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Yes, although the risk of getting pregnant in this way is very low. If you It's possible for you to get pregnant without having sexual intercourse if, for example:​. BackgroundThe association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical. The WHO report also distinguishes four modes in which violence may be inflicted (physical, sexual, psychological, and deprivation or neglect).

Tell your partner what feels good — and what doesn't. Make time. Set aside time for sex when you're not too tired or anxious. If sex continues to. Yes, although the risk of getting pregnant in this way is very low. If you It's possible for you to get pregnant without having sexual intercourse if, for example:​. One in 16 US girls and women were forced into their first experience of sex, either physically or through other kinds of pressure. The figure.

Tell your partner what feels good — and what doesn't. Make time. Set aside time for sex when you're not too tired or anxious. If sex continues to. BackgroundThe association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical. Managing Sex Education Controversy Deep in the Heart of Texas: A Case Study of the North East Independent School District (NEISD). Wiley et al. Published.

Selling sex has been illegal in South Africa since at least the early s and buying sex was criminalised in The criminalisation of sex work has not deterred people from selling sex to make a living. Criminalisation has, however, made sex work less safe. Most sex workers in South Africa are poor, black, and female, and sell sex primarily in order to support their children, as well as other dependents. This report attempts to represent some of the fear, emotional pain, and frustration that South African sex workers experience because the work they do to try to ensure a better life for their children is criminalised.

The report calls for law reforms including the decriminalisation of sex work in South Africa and encourages the Department of Justice and Constitutional Development to take up this task now with seriousness and urgency after years of debate on the issue.

Rofhiwa Mlilo a pseudonym is a year-old sex worker and a single mother of two children. Almost sex of the 46 women interviewed for this report matriculated from school; Rofhiwa Mlilo did not go at all. She sees sex work as one of the very few options available to earn an income to keep a roof over the heads of her children, for her, preferable to backbreaking farm work that brings in less money.

Rofhiwa Mlilo described the sometimes dangerous contradictions inherent in selling sex in South Africa: her relationship with the police is characterized by arbitrary arrests, lack of due process, and abusive policing practices.

Interviews were conducted with female sex workers, including three transgender women, in ten sites in three provinces. Around 40 government and nongovernmental experts in health, law, and provision of services for sex workers and were also interviewed. The report documents how the criminalisation of sex work fuels human rights violations against sex workers, including by police officers, and undermines their right to health.

The report provides recommendations to reform the legal system to provide protection for sex workers. Almost three-quarters of the sex workers Human Rights Watch interviewed have been arrested multiple times, some as often as two or three times per month. Sex workers who worked indoors were less vulnerable to arrests but were also targeted from time to time. The pattern of arrests described to Human Rights Watch suggest that sex workers are targeted for arrest because the police either know them from previous contact, or believe they match the profile of sex sex worker, and not because they have been seen to engage in illegal activities.

Every sex worker interviewed for this report with a history of arrest had been arrested or detained by police for apparently nothing more than standing or sitting where sex workers were known to wait for clients, or because they were already known to the arresting officers.

Sex workers believed that their arrests were part of a wider pattern of police harassment that includes extortion, coercive sex, and insulting language. Academics and nongovernmental organizations NGOs have often in the past reported rape by police and abusive use of pepper spray.

Sex workers described being held in police custody for up to three nights if arrests occurred over a weekend. Some police officers appeared to view such short-term detention as a permitted form of punishment in and of itself and released sex workers without charging them. Others demanded sex or a bribe in exchange for release or issued fines in the police station that, in at least some cases appeared to be simply extortion.

Sex workers told Human Rights Watch they believed that legalising sex work would be the only way to end police harassment against them.

They also called on the South African government to help them find safer ways and places to work. Sex workers described often falling victim of crimes, including rape and armed robbery, as a result of engaging in sex work in a criminalised context. Few, however, were willing to report these crimes to the police, including because they feared that they themselves would be arrested or because they did not believe that their cases would be taken seriously.

Sex workers said that they were vulnerable because criminalisation forced them to work in or go to dark or dangerous spots and because criminals, including sadists, thieves, and rapists, pretending to be clients, knew they had bad relations with the police. Sex workers described being laughed at by police when they tried to report rapes, or being told that as sex workers, they could not be raped.

The experiences with seeking health care that sex workers reported to Human Rights Watch stand in sharp contrast to their reports of treatment by the criminal justice system. Rofhiwa Mlilo and all of the other sex workers interviewed for this report did not face discrimination in accessing health care and most described having access to health settings where they could safely disclose what they did for a living and receive access to useful and relevant health-related information, services and commodities.

However, it should be noted that many interviewees were identified with the assistance of health care NGOs that ran clinics and outreach services for sex workers, which may make their experiences with access to health care different from other sex workers see methodology for more on this. Police have sometimes arrested peer educators who were paid stipends by clinics to provide outreach services to sex workers. Police reliance on the carrying of condoms as evidence of criminal activity has discouraged sex workers from carrying, and therefore using condoms.

Health officials interviewed for this report expressed frustration and concern at how criminalisation of sex work undermined access to health care sex efforts to prevent new HIV infections amongst sex workers, their clients, and sexual partners.

Arrests and detentions were particularly concerning for sex workers living with HIV on antiretroviral treatment. Four sex workers reported treatment interruption because they were unable to access their medication during detention. Others reported missing clinic or hospital appointments. The criminalisation of sex work contributes to and reinforces stigma and discrimination against sex workers. Many of those interviewed for this report described multiple experiences of stigma and discrimination, ranging from being denied access to housing to verbal abuse by members of the public.

Sex workers were particularly concerned about protecting their children from knowing that they were sex workers. Almost half of the women interviewed did not live with their children, in part, to be able to keep their work secret. Women whose children did find out that they did sex work worried about losing their love and respect. Although sex work is illegal in South Africa, people who engage in sex work are entitled to the same rights and freedoms as other people, including the rights to equality and privacy, security of person, freedom from arbitrary detention, equality before the law, due process of law, health, and the right to a remedy when their rights are violated.

The criminalisation of voluntary, consensual sex between adults violates several internationally recognized human rights, including the rights to personal autonomy and privacy. In many countries, Human Rights Watch has found that criminalisation of sex work creates barriers for those engaged in sex work to exercise basic rights such as availing themselves of government protection from violence, access to justice for abuses, access to essential health services as an element of the right to health, and other available services.

Sex workers interviewed for this report described how poverty, lack of education and severely limited economic opportunities, amongst other factors, made sex work one of the only viable options for supporting themselves and their families.

Many were single mothers, often supporting children of siblings as well as their own, and many said they were proud to be able to provide for their families. While many expressed sadness and frustration at the lack of opportunities that would allow them to leave sex work, most were clear-eyed and pragmatic about their desire, in the near future at least, to undertake sex work more safely and without fear of police abuse or being arrested and detained.

A discussion about the legal status of sex work has been ongoing in South Africa for almost three decades. There is significant support for decriminalisation, including from various government ministries and institutions, trade unions, public health officials, civil society, and most importantly, sex workers themselves. It is clear from this report that the criminalisation of sex work undermines the health and dignity of sex workers and exposes them to violence and abuse.

The South African government should act urgently to end criminalisation of sex work and work with sex workers to protect their rights. Human Rights Watch interviewed 46 women currently working as sex workers in semi-structured interviews that generally lasted 45 minutes to an hour.

Three sex workers were trans women, six of the interviewees worked in a building and the rest found customers in bars or on a street.

All these interviews were conducted in person and all were conducted in English except two interviews, conducted in Xitsonga with the assistance of peer educator activist.

Six sex workers were interviewed in Musina town, four in Makhado and five in Tzaneen and four in Hoedspruit. In one case, two sex workers chose to be interviewed together but all other interviews were conducted individually.

Privacy for interviews was provided in the offices of NGOs or where the sex worker was working, except for some interviews in Johannesburg where sex workers expressed a preference to do the interview on the streets where they were working.

Human Rights Watch identified interviewees through the assistance of organizations or individuals working with sex workers, which were either sex worker rights organisations or health care NGOs that ran clinics and outreach services for sex workers see Acknowledgements for details.

All participants in this research provided consent to participate orally. All participants were informed of the purpose of the interview, its voluntary nature, and the ways the data would be collected and used. Interviews were told they could end the interview at any time and choose not to answer any question, without sex negative consequences.

All sex worker participants were assured that a pseudonym would be used when documenting their experiences in this report. No interviewee received compensation for providing information but sex workers who travelled to interview sites in Limpopo and Mpumalanga provinces were provided with compensation for transport expenses.

Staff members in the health NGOs that helped coordinate the interviews provided guidance on how much compensation should be provided for transport. Some interviewees also received lunch before or sex their interview. First, we chose to narrow our focus to the experiences of female sex workers, and almost all women interviewed were cisgender, meaning their gender identity matches their sex as assigned at birth.

Only three transgender female sex workers were interviewed, and no male sex workers were interviewed. The Sex Worker Education and Advocacy Taskforce SWEATan organisation that addresses the health and human rights of sex workers in South Africa, estimated in that 90 percent of sex workers in South Africa are cisgender females, while 5 percent are transgender females and 4 percent are males.

We recognize the limitations of this focus, in sex our findings cannot be generalized to male and trans female sex workers, although it is clear from the work sex other organizations that male and trans female sex workers also experience violence and discrimination in South Africa. Further research on these abuses through an intersectional lens, looking at the particular ways in which violence and discrimination impact sex workers who are marginalized on the basis of their race, sexual orientation, or gender identity, as well as their profession, is warranted.

We believe, however, that decriminalisation of consensual adult sex work would benefit all sex workers, not only women. A second limitation of our research stems from the fact that most sex workers we interviewed were already in contact with sex workers rights organizations or health organizations that provided services to sex workers, meaning that our interviewees were more likely to have access to nondiscriminatory health care than sex workers who are unconnected to such services.

In addition, sex workers in Johannesburg probably have better access to health care, on the whole, compared to other parts of South Africa, especially rural areas. Sex work in South Africa is enormously varied and not all women who sell sex self-identify as sex workers, as our interviewees do. Attempts were made to speak to women working on streets and indoors, in smalls towns and in Johannesburg, but it is inevitable that the experiences and perceptions represented here do not speak to those of all South African sex workers.

Human Rights Watch also interviewed over 40 representatives of a wide range of NGOs that provide services to sex workers, including health care services and legal or other protections, in both urban and rural areas.

Human Rights Watch also sent the SAPS a formal letter requesting information on arrest numbers and standard operating procedures among other issues but received no reply. The term excludes child sex work and other forms of coercive sexual exploitation such as sex trafficking, both strictly prohibited under international law.

South Africa has a population of approximately 55 million people, with black South Africans accounting for just over 80 percent of the population. Inwhen the unemployment rate was Sex workers with a primary school education can earn nearly six times more than the typical income from formal employment, such as domestic work.

The legal status of sex work is currently a subject of debate in South Africa and some pressure exists for legislative change. What that change should look like is deeply contested. Another segment of civil society, including some religious and anti-trafficking organizations, maintain that while current laws may need to be reformed, full criminalisation sex be retained to protect morality or society as well as vulnerable women from the harms of sex work.

South Africa currently uses a model of total criminalisation or prohibition of sex work, which means that the conduct of an estimatedtosex workers is subject to criminal sanction. The law also broadly bans solicitation or enticing a customer. The Sexual Offences Amendment Act, passed inalso makes buying sex criminal and specifically criminalises all those involved in the prostitution of children persons below the age of Insex legislation was signed into law.

As a result, officials lack adequate training on identifying potential trafficking victims, which occasionally leads the government to arrest, detain, and deport victims. Advocates for decriminalisation, academic researchers, and health workers working with sex workers complained to Human Rights Watch that politicians, police, and journalists commonly conflate trafficking and sex work, assuming everyone who sells sex is a victim of trafficking.

The US Department of State, which tracks global efforts to end trafficking by state, has also heard reports that police often fail to identify and refer to appropriate services victims of trafficking and instead sometimes sex them with prostitution-related offences and other violations. Decriminalisation of sex work has been under discussion since shortly after the end of apartheid. Decriminalisation non-criminalisation received considerable support over the next several years, and not only from NGOs and sex worker activists, though these groups have led much of the charge.

The SALRC position frustrated decriminalisation proponents who have said the report writers failed to consult widely enough with sex workers and that, because the writers took a prima facie moral position from the start that sex work is harmful, no other option but abolition was properly considered.

Finally, the report recommends better practices and guidelines for police to end long-running abuse of sex workers and investigate police crimes against sex workers.

Attacks on female sex workers by clients, persons pretending to be clients, police, partners, and others should be understood within the context of a country suffering an epidemic of violence against women and girls.

A progressive constitution, targeted legislation such as the Domestic Violence Act and the Sexual Offences Act, and government policies designed to prevent, respond to, and eventually eradicate gender-based violence all exist.

Intra-arterial angiography showed no evidence of atherosclerotic vascular disease or dissection. A PFO was visualized by 2-dimensional transesophageal echocardiography at rest; its presence was confirmed by color Doppler and contrast injection.

A year-old woman with a history of 3 spontaneous abortions developed the acute onset of right arm dyscoordination and nonfluent aphasia immediately following sexual intercourse. Magnetic resonance imaging revealed a left parietal infarct; extracranial and intracranial magnetic resonance angiography results were unremarkable.

Transesophageal echocardiography showed the presence of a small right-to-left shunt following injection of agitated saline; the shunt was present at rest and accentuated with the Valsalva maneuver.

The prevalence of PFO may be higher in young patients with cryptogenic stroke than in the general population, 1 although the strength of this association has recently been called into question.

One would predict that paradoxical embolization should occur more often in persons prone to deep venous thrombosis and in situations where the right atrial pressure exceeds the left atrial pressure, such as with the Valsalva maneuver.

While neither deep venous thrombosis nor stroke onset during the Valsalva maneuver are reliably documented in patients with PFO and cryptogenic stroke, emerging evidence suggests that thrombophilias are more prevalent in these individuals.

During the Valsalva maneuver, there is an increase in intrathoracic, central venous, and right atrial pressure; if the right atrial pressure exceeds that of the left atrial pressure, right-to-left shunting will occur through a PFO.

In 3 of the patients presented here, however, right-to-left shunt occurred at rest, suggesting that such an increase in intrathoracic pressure is not required to precipitate paradoxical embolization but may make such an event more likely. In our series, 2 of the 3 women were taking oral contraceptive pills, both had migraines, and 1 smoked.

While migraine headaches and oral contraceptive pill use are independently associated with increased risk of stroke, especially in smokers, the mechanism of increased risk is not fully understood. Oral contraceptive pills increase the risk of deep venous thrombosis, especially in persons with inherited thrombophilias.

Moreover, 2 of the patients had no history of migraine or oral contraceptive pill use. Only 1 of our patients met criteria for atrial septal aneurysm; atrial septal aneurysm, either alone or in addition to PFO, is associated with increased risk of stroke. Because these patients were seen in referral at a time remote from their stroke, evaluation for deep venous thrombosis was not undertaken.

None of the patients were taking illicit drugs. There are several reports describing benign postcoital headache and subarachnoid hemorrhage, but there is only a single description of ischemic stroke occurring following intercourse. Angiography revealed filling defects in the right posterior cerebral artery. The presence of a PFO was not commented on; the filling defects could therefore have represented partial recanalization of the vessel following paradoxical embolization.

In summary, we report the occurrence of ischemic stroke during sexual intercourse in 4 young persons with PFO. Despite thorough workup, no obvious etiology of stroke was identified in any of these patients.

We propose paradoxical embolization through the PFO due to elevated intrathoracic pressure during sexual activity as a possible stroke mechanism. Correspondence: Kyra J. Author contributions: Study concept and design Dr Becker ; acquisition of data Drs Becker, Skalabrin, Hallam, and Gill ; analysis and interpretation of data Drs Becker, Hallam, and Gill ; drafting of the manuscript Dr Becker ; critical revision of the manuscript for important intellectual content Drs Becker, Skalabrin, Hallam, and Gill ; administrative, technical, and material support Drs Becker, Skalabrin, Hallam, and Gill ; study supervision Dr Becker.

Arch Neurol. All Rights Reserved. Considering the recent recommendation of the Agenda for Sustainable Development, violence is one of the most urgent worldwide problems to be assessed in the next two decades 1 , 2.

Interpersonal violence IPV includes violent acts and intimidation between family members, intimate partners, or individuals who are known or unknown to each other 3. This definition was presented in the Report on Violence and Health of the World Health Organization WHO 4 , which classified IPV into family violence when involving intimate partners and family members or community violence when involving people who may be known or unknown to each other.

The WHO report 4 also distinguishes four modes in which violence may be inflicted physical, sexual, psychological, and deprivation or neglect. Every year, 1. For each death, there are innumerable other individuals who seek help due to injuries resulting from IPV 4. A representative study carried out in the 26 Brazilian states and the Federal District revealed that It is well recognized that the burden of IPV falls mainly on women, and this is a worldwide reality.

Family violence is very connected to affective and relational issues, especially when it involves intimate partners, whereas community violence occurs mainly in the social and economic context. The temporal evaluation of family and community violence rates, separately, considering the sex of victim and perpetrator, can contribute to understanding the pattern of occurrence according to the violence types and guide actions to prevent this ongoing process, considering the specificities involved in each type of violence 8.

In this context, the aim of this study was to evaluate the trends in physical violence rates between January and December 84 months , considering the time and the sex of victims and perpetrators separately. The scenario used for data collection was an area located in the Northeastern region of Brazil. Data related to violence were obtained by consulting the records of traumatic physical offense reports in non-fatal victims from a Forensic Service in Campina Grande, PB, Brazil.

Counting with a , population in a , the municipality is a metropolitan region that influences surrounding cities, with intense commerce, industry and university activity. The Forensic Service corresponds to the official service of the state government to carry out corpus delicti examinations on victims of physical violence.

The examination is performed by an official expert, usually a physician and occasionally a dental surgeon when it involves the face , who describes the visible wounds in victims and issues a traumatological report. The performance of corpus delicti examination is essential in legal proceedings against the accused of a crime, and can only be performed after an official referral of a police authority or demand for legal authority. This examination is legislated by Decree-Law 3, 9 of of the Brazilian Code of Criminal Procedure, which is a legal instrument in criminal trials and its absence may result in nullity of criminal proceedings.

We included all reports of IPV only physical wounds or injuries occurring in Campina Grande during the period of 84 months, between January and December The type was classified as family or community violence according to WHO 4. The following variables were also considered in this study: a year or month of occurrence; b sex of victims male or female ; and c sex of perpetrators male or female.

We did not include reports of sexual, psychological, and neglected violence. Before data extraction, theoretical training was carried out aiming to standardize the information search process, with the participation of eight team members. The discussion considered how and where the variables in the study were present in the reports, following the WHO classification 4 of family or community violence. Then, a pilot study was conducted among all team members, with 30 reports of not included in the research , with the purpose of analyzing the information and preparing the final form.

To test the inter-examiner differences, 30 reports from not included in the research were read in a two-week interval for each evaluator, and after that, the agreement was compared. The Kappa result between all eight researchers was satisfactory, ranging between 0. Initially, the descriptive analysis of the type of violence was performed considering the percentage of cases throughout the years. The monthly rates were analyzed to verify possible seasonality.

This annual variation was obtained by the exponential of the product of the regression coefficient by 12 months. Four negative binomial regression models were used to evaluate: 1 the effect of the sex of victims and the time on family violence; 2 the effect of the sex of perpetrators and time on family violence; 3 the effect of sex of victims and time on community violence; and 4 the effect of sex of perpetrators and time on community violence.

The incidence rate ratios IRR were estimated and the interaction between sex and time was tested on all four models in which the time was considered in months. Moreover, for each model, one dummy variable was included to test for possible trend changes at a certain month, defined by the visual inspection of the series.

In this case, a new binary variable was created 0: before and 1: after the defined month. The binomial negative regression was compared to the Poisson regression model by the likelihood ratio test of the parameter alpha. The binomial negative model was used to account for overdispersion of data.

Also, the Stata program version Furthermore, we declare no conflict of interest in the stages of this research, including data extraction and manuscript elaboration. A total of 8, records of IPV were searched, including 4, cases of community violence, 3, cases of family violence, and records 3. Table 1 summarizes the descriptive analysis of the annual series about the type of violence considering the relationship between victim-perpetrator.

The major variation in family violence occurred between intimate partners; increasing from In community violence, the major variation involved violence practiced by an unknown person, with a negative decrease of Among events involving intimate partners, women were victims in The other frequencies for the female sex were: ex-partner There was an increase in family violence rates and a reduction in community violence over seven years Figure 1. The distribution of rates, from to , was similar over the months, indicating no seasonality.

The analysis of family violence showed that the annual average rate of general family violence was 6. In regression models, the interaction coefficients represent the slopes of the outcome on the time for each of two levels of sex. Model 1 and 2 showed a significant increase in family violence rates for female victims and male perpetrators, therefore, the average risk with the time was 1.

The analysis of the community violence showed that the average rate of general community violence decreased from Considering community violence rates, there was a significant interaction between sex victim and perpetrator and time. A dummy variable time cut in 48 months was included in model 3. This model showed a lower risk of community violence over time comparing after and before 48 months for male victims.

The main effect of the sex of victim was not significant for community violence rates. In the same model, a significant decrease was observed in the community violence perpetrated by men and a rate that remains constant over time was obtained for female perpetrators Figure 2. Regarding the interaction between sex victim and perpetrator and time, the IRR for each year and sex victim and perpetrator was presented considering as a reference: and female sex Figure 3.

The figures showed the IRR changes over time. IRR: incidence rate ratios. This study described the evolution of IPV rates in a Brazilian area. In the family context, the violence over time happened mainly among intimate partners and were perpetrated by men, with women being the predominant victims.

The temporal analysis showed an increase in the rates of family violence for female victims and male perpetrators. Criminalisation of both the sale and the purchase of sex interferes with the ability of sex workers to build physical, financial, civil society and social infrastructure around themselves. A terrifying gang rape stopped Margaret Sisulu from working at night, even though she used to charge more after the sun went down on Johannesburg. Sixteen of the forty-six sex workers interviewed reported being raped, mostly when working and mostly in the past five years.

Pume Mbatha, a Johannesburg-based sex worker for fifteen years and originally from Kwa-Zulu Natal province, described three vicious rapes over the past five years. One attacker broke a tooth when he hit her with a bottle; in another case the rapist held her arm when she was on her knees and then stamped down on it, breaking a bone. She never reported any of the attacks to the police. Rapists generally did not use condoms in reported incidents.

Sometimes an argument between the sex worker and the perpetrator over condom use preceded the rape. Many of the reported rapes also included others forms of violence and seemed to be especially sadistic in nature.

Zandile Makuyaa, a mother of two young boys, was raped by a man in and still has scars on her arms and chest from where he beat her with an electric cable. In several cases, rapists held women for hours before letting them go. A Zimbabwean sex worker, Lucy Kege, who works in the South African border town of Musina to support her year-old daughter back home, described being held for 6 hours by a man. Most of the sex workers who had been raped said that they had chosen to access post-rape care from clinics or hospitals and were satisfied with the treatment they received.

However, choosing to report rapes to the police was much rarer. Sisulu, whose rape was described at the beginning of this section, provided a typical explanation as to why she did not report:. Anna Matamela, who is 33 years old and has been selling sex since she was 17 to support a son, was raped by a man who said he wanted to be a client in February The man then raped her without a condom after seizing her by the throat and threatening her with a gun. She was so depressed and hurt by the attack, she could not get out of bed for a week.

No one had reported these incidents. Several women said that police arrests made them less safe because they were chased into dangerous areas, or forced to work where they, and criminals, can easily hide. One woman, Kim Xitsonga, was literally run into danger.

Four interviewees did report rapes to police, or had the police involved in their case. After Lucy Kege was raped, she called a friend who called the police. They came to the scene but, she felt afterwards, mostly to shout at her. Sex workers interviewed for this report said that they had experienced physical violence from clients and men pretending to be clients, ranging in severity from slapping to more extreme beating.

Sex workers described perpetrators of serious violence as, like rapists, relatively rare, although always a danger, especially for street workers. Several sex workers had also experienced domestic violence from husbands and boyfriends. Yolanda Nkgapele did not report a rape to the police but has relied on police assistance to end serious physical abuse from two boyfriends.

In one case she successfully managed to get a restraining order. Sometimes men inflicted serious violence on female sex workers while robbing them experiences of theft are described in more detail below. A personal history marked by violence was not uncommon. Other sex workers reported being beaten as children or sexually abused; many suffered from extreme poverty. Two interviewees said they had entered sex work to escape violent husbands. Most of the interviewees said they had been victims of theft, sometimes many times.

Sex workers reported losing their money to clients who changed their mind after sex and demanded their money back, sometimes with knives, guns, or the threat of physical violence. Some sex workers only experienced this once or twice; for others with no security or back up, this was a regular occurrence.

Because of the threat of violence, interviewed sex workers often said that there was little they could do about men demanding their money back or stealing from them. Men working in the building will sometimes interfere if there are problems, but often choose not to.

Some women said they had adjusted their ways of working to make them safer and less vulnerable to theft. Working in taverns is safer than on the streets because of the presence of other sex workers, interviewees said. In taverns, others can see who a sex worker leaves with and a sex worker can leave upfront payment behind with a friend while she has sex with a client. Aside from men who renege on deals, sex workers also work at the mercy of tsotsi , gang members or single criminals who rob, often at knife or gunpoint.

Zandiel Mukuyaa, a sex worker in Makhado, said two or three times a year local tsotsi steals everything she has, usually at knife point. In general, sex workers said that, even if they would contemplate reporting violent crimes to police, they saw no point in reporting thefts while working. None of the sex workers interviewed were under 18 years of age, although a minority had begun the work at 17 years or younger, usually because of poverty, sexual abuse, or other serious problems at home, or an early pregnancy and single motherhood.

Generally, interviewees in towns in Limpopo, in Bushbuckridge town, Mpumalanga, and in De Deur and Eikenhof towns in Gauteng, said that they did not know any underage girls selling sex, although some said they would occasionally spot young-looking girls or women. Underage sex work was more commonly reported in Johannesburg.

Interviewees said most girls selling sex appeared to be working alone, sometimes for drug money, and did not appear to be trafficked or controlled. Sex workers working in a brothel where they rented rooms by the day in Johannesburg said that underage girls were not allowed to work there.

Similarly, sex workers said that taverns where they met clients did not allow underage sex workers. Several interviewees said that they had reported underage girls selling sex, telling staff working in organizations they see as allies, such as SWEAT and Sisonke. Some said they might report trafficking or exploitative situations to the police, but many said they would not be able to trust police.

A few interviewees reported that their current boyfriends exploited them, or previous boyfriends had done so in the past, including by taking money they earned through sex work. Three sex workers said they had also handed over cash to other, older sex workers who had guided or protected them when they had first begun working.

These situations were recognized as exploitative in hindsight, but interviewees were able to leave them. None of the sex workers interviewed for this report said they had a pimp or manager. One woman, Cindy Khoza, started sex work in after a friend told her to travel to Nelspruit, Mpumalanga province, promising her a job in a restaurant. When she arrived, the work available turned out to be sex work.

Now 40 years old and a mother of a year-old boy, Lerato Munarine was trafficked between and in Middleburg, Eastern Cape province. She said she was not even able to send money home for her son during this time, and when she finally escaped with the help of a client, she did so empty-handed. Conflation of trafficking and sex work can be mitigated by protocols and guidelines for law enforcement in their interactions with sex workers and suspected victims of trafficking. For example, KwaZulu-Natal and Western Cape provincial task teams use an interagency protocol to guide law enforcement interactions with female sex workers.

Criminalizing sex work means sex workers and sex worker organizations are generally excluded from anti-trafficking responses. Any decision should be the result of extensive consultation with the most important constituency: sex workers themselves. This chapter encourages the South African government to conduct such consultations and explores sex workers' answers to questions about why and how they entered sex work.

This chapter also describes some of the difficulties reported by sex workers not already covered in earlier chapters. Of the 45 women interviewed for this research, almost all were single mothers. Most interviewees had one, two, or three children and only six did not have any children at all. Two interviewees were married and twelve of the unmarried interviewees reported that they had a boyfriend or other partner. Only a few of the sex workers interviewed said that the biological fathers of their children were providing any form of support.

In short, our interviewees were single mothers with significant responsibilities. Supporting children was the immediate and main reason for choosing and continuing sex work. One year-old mother of an adult son noted that she had single-handedly got him through schooling, and that he was now studying at university on a government bursary.

For many sex workers, this pride was often mixed with less positive feelings about selling sex. Painfully, these feelings were not just a reflection of wider stigma and the hardships of the work, but also rooted specifically in concerns about how their children might view their work. Single parenting is a reality for many in South Africa. According to the South African Institute of Race Relations SAIRR , only one-third of children in South Africa live with both their parents, with the rest living with single parents, on their own, with relatives, or in foster care.

Other facts of contemporary South Africa must also give pause to anyone considering a government policy based on ending sex work that does not also address the economic realities of black women.

The South African government does provide social security support for some of the population, including older people and people with disabilities. Disability grants and pensions were generally not available to the interviewees one woman interviewed had a disabled child and received some assistance. Most of the interviewees were not doing any other work except for sex work at the time of the interview, although some had worked intermittently in bars, farms, beauty salons, as domestic workers, and as municipal workers.

At least some women in all the locations where we conducted interviews said that there were basically no other employment opportunities for them nearby, or nothing that could provide them with a similar income as sex work. This was especially the case because almost none of the women we interviewed had matriculated, and almost all of them said that finding other decent-paying work, such as in a shop or waiting tables, was difficult as a result.

Various reasons were provided for low education levels, including lack of funds—including for uniforms, teenage pregnancy, unhappiness at school or truancy, and sexual, emotional or physical abuse at home, or other problems like the early death of one or both parent s. Even when other work was available, most sex workers were not confident that these jobs represented a potential path out of poverty for themselves or, most importantly, for their children.

Some women said they earned thousands of rand for a weekend of work with one client. Others found ten or more clients a day at the end of the month when clients had been paid but struggled to find two or three clients a day on slower days. Some sex workers said they had money for clothes and nonessentials because of their work; others said they were living hand to mouth. Many interviewees not only supported their own children and the caretakers of their children, but also siblings who were out of work and nieces and nephews, as well as other family members.

Almost none of the interviewees had less than three dependents. The children of deceased siblings were recipients in several cases. Thuli Modiselle was the only sex worker interviewed for this report who had not only matriculated but had also gone on to further education. She worked for many years as a secretary before starting sex work in after her sister died.

Now 44 years old, her own children are young adults, but her sister left seven children with no other support. Modiselle could only think of one way to earn enough money to support her five nieces and two nephews: she leaves her home every day to sell sex in a room in Hillbrow that she rents for R a day.

About half of the Johannesburg-based interviewees had school-age children who lived with them. Being able to leave work when they needed to, including by about 4 p. This, as well as safety, was often cited as a reason why interviewees preferred working during the day. Others liked the readiness of the cash. Esther Makaza, a bespectacled sex worker from Zimbabwe raising two daughters, commented on the advantages of both a constant source of cash and her connected feeling of independence:.

Seven of the interviewed sex workers did not grow up with their mothers, who had either died or abandoned them as babies or young children. Serious troubles in childhood were not uncommon. One interviewee ran away from home because no one would defend her against an uncle who was raping her; another had an aunt who sold her for sex to farm workers; a third was so hungry as a child, she sold sex for food.

How negligence or abuse may have contributed psychologically to the decision to do sex work is beyond the scope of this research.

Choosing to sell sex was usually seen as one choice among poor alternatives, and the sex workers we interviewed were ill-equipped, through no fault of their own, to benefit from a limited job market.

With the exception of two or three sex workers who said they enjoyed the work, all the respondents would have preferred another career, but generally not one that was worse-paying, demoralizing, or physically draining.

Most of the interviewees, who ranged in age from 26 to 52 years of age, had been doing sex work for years and had no immediate plans to change their line of work. The difficulties that many adult sex workers experience should not impair their right to choose to do the work, but nor should these difficulties be understated. Every sex worker interviewed had her own views and feelings about her work.

Some were proud and felt that they were providing an essential service. Others were nonchalant or realistic. Many sex workers expressed ambiguous and at least some negative feelings.

Some hated it and cried during the interview about their work. The dangers of sex work and the humiliation of working outside the law have been described in earlier chapters. But sex workers also must struggle with societal stigma. Sex workers experience multiple and overlapping forms of stigma and discrimination. Name-calling from other community members was a commonly reported experience.

Harassment of sex workers by communities in South Africa can be malicious. Sex workers in Primrose, a neighbourhood in Germiston, Gauteng province, east of Johannesburg, opened a legal case in after they were attacked by dogs and snakes released into their homes, allegedly by members of the community there. For our interviewees, the most emotionally difficult form of stigma appeared to be when unkindness was directed at their children.

Lovejoy Moyo, a year-old, said:. Roughly half of the mothers interviewed kept their children in their home villages under the care of family members, to protect them from witnessing sex or experiencing violence, but also to keep their work a secret. Sex workers almost ubiquitously declined to appear on an Internet video to accompany this report, even anonymously.

The reason given was always fear that children or others would spot them on the Internet, not that the authorities would. Several women were hiding their work from boyfriends or their communities. It was not uncommon for sex workers to report that although some members of their family knew what they did to support them, their work was never discussed.

Interviewees often said that they dreaded the thought of their children, or nieces, working selling sex. Most answers to this question fell into one, two, or all of three categories: 1 end criminalisation, or at least arrests, 2 provide safer places to work, and 3 provide alternative jobs. As described in the second section, sex workers experienced arrests and other forms of police harassment as confusing, unfair, and damaging.

Just last week on Sunday we had to all run away in different directions because the police arrived. Especially in rural towns, women said it was already difficult to find enough business without placing further disincentives on buyers. The idea that the government should provide serious alternatives to sex work was attractive to many.