As one of the most-at-risk populations, female sex workers (FSWs) have long been a target of public health interventions aimed at reducing the spread of HIV/AIDS. Historically, research has been focused on FSWs themselves, with hardly any attention directed toward the vulnerabilities placed on the children of FSWs. In an article published in the July issue of the Journal of International AIDS society, Beard and colleagues reviewed the literature to assess the vulnerabilities affecting the children of FSWs and injection drug users and to describe current models of care.
The definitions of sex work or FSW may vary by region or culture. Quantifying the number of FSWs tends to be a challenging exercise and thus, determining the number of children of FSWs is even more difficult. In the review of literature, Beard et al., describe that there are no specific global estimates for the number of FSWs, the number of children of FSWs, or even the fertility rates among sex workers. In the study, the term FSW included all categories of women participating in transactional sex.
To most people, the sex work industry is considered taboo; sex work is often illegal and transactional sex tends to be associated with stigma and discrimination. But, there are many reasons why people sell sex. Females may be forced into the sex trade, for some sex work is the only means available to support a family, and for others it may be a way of life passed on through generations of mothers and daughters. Regardless of how or why someone enters the sex work industry there are obvious risks to the physical and psychological well being of FSWs. Beard et al. raise an important concern about a population that seems to be overlooked- the children of sex workers. These children, especially the girls, are more likely to become future sex workers, increasing the number of those most-at-risk for developing HIV/AIDS.
Literature regarding the vulnerabilities of children of sex workers is limited. Among what research is available, several vulnerabilities affecting children of FSWs has been noted including, separation from parents, sexual abuse, early sexual debut, introduction to sex work, low school enrollment, psychosocial issues and social marginalization. Much of the research focuses on girls, and how sex work is often passed on from parent to child.
Although the children of sex workers may be at an increased risk for a wide range of social and psychological issues, Beard et al. found that there are few programs focusing on the needs of these children. Eighteen organizations were identified as currently providing care to the children of FSWs. These programs included educational opportunities for children, vocation training for women, child care and housing so that children had a safe place to stay when their mothers were working.
TASINTHA, a non-governmental organization formed in Zambia in 1992, is dedicated to “transforming the lives of women engaging in sex work, trafficked girls, women and those of vulnerable children throughout Zambia, by providing alternative lifestyles through life saving, professional skills and educational support”. TASINTHA provides day care, residential assistance, rehabilitation and vocational training for mothers, education programs for children, counseling, and health services. TASINTHA assists women in renting homes, reunites mothers with their family, and partners with the police and the government to reduce exploitation and recruit women to join the program.
TASINTHA demonstrates that a successful intervention must focus on both the FSWs and their children. If support is directed only at FSWs there will always be pressure for the mother to provide for her children. This pressure is what leads many women to enter the sex trade in the first place and may lead them to return to sex work, unless there are other opportunities for supporting their children.
Although TASINTHA has helped many Zambian sex workers and their children, there is still a global shortage of support for the children of FSWs. The lack of research is unfortunate, as we are unable to determine all of the consequences and vulnerabilities on the children of sex workers or the short-term and long-term impact of interventions like TASINTHA. Beard et al. suggest that it is imperative to accurately identify the people in need, the sex workers and their children. This should be done with great caution, as it must not further discriminate or put them at risk of legal consequences. Since none of the organizations serving the children of FSWs have been evaluated, the effectiveness of these programs needs to be determined before any attempt is made to duplicate or create new interventions.