Characterizing the patterns of HIV disclosure to clients among South African female sex workers in Port Elizabeth

Cassia Wells, Sheree Schwartz, Nancy Phaswana-Mafuya, Andrew Lambert, Zamakayise Kose, Mfezi McIngana, Harry Hausler, Amrita Rao, Clarence Yah, Sosthenes Ketende, Stefan Baral

Research output: Contribution to journalArticlepeer-review


Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.

Original languageEnglish (US)
Pages (from-to)3924-3932
Number of pages9
JournalAIDS and behavior
Issue number12
StatePublished - Jan 1 2018


  • Clients
  • Disclosure
  • Female sex workers
  • HIV
  • Sex work
  • South africa

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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