“Many People Do Not Consider Us Human” Violence Against Commercial Sex Workers in Gondar City: A Phenomenological Study

Study Setting and Period

The study was conducted in Gondar city, located 728 km from Addis Ababa, the capital city of Ethiopia. Gondar had an estimated total population of 500,788, of whom 300,000 were men and 200,788 women. The majority of the inhabitants (90.2%) are affiliated with the Ethiopian Orthodox Christian church, while 8% of the population were Muslim and 1.1% were protestant. According to Mahibere hiwot (NGO; which serves the community and especially commercial sex workers) report shows that there are around 2,300 commercial sex workers. Gondar is an ancient historic site which a number of tourists visiting it. The study was conducted from October to November 2020.

Study Approach and Selection of Study Participants

A phenomenology study approach was employed to understand the hidden meanings and essences of lived experience. It is recommended that researchers who want to conduct a phenomenological study must therefore locate participants who have experienced the phenomenon in our case violence, and who are able to explain their experiences to the interviewer effectively (Osborne, 1994). Snowball purposive sampling method was used to recruit study participants. First, we approached health extension workers (a type of healthcare provider who treats patients and offers various community health services) and a volunteer peer educator working with commercial sex workers, though they themselves had no history of sex work. They were familiar with the sex workers through their community service. They then introduced us to a sex worker. We conducted our first interview with this commercial sex worker, who then assisted us in identifying the next study participant by providing information on where most sex workers could be accessed. The participant recruitment continued in such a way until we reached the level of saturation, the interview ceased after three continuous similar findings. Twelve commercial sex workers who worked for at least 12 months and experienced one form of violence were included in this study.

Data Collection Procedure

Data was collected through face-to-face in-depth interviews using a semi-structured guide. The interviews were conducted in a private setting with minimal sound disturbance, ensuring convenience for the study participants. The time and place of the interview was determined by the interviewees themselves. The interview guide was prepared in English language and translated into Amharic (local language). The four of the authors (HB, AZ, AK, and SH) conducted in-depth interviews. The data collectors had experience in qualitative research data collection and analysis. The data was recorded using a voice recorder and notes were taken by the investigators. The interviews took from a minimum of 30 min to a maximum of 1 hr and 2 min. To ensure data quality, the interview guides were reviewed by experts, and pilot interviews were conducted with commercial sex workers to validate them. Based on the findings from the pilot interviews, vague questions and concepts were modified before applying the guides to the actual study participants. The investigators also used simple language and descriptions in conducting the interview. Prolonged engagement and audit trail were considered crucial techniques to ensure the authenticity and credibility of the results.

Data Analysis

All audiotaped in-depth interviews and field notes were independently transcribed verbatim to Amharic (the local language) after repeatedly listening to the records and then translated into the English language. The translated transcription documents were imported into Open code version 3.1 software of qualitative data analysis for coding and analysis. After repeatedly reading the transcribed document, the investigators coded and categorized the data into themes and sub-themes. Central themes were constructed based on the natural meaning of the categories. The investigators cross-cheeked the themes that emerged after analysis with the respective quotes of the themes. The findings were reported by a detailed description and interpretation of the meanings of the themes. Direct quotes from the participants were also included in the write-up of the findings to provide clear images for readers. The overall process of data analysis used an inductive approach. Finally, these study findings were reported based on the consolidated criteria for reporting qualitative research (COREQ) guidelines (Supplemental Document 1).

Ethics Approval and Consent to Participate

Ethical approval and a permission letter were obtained. The participants were well-informed about the purpose of the study, the data collection procedure, confidentiality, and privacy. They were also informed that they could withdraw from participation at any time as the interview process unfolded. Written informed consent was obtained to undertake audio records from each participant before the interview. Since some of the study participants were unable to read and write, the data collector read the consent form and explained the purpose and procedure of the study. Then, the data collector marked “Yes” on the written consent form when the study participants volunteered to participate in the study and recorded their signature with “thumbprint.” The anonymity and confidentiality of the respondents were ensured.

Background Information of the Study Participants

A total of 12 interviewees who work in brothels, homes, hotels, and street-based participated in this study. The age of the participants ranged from 23 to 45 years old. Many of the participants were unable to read or write, and their highest level of education was completion of grade 10. The women had 4 to 18 years of lived experience in commercial sex work. Many of the participants were originally from rural areas prior to engaging in commercial sex work. The background characteristics of in-depth interview participants were presented in Table 1. Types of violence and coping mechanisms to deal with the violence were the main categories (themes) that emerged from the analysis.

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Table 1.

Background Information of the Study Participants (Commercial Sex Workers) in Gondar City Northwest Ethiopia, 2020.

Participant ID	Age	Education	Years in commercial sex work
1	40	Unable to read and write	18 years
2	23	Grade 7	5 years
3	29	Grade 5	4 years
4	28	Unable to read and write	8 years
5	30	Grade 5	10 years
6	30	Unable to read and write	13 years
7	45	Unable to read and write	7 years
8	29	Unable to read and write	4 years
9	38	Unable to read and write	10 years
10	26	Grade 6	3 years
11	37	Grade 8	4 years
12	23	Grade 10	2 years

What Drives Women to Commercial Sex Work?

The main reasons for engaging in commercial sex work were family instability, marriage dissolution, and a lack of money to care for a child. Sex work is sometimes the only viable option for women in countries coping with poverty, and unemployment. Sex work is frequently a more flexible, remunerative, and time-efficient alternative for single moms with children than manufacturing or service employment. Women do not have access to educational opportunities, skills, and knowledge that enable them to improve their lives. Especially in developing countries like Ethiopia, their only fate is often to marry at an early age instead of pursuing education. When a marriage breaks down, the resulting lack of financial resources to meet their own and their children’s needs becomes a primary reason for engaging in commercial sex work. A woman explained this as follows:

Previously I was married. However, it became intolerable to go on. I don’t have a choice … Due to a lack of resource/money, I was unable to serve my child even for the sake of meals. [p#8]

Others’ pressure was also mentioned as a motivator for engaging in commercial sex work. This could come from close friends, hotel managers or owners, or customers, or it could be from witnessing someone whose lifestyle has improved as a result of commercial sex work. For example, the participant explained it as follows:

I worked as a waiter in a hotel; my friends told me about this job [commercial sex work], and they told me they made a lot of money and handed it to me to keep. Then I became interested in doing this work. I wondered why I was so tired as a hotel maid. And I imagined that working in commercial sex would transform my life with low effort … I joined. [p#3]

Violence Against Commercial Sex Workers

Many of the participants experienced at least one or more sexual, physical, psychological/emotional, and economic violence incidents in their work setting. Sexual violence is by far the most common form of violence. Disagreement on condom use and sexual position against one’s will and interest were the key causes of the abuse. It was also the cause of all other types of abuse, physical and emotional violence in particular. Sexual violence increases the prevalence of sexually transmitted diseases (STDs) including HIV in these high-risk groups and the general population at large.

Who Are the Violators?

In this study, the women reported that clients were the most common perpetrators of sexual, physical, psychological, and economic violence. Regular customers, those who are married, and those who are from a long-distance were less likely to be violent. Study participants explained this as follows:

We didn’t always have regular customers … they were the major perpetrators … Our customers engaged in forced sex, striking us, breaking/stealing our goods, refusing to pay us after having sex, and other similar acts. … [P#8]

Some of our clients had their own life (marriage). They didn’t want to collide with us … they will come hiddenly … they feared that getting into trouble with us would reveal their secret. So, they would prefer negotiation than engaging in any form of violence. [P#4]

In the instance of psychological violence, alcohol drinkers, neighborhoods, friends, and other community members also commit the violence.

Almost everyone around us was insulting and humiliating us. Customers, alcoholics, and even our neighbors make fun on us. Many people would not consider us a human being. [P#2]

Sexual Violence

Sexual violence is one of the most common forms of violence and the most serious problem that commercial sex workers experience. It was also the cause of all other types of violence. The commercial sex workers did not have regular customers and most of their clients enforce them to have sex without a condom against one’s will. Other forms of sexual violence include forcing women to have sex in strange sexual positions, oral sex, anal sex, and prolonged intercourse. Clients frequently threatened or acted violently in response to women’s refusals to engage in specific sexual activities, notably anal intercourse, condom nonuse, or dealing with the women at all.

Some men suck my breast and ask me to suck their penis, and they will try to convince me by adding extra money … when I refused them, they would try to do so by coercion. I knocked out one person with a bottle because of such forced sexual acts. [p#1]

The perpetrators will use a variety of techniques that enable them to meet their needs and commit sexual violence. For instance, they encourage the woman to consume heavy drinks or large amounts of alcohol so that they can do whatever they want after she is inebriated. One of the participants stated this:

One of my customers invited me to a lot of alcoholic drinks. Then he took me somewhere and we had sexual intercourse without a condom. A few days later, I heard of that person’s death from HIV/AIDS. But he didn’t tell me whether or not he had the disease. Once upon a time, I got sick … my relative took me to the health center … they told me that I am HIV positive and I became unconscious … [p#6]

Physical Violence

The other type of violence faced by commercial sex workers was physical violence, which was primarily a result of disagreements on sexual matters like forced sexual acts against one’s agreement, and refusal to use condoms. Conflict with abusers was a prominent feature of commercial sex work. This physical violence ranged from minor pushing to forceful punching, and stab injury which leads to loss of consciousness and even death. The women explained such physical violence as follows;

I have had a lot of problems. For example, one of my customers stabbed me with a dagger, and look at this … (Showing the scar on her hand). And he has been arrested and imprisoned for a long time … [p#11]

During the night my customer took me to Paisa (a place found in Gondar city) and asked to had sex without a condom. But I refused. We got into a quarrel and he punched me in my face, and, embrace the pillow firmly over my mouth to keep me from shouting and being heard by others. He forced me to have sex without a condom. At the time, I was unconscious and someone took me to hospital … After that, I will never work at night again. [p#5]

Physical violence was not limited to being slapped, pushed, or hit—an experience commonly expected among commercial sex workers—but, in severe cases, it could even lead to the death of the woman. The participants witnessed the death of their friends due to physical violence. A woman described the condition as follows;

…my friend was killed … I also stayed here, because I didn’t have any other options and decided not to do this work at night. It is safer if I get customers during the day, unless I will not do at night. [p#6]

Psychological Violence

Emotional violence was common among the study participants, which leads to feelings of stress, shame, and embarrassment. For all commercial sex workers, psychological violence like insult, humiliation, intimidation, and warning was a common experience. The woman accepted the insults as their identity. They were labeled by their friends, customers, and neighbors, they were given unique names which described their sexual work which leads them to be isolated from the community.

Insult is common … almost everyone around us insults and humiliates us. Our customers and even alcoholics make fun of us … When we went to a social occasion with others, people didn’t respect us. [P#2]

Similarly, other participant explained her experience as:

… We’ve been called “lame” or AIDS by a woman … She is my neighbor, I told her … don’t say things like that, you might get HIV/AIDS one day since you are not out of this work, … [P#1]

Economic Violence

Economic violence was distinct but common violence among commercial sex workers. This includes withholding, declining, and denying payment, breaking one’s material, and stealing one’s money (Fawole, 2008). Commercial sex workers struggle for daily survival like rent of room and food expenses. For these women, economic violence became an added burden. Here also disagreement on sexual matters became a cause of economic violence. For example, some customers want prolonged intercourse time, and if the women try but fail to meet this demand, they were enforced to return the money back. It is even worse that the men might not even be willing to pay. In such a case, they will have to cover their daily needs on their own. They were unconcerned about the women’s time and energy spent with them. One study participant explained this:

They would not leave me quickly; taking prolonged time to reach orgasm. This becomes a source of conflict. They will say ‘if you can’t stay until we finish, you should return the money back and trouble me. If they intend to harm me, I will refund half their money and let them to leave. In some cases, I may be forced to return all of the money in order to protect my life. [P#12]

Some customers may take women’s goods such as cell phones, bracelets, and other valuable materials. Sex workers are struggling to generate money, feed their children or their family, and pay different debts, but even their customers stole their property, which leads them to a serious economic crisis.

… Six of my phones have been stolen … for the seventh time, I saw him while he pick my phone and put it in his pocket … I returned my phone back … [p#3]

Structural Violence

Sex workers also faced structural violence in the different sectors including the community structures. Commercial sex workers were often excluded from social occasions and interpersonal relationships to the level that they were not considered human beings. Considering them as inferior and dehumanizing these populations is common in society. The community didn’t allow them to participate in social events like wedding ceremonies, coffee ceremonies (which the very famous ceremony in Ethiopia), and funeral ceremonies. In addition, the women were to seek help from police, lawyers, neighbors, and friends, while they reported that they had been violated, some police officers did not support them. The policies, according to the participant, did not treat them similarly and fairly as other people. They would be biased in favor of the culprit. As a result, most commercial sex worker women choose to shout and call their neighbors and friends rather than seek police aid.

… when I was a beginner, I went to the police office. Since there is no solution, nowadays I will not go there … I cried a lot of times, I returned their money even after having sex, … there is no rule and regulation in place to address these issues. We are not equally treated by the law, and no one wants to hear to us … we were not heard before the law, even in our village we were undermined despite our equal contribution in all affairs. [p#4].

Mechanisms for Dealing With Violence

The coping methods employed by commercial sex workers to reduce or halt violence were also investigated in this study. Sexual violence was a source of all other forms of violence, and women dealt in a variety of ways. First, the women try to take one’s measures and then, seek support from external bodies. They started by crying and continued to counter-attack the perpetrators. Returning the money back was also a coping method used by the women. Others physically strike the perpetrator with a stick and a bottle. From all mechanics, returning the money was the most frequent, and also had a positive response.

… I’m powerless in the face of such individuals. Because if you get into a fight with a man, you never know how they will hurt you. If they refuse to accept my idea, I will return their money and let them leave. [P#6]

The other woman explained this as follow:

… I strike a man with a bottle in his head, and he bleeds. The police arrived and arrested me … and they took him to the hospital for treatment … but I told them he forced me to suck his penis … [p#11]

Strength and Limitations

The strength of this study is that a qualitative study that explored the lived experiences of commercial sex workers from their own perspectives and experiences; it strengthens the existing knowledge of violence among sex workers. However this study is not free of limitations, first, due to the phenomenology nature of the approach, the study did not include the perspectives of institutions like police, legal, and other government bodies of the study subject. Second, the absence of data from perpetrators limits the ability to comprehend their motives for violence. Last, all the data collectors were males, which may influence the response of the participants.