Intersectional vulnerabilities and differential impacts of COVID-19 responses on young people who sell sex in Zimbabwe.

The varying impact of the COVID-19 pandemic on different populations has brought into focus the pre-existing inequalities which shape vulnerabilities amongst marginalised and key populations. More nuanced approaches which understand intersectional vulnerabilities and differential impacts of the pandemic on gender and sexuality diversity within these groups are required. We investigated the economic, social and health impacts of COVID-19 on young people of diverse genders and sexualities who sell sex (16-24 years) in Zimbabwe. We found that all groups had heightened vulnerability to economic and social hardship during the first two COVID waves in Zimbabwe. However, vulnerability was unequally distributed by geography and socio-economic position, as well as by gender and age, both within and between groups of participants. With limited funding resources for the promotion of sexual and reproductive health and rights in the push for universal health coverage, nuanced approaches which include analysis of multidimensional vulnerabilities between and within groups is required to develop the most cost effective and impactful policy and programme interventions.

Economic and social dimensions influencing safety of induced abortions amongst young women who sell sex in Zimbabwe.

Globally, women, experience inequities in access to safe abortion services and this is most acutely felt in country contexts where legal abortions are highly restricted. Data around abortion amongst young women who sell sex (YWSS) in sub-Saharan Africa are very limited. We conducted 30 focus group discussions and 42 in-depth interviews (IDIs) amongst YWSS (16-24 years) in urban and peri-urban areas of Zimbabwe, as well as IDIs amongst 16 peer educators, five health care providers and four key informants. Our findings indicate that abortions occur amongst YWSS in Zimbabwe but there remain questions over the extent of safety of abortions. The restrictive legal context around abortion and illegality of sex work in the country are key determinants underlying the clandestine nature of abortions. Socioeconomic concerns are key in decision-making around abortions. Youth, cost and lack of referral networks contribute towards unsafe abortions, even when safe abortion services are available. Many YWSS are not aware of the availability of post abortion care (PAC) services and resort to self-administered PAC. Being young and selling sex combine and interact on the economic and social levels to produce vulnerabilities greater than their sum to experiencing unsafe abortion.

Age Matters: Determinants of sexual and reproductive health vulnerabilities amongst young women who sell sex (16-24 years) in Zimbabwe.

INTRODUCTION: Female sex workers bear a disproportionate burden of HIV and other poor sexual and reproductive health (SRH) outcomes which has led to the tailoring of SRH interventions to mitigate risk. Understanding of the SRH vulnerabilities of young women who sell sex (YWSS) (16-24 years) in Southern Africa is under-represented in research which may result in a mismatch in current SRH interventions and service design. OBJECTIVE: This paper is based on a sub-analysis of a qualitative study investigating the SRH of young women who sell sex (16-24 years) in Zimbabwe. We explored the differences in dynamics of SRH vulnerability amongst YWSS within the 16-24 year age band. METHODS: In-depth interviews (IDIs) were conducted amongst key informants (n = 4), health care providers (n = 5), and peer educators (n = 16). Amongst YWSS, we conducted IDIs (n = 42) and focus group discussions (n = 30). Transcripts were inductively coded for emergent themes and categories. RESULTS: Age and life stage determinants led to key differences in SRH vulnerabilities between younger (16-19 years) and older YWSS (20-24 years). These determinants emerged in the following ways: 1) distancing of younger participants from a "sex worker" identity leading to difficulties in identification and limiting intervention reach, 2) inexperience in dealing with clients and immature cognitive development leading to greater exposure to risk, and 3) the subordinate social position and exploitation of young participants within sex worker hierarchies or networks and lack of protective networks. CONCLUSIONS: We highlight the presence of a diverse group of vulnerable young women who may be missed by sex worker programme responses. In future intervention planning, there is need to consider the age-related needs and vulnerabilities within a spectrum of young women involved in a wide range of transactional relationships to ensure that services reach those most vulnerable to poor SRH outcomes.