Research Article: Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon

Date Published: June 18, 2018

Publisher: Public Library of Science

Author(s): Derick Akompab Akoku, Mbah Abena Tihnje, Thomas Achombwom Vukugah, Elvis Enowbeyang Tarkang, Robinson Enow Mbu, Meghna Ranganathan.


The purpose of this study was to examine the relationship between socio-demographic characteristics, risky sexual behaviour, alcohol use and transactional sex among female bar workers in Yaounde, Cameroon.

A cross-sectional survey was conducted among a representative sample of 410 female bar workers, recruited through a modified version of venue-based cluster sampling technique from May to June 2017. Transactional sex was defined as having received money/gifts in exchange for sex with any sexual partner in the past 12 months. Logistic regression models were performed to identify the factors associated with transactional sex. The level of statistical significance was set at p< = 0.05. About 14.9% (n = 61) of respondents reported to have engaged in transactional sex, 83.7% (n = 338) had multiple sexual partners at the time of the study, 14.4% (n = 55) had sex with one or more of their male customers in the past 6 months. Almost 73.4% (n = 301) reported alcohol use. Of these, 37.2% (n = 112) were frequent alcohol consumers. About 17.6% (n = 72) reported to have had unprotected sex under the influence of alcohol in the past 6 months. Multivariate logistic regression analysis showed that those who engaged in transactional sex were more likely to have had sex with a male customer in the past 6 months (aOR = 7.34; 95% CI, 3.63–16.98), had sex under the influence of alcohol in the past 6 months (aOR = 2.42; 95% CI, 1.18–4.96) and frequent alcohol consumers (aOR = 2.06; 95%CI, 1.04–4.10). Respondents who had their last sexual intercourse 4 weeks or more prior to the study (aOR = 0.26; 95% CI, 0.08–0.84) were less likely to have engaged in transactional sex. Our study concludes that female bar workers are exposed to male customers and engage in risky sexual practices including transaction sex. Most of them also consume alcohol which increases their risk of HIV and STI acquisition. They are a high-risk group that need to be targeted with HIV prevention interventions.

Partial Text

HIV/AIDS and other sexually transmitted infections (STI) still pose a significant public health challenge in Cameroon. With a population of about 23 million inhabitants [1], the country has an estimated HIV prevalence of 4.3% among adults aged 15–49 years [2]. Young girls and women continue to be disproportionately affected by HIV than their male counterparts. The prevalence of HIV was reported to be almost twice as high among women (5.6%) compared to men (2.9%)[2]. Among women, the HIV prevalence is higher among those living in urban areas (6.4%) compared to those living in rural areas (4.6%)[2]. Generally, many factors have been reported to increase women’s vulnerability to HIV including biological, social, behavioural, cultural, economic and structural [3–5].

This study was designed to test the hypothesis that FBWs are exposed to male customers and due to their limited financial means, some engage in transactional sex. Our findings also support the hypothesis that because these women promote the sale of alcoholic drinks, some of them consume alcohol which increase their likelihood of engaging in risky sexual behaviour and HIV and STI vulnerability. To our knowledge, this is the first comprehensive study conducted in SSA to have investigated HIV vulnerability and transactional sex among this subgroup of women.

This study concludes that FBWs are a group of women whose profession exposes them to men and given that they promote beer consumption to male customers, most of these women also consume alcohol. These factors motivate them to engage in risky sexual practices which increases their risk of acquiring HIV and STI. Additionally, these women also earn low wages and due to limited socio-economic opportunities, some engage in transactional sex with their male customers as a means of survival. These findings are useful as they will inform the design and implementation of HIV prevention interventions to target this group of women. Although interventions aimed towards reducing risky sexual behavior are important, there is a need for economic empowerment interventions directed towards these women. Such interventions will enable them to be financially viable which may decrease their likelihood of engaging in transactional sex and hence reducing their HIV and STI vulnerability.




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