Open Access Open Badges Research article

"I do what I have to do to survive": An investigation into the perceptions, experiences and economic considerations of women engaged in sex work in Northern Namibia

Alanna Fitzgerald-Husek1, Alexandra LC Martiniuk2345*, Reece Hinchcliff6, Christine E Aochamus7 and Richard B Lee8

Author Affiliations

1 Michael G. DeGroote School of Medicine, McMaster University (Class of 2011), 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada

2 The George Institute for Global Health, PO Box M201 Missenden Road, Sydney, NSW, 2050, Australia

3 Sydney Medical School, The University of Sydney, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia

4 Dalla Lana School of Public Health, University of Toronto, 155 College St,Toronto, ON, M5T 3M7, Canada

5 Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

6 Australian Institute of Health Innovation, The University of New South Wales, Level 1, AGSM Building, UNSW, Sydney, NSW, 2052, Australia

7 The Namibian Business Coalition on AIDS, PO Box 25 746 Windhoek, Namibia

8 The Department of Anthropology, University of Toronto, 19 Russell St, Toronto, ON, N5S 2S2, Canada

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BMC Women's Health 2011, 11:35  doi:10.1186/1472-6874-11-35

Published: 3 August 2011



There is little published research investigating sex work in Namibia, particularly in rural areas. Therefore, the aim of this paper was to determine the views of women engaged in sex work in the Oshakati area of Namibia concerning the main factors influencing their use, or non-use, of male condoms during transactional sexual exchanges.


Qualitative interviews were used to better understand the perceptions, experiences and economic considerations of female sex workers in Namibia who were involved in a Behavior Change Communication Program encouraging safer sex practices among high-risk populations in 2006 and 2007.


While the Behavior Change Communication Program has made significant strides in educating and empowering young women to negotiate more consistent condom use with sexual partners, the gendered economic inequalities and power imbalances within rural and semi-urban Namibian society that favor men hinder further advancement towards positive behavioral change for HIV prevention and also hinder the development of the loving relationships sought by some sex workers.


This study found that sex workers and transactional sex encounters are heterogeneous entities dependent upon the characteristics of the man (known, stranger, wealthy, attractive to the woman) and the woman (in financial need, desiring love). These features all influence condom use. The 3 E's 'education, empowerment and economic independence' are critical factors needed to encourage and facilitate consistent condom use to prevent HIV transmission. Without financial independence and occupational alternatives building on their health education and empowerment, women who engage in sex work-and transactional sex more generally-will remain largely marginalized from Namibian society, and will continue engaging in risky sexual practices that facilitate HIV acquisition and transmission throughout the community.