cent of sex workers had been physically assaulted, 83 per cent had been threat- ened with a weapon and 68 per cent had been raped while working as sex workers. Eight per cent reported physical attacks by pimps or customers that had resulted in serious injuries, such as gunshot or knife wounds (Farley & Barkan, 1998). A study in Miami found that half the street-based sex workers interviewed experienced ‘date’ violence during the year preceding the survey (Kurtz, Surratt, Inciardi & Kiley, 2004). DOI: 10.1111/j.1468-2397.2010.00770.x Int J Soc Welfare 2012: 21: 186–193 INTERNATIONAL JOURNAL OF SOCIAL WELFARE ISSN 1369-6866 Int J Soc Welfare 2012: 21: 186–193 © 2011 The Author(s) International Journal of Social Welfare © 2011 Blackwell Publishing Ltd and the International Journal of Social Welfare. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA 186