The Intersections of Motherhood and Vulnerability to HIV/AIDS Among Women Engaged in Sex Work in Sub-Saharan Africa: A Scoping Review

Background and Purpose: Despite significant strides in HIV prevention and treatment, women engaged in sex work (WESW) remain a profoundly vulnerable population to HIV/AIDS due to poverty, violence, and gender inequities. In Sub-Saharan Africa (SSA), motherhood is a pivotal identity and most WESW are mothers. Bearing children not only symbolizes womanhood, but also serves as a pathway to societal recognition and full status. Motherhood shapes WESW’s self-perception, resilience, engagement in sex work, financial stability, and HIV-related service utilization. Yet, the nexus between motherhood and HIV risk remains poorly investigated. This scoping review aims to: (1) synthesize existing studies to examine the experiences of motherhood among WESW in SSA; (2) evaluate the current state of peer-reviewed literature to elucidate how motherhood influences HIV risk behaviors and uptake of HIV prevention and care services among WESW; and (3) provide actionable policy and practice recommendations for HIV prevention and care for WESW who are mothers.

Methods: Following Arksey and O’Malley’s scoping review framework, we searched PubMed, SCOPUS, SocINDEX, CINAHL, Social Work Abstracts, APA PsychInfo, and Anthropology Plus for studies from 2000 to 2024. Screening and selection involved dual reviews by two team members and consultations with an expert in the field of sex work to resolve discrepancies. We extracted data on publication year, study year, location, sample size, study aims, methodology, outcome measures, and findings related to motherhood.

Results: A total of 26 studies from 13 countries in SSA were included in this review. Most studies utilized qualitative (n = 14) methods, while there were five quantitative, four mixed-methods, two scoping reviews, and one systematic review. A notable observation from our review is the scarcity of research explicitly addressing the convergence of women's dual identities as sex workers and mothers. Our findings shed light on the intricate and often paradoxical pathways of experience that characterize the lives of WESW in SSA. Despite the myriad of challenges they encounter, WESW demonstrate remarkable resilience and agency, leveraging their involvement in sex work to create opportunities for themselves and their families. The role of motherhood in shaping WESW's perceptions and behaviors is of particular significance. Becoming a mother not only deepens their sense of self but also empowers them to resist the internalized stigma associated with sex work. Moreover, children serve as both motivators and barriers in WESW's engagement in safer sexual practices and contraceptive use, as well as their utilization of healthcare services.

Conclusions and Implications: The findings of this scoping review reiterate the importance of moving beyond the deficit-based view of WESW to recognizing mothers' continuum of choice in their engagement with sex work to inform policies and interventions to effectively curb the epidemic in SSA. They highlight the urgent need for tailored interventions addressing WESW’s multifaceted roles as mothers and sex workers in conjunction with HIV/AIDS risks. Child-centric policies such as universal education, free school meals, and afterschool programs offer non-stigmatizing avenues to alleviate financial strain and potentially mitigate risk-taking behaviors associated with sex work.