Economic vulnerability and client coercion as drivers of HIV risk sexual practices among sex workers in Burundi: a semi structured qualitative study
1
Health innovation and research, Health Generation Alliance, Bujumbura, Burundi
2
Community Health, Solidarity of nurses for the promotion of maternal and children's health_SIPROSAMI, Bujumbura, Burundi
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Burundi continues progressing toward the 95 95 95 targets, yet HIV remains a major threat to sex workers (SWs). Economic vulnerability and client pressure drive high risk behaviours, especially unprotected anal sex. Although many SWs understand HIV transmission risks, higher financial incentives often lead them to accept unprotected sex. This study seeks to understand how socioeconomic pressures influence these behaviours and to identify appropriate interventions.
METHODS:
A qualitative field study was conducted in Bujumbura from March to April 2025 using semi structured interviews with 103 SWs. The study examined how economic vulnerability affects sexual decision making. It also incorporated findings from UNAIDS and UNFPA 2024 reports and evaluations of HIV prevention programs such as LINKAGES Burundi, RISE Burundi, and SWAA Burundi. Data were processed and analysed using Google Sheets.
RESULTS:
Existing data show HIV prevalence among SWs at 21.3%(PLACE 2013 study), with some estimates up to 30%, compared to 0.9% in the general population. Participants reported being perceived as vectors of HIV, with estimated risks of transmission to clients (3.8%) and partners (5.2%). Among the 103 interviewees, 8 (7.8%) engaged in unprotected anal sex at client request, while 26 (25.2%) accepted unprotected vaginal or anal sex for higher payment. Overall, about one third of SWs were unable to negotiate condom use due to economic need. Additionally, 18 SWs reported partner pressure, despite over 79% demonstrating strong awareness of HIV risk behaviours.
CONCLUSIONS:
Unprotected vaginal and anal sex remains a significant yet underestimated risk factor among SWs in Burundi. Economic vulnerability and client coercion strongly undermine safer sex negotiation, while stigma and criminalization restrict access to prevention services. Expanding access to condoms and lubricants, establishing anonymous reporting/support platforms, and implementing economic empowerment initiatives may enhance safer sex adherence and reduce HIV vulnerability in this key population.
Burundi continues progressing toward the 95 95 95 targets, yet HIV remains a major threat to sex workers (SWs). Economic vulnerability and client pressure drive high risk behaviours, especially unprotected anal sex. Although many SWs understand HIV transmission risks, higher financial incentives often lead them to accept unprotected sex. This study seeks to understand how socioeconomic pressures influence these behaviours and to identify appropriate interventions.
METHODS:
A qualitative field study was conducted in Bujumbura from March to April 2025 using semi structured interviews with 103 SWs. The study examined how economic vulnerability affects sexual decision making. It also incorporated findings from UNAIDS and UNFPA 2024 reports and evaluations of HIV prevention programs such as LINKAGES Burundi, RISE Burundi, and SWAA Burundi. Data were processed and analysed using Google Sheets.
RESULTS:
Existing data show HIV prevalence among SWs at 21.3%(PLACE 2013 study), with some estimates up to 30%, compared to 0.9% in the general population. Participants reported being perceived as vectors of HIV, with estimated risks of transmission to clients (3.8%) and partners (5.2%). Among the 103 interviewees, 8 (7.8%) engaged in unprotected anal sex at client request, while 26 (25.2%) accepted unprotected vaginal or anal sex for higher payment. Overall, about one third of SWs were unable to negotiate condom use due to economic need. Additionally, 18 SWs reported partner pressure, despite over 79% demonstrating strong awareness of HIV risk behaviours.
CONCLUSIONS:
Unprotected vaginal and anal sex remains a significant yet underestimated risk factor among SWs in Burundi. Economic vulnerability and client coercion strongly undermine safer sex negotiation, while stigma and criminalization restrict access to prevention services. Expanding access to condoms and lubricants, establishing anonymous reporting/support platforms, and implementing economic empowerment initiatives may enhance safer sex adherence and reduce HIV vulnerability in this key population.
| eISSN: | 2654-1459 |
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