The status of commercial sex & its Psychological Impact on its workers in Ethiopia

1. College of Health Science
School of Medicine
Department of Medical Physiology
Pedagogy Assignment on:
The status of commercial sex & its
Psychological Impact on its workers in
Ethiopia
Prepared By:
Name ID No.
1. Genet Tesfaye GSR/3688/14
2. Habtemariam Mulugeta GSR/2895/14
3. Haymanot Andualem GSR/4531/14
4. Tewodros Dula GSR/6483/14
5. Zeleke Endalew GSR/2023/14
Addis Ababa, Ethiopia
November, 2021

2. Table of Contents
1. Introduction............................................................................................................................. 1
1.1 Definition of Commercial Sex Work....................................................................................... 1
1.2 History of Commercial Sex Worker World Wide ................................................................... 2
1.3 History of commercial sex work in Ethiopia........................................................................... 2
2. Status of commercial sex work in Ethiopia................................................................................... 3
2.1 Economic Policy & Programs for Sex Workers ...................................................................... 4
2.2 HIV prevention & care programs that target sex workers...................................................... 5
2.3 Factors Contributes to Engage in Commercial Sex Work....................................................... 5
3. Psychological Impacts of Commercial Sex Work on Its Worker in Ethiopia................................ 6
3.1 Emotional Effects ................................................................................................................... 6
3.2 Physical Effect........................................................................................................................ 6
3.3 Spiritual Effects...................................................................................................................... 6
3.4 Mental Effects ........................................................................................................................ 7
3.5 Some Elements That Negatively Impacts Psychological Well-Being of Sex Worker................ 7
3.5.1 Attitudes of the profession................................................................................................ 7
3.5.2 Self - Viewpoint of Societal Attitudes................................................................................ 7
3.5.3 Work/Life Conflicts.......................................................................................................... 7
3.5.4 Personal Growth .............................................................................................................. 8
3.5.5 Effects on Mental Status................................................................................................... 8
3.5.6 Self-Acceptance................................................................................................................ 8
4. Conclusion................................................................................................................................... 9
5. References.................................................................................................................................. 10

3. 1
1. Introduction
Commercial Sex Work defined as the provision of sexual services to clients who request it,
receiving money or goods in exchange. In this activity, the occurrence of sexual, physical and/or
verbal violence tends to be frequent, contributing to the greater severity of the negative
psychological impact associated with Commercial Sex Worker.
Commercial Sex Work has been practiced throughout ancient & modern culture. Commercial Sex
Work has been described as "the world's oldest profession" although the oldest professions are
most likely farmers, hunters, & shepherds.
Commercial sex workers have been known in Ethiopia since olden times, although there are no
data as to when & where commercial sex first appeared in the country. There are approximately
210,967 female sex workers in Ethiopia according to recent estimates.
Commercial Sex Work has serious problems of physical & psychological injury in Ethiopia, such
as the spread of HIV/AIDS, other, drug addiction, unwanted pregnancy, crimes, cultural &
religious confusion, & behavioral changes. the psychological effects include emotional, physical,
social, spiritual, & mental effect.
1.1 Definitionof Commercial Sex Work
The word commercial sex work is derived from the Latin word “prostare” which means publicly
selling oneself (1,2). The term “sex worker” was coined in 1978 by sex worker activist carol Leigh.
its use became popularized after publication of the anthropology, sex work; writings by women in
the sex industry in 1987, edited by Frederique Delacoste & Priscilla Alexander (3–6).
Sex work can be defined as the provision of sexual services to clients who request it, receiving
money or goods in exchange. Prostitutes may be female or male or transgender, & Commercial
Sex Work may entail heterosexual or homosexual activity, but historically most prostitutes have
been women & most clients men (6–9).
Commercial sex work occurs in a variety of forms, & its legal status varies from country to country
(sometimes from region to region within a given country), ranging from being an enforced or

4. 2
unenforced crime, to unregulated, to a regulated profession. It is one branch of the sex industry,
along with pornography, stripping, & erotic dancing (10,11).
1.2 History of Commercial Sex Worker World Wide
Historically, commercial sex work dates back to ancient societies & occurs throughout human
history. This practice is an age long phenomenon recorded between 650-556 B.C & characterized
by the provision of sexual favors for financial & non-financial rewards. It is constantly assumed
as an existing fact in biblical history. It is estimated that prostitutes were common among the Jews
before the Birth of Christ (2)(12–14) .
Commercial Sex Work as a profession in African context started after the coming of colonialism.
Even though the cultural condition did not allow women to engage in Commercial Sex Work, the
disintegration of the social structure & the change in the overall cultural values & norms after
colonial’s rule made the environment favorable for Commercial Sex Work to be a common
phenomenon especially among the urban dwellers, it was practiced. Generally, the emergence of
Commercial Sex Work on the African historically traced back to the period of colonialism (15–
17). Commercial Sex Work has been practiced throughout ancient & modern culture. Commercial
Sex Work has been described as "the world's oldest profession" although the oldest professions
are most likely farmers, hunters, & shepherds (18).
1.3 Historyof commercial sexwork in Ethiopia
Commercial sex workers have been known in Ethiopia since olden times, although there are no
data as to when & where commercial sex first appeared in the country. Some sources associate the
beginnings of commercial sex with the movement of kings, nobles & warlords, the establishment
of cities & the development of trading (19).
Even though, Commercial Sex Work has an early beginning in Ethiopia but the practice becomes
& used as one of financial income work was during the period of Italy invasion which lasts for
five years. The Italians were customers in this practice especially the soldiers were the most one
who came to females whom engaged as prostitutes. The 1950s & 1960s, the number of hotels,
bars/restaurants, tella, araki, tej, & other eating & drinking establishments, & the number of sex
workers increased markedly. These establishments were the primary sites where clients met sex
workers (20).

5. 3
Commercial sex work is not a legally recognized ‘profession’ in Ethiopia. However, most of the
establishments where the sex workers are based (hotels, bars/restaurants, night clubs etc.) operate
legally with working licenses (21,22).
2. Status of commercial sex work in Ethiopia
There are about 42 million prostitutes in the world, living all over the world (though most of
Central Asia, the Middle East & Africa lack data, studied countries in that large region rank as top
sex tourism destinations). Estimates place the annual revenue generated by Commercial Sex Work
worldwide to be over $100 billion (23,24).
In sub-Saharan Africa, the commercial sex worker prevalence in the capital ranged between 0.7%
& 4.3%. Ethiopia has become a magnet for sex tourism, including child sex tourism. Ethiopia’s
urban areas are home to hundreds of thousands of youths who live & work on the streets – out of
whom many adolescent girls end up being sexually exploited & many more young women opting
to engage in commercial sex work due to limited options & more lucrative income in the sector
(23–25).
According to the 2015 summary report of Population Services International (PSI) Ethiopia about
85294 Commercial Workers found in 89 towns, in which in the distribution of commercial sex
workers in the different regional states were Oromia (23163) that the majority of them were found
in Adama City (3530), Amhara (20099) that the majority of them were found in Bahir Dar City
(6750), Tigray (10614) that the majority of them were found in Mekele City (4658), SNNPR
(10288) that the majority of them were found in Hawassa City (3516), Afar (3658) that the majority
of them were found in Logia City (932), Somalia (696) that the majority of them were found in
Jijiga City (529), Benshangul - Assosa (640), Harari (817), Gambella Town (1485), Dire Dawa
Town (2202) & Addis Ababa (11632) that the majority of them were found in Addis Ketema
(2890) (26). Also, a study done by Federal HIV/AIDS Prevention and Control Office in 2020,
pointed out that 210,967 female sex workers were identified across the country. This shows the
number of women engaged in selling sex is increasing from time to time. Estimates suggest that
65% of street children & adolescents lack access to social services, & face heightened risk of
involvement in transactional sex, substance abuse & exposure to sexual assault (27) (28).

6. 4
An estimated 14% of all young people involved in commercial sex work are under the age of 18,
while nearly 45% of street connected girls in Addis Ababa engage in sex for payment, In Ethiopia,
especially Addis Ababa & Nazareth women working as waitress are about 40-45% admitted to
being involved in sex work beside their official job (25). There are different kinds of commercial
sex worker in Ethiopia. Formal (organized) or informal (not organized). Formal sex worker is
establishment based & managers & /or pimps act as clearly defined authorities & as intermediaries
between the sex worker & client. establishment based sex workers maybe sex workers & /or
waitress they worked in Hotels, Bars & Restaurants, Red light houses, Tella bets, Arakai bets, Tej
bets, Pastry houses & massage houses (29).
Informal sex workers such as street based sex workers & self- employed usually find their clients
independently like seeker of sugar mommy & sugar daddy commercial sex worker. Occasional
sex workers perform another type of informal sex work. They may sell or trade sex to meet short-
term economic needs (such as school tuition, a family financial crisis) (30).
There are a number of difficulties involved in collecting meaningful commercial sex worker
statistics, Because of most kind of commercial sex are not easily visible. Many factors making it
difficult to collect statistics for the sex industry, including low response rates, the small scale of
research compared to the size of the sex industry, & the diversity of the industry. As a result, only
estimates are available for the number of commercial sex worker in Ethiopia as well as other
countries (30).
FSWs generated 90.1% of total cash from sex work, with a median weekly income of USD 60.53.
They engaged mostly in protected vaginal sex, earning approximately USD 4.57 per act. Food,
housing, & clothing represented the largest areas of expenditure. Around 17% of expenses were
recorded as costs of sex work (e.g., alcohol) (31).
2.1 Economic Policy & Programs for Sex Workers
The history of official policy on poverty alleviation for sex workers is short. In 2012 the
government Social Protection Policy included sex workers for the first time. The economic
empowerment interventions recommended by the policy for vulnerable groups are microfinance
services, skills training & conditional & non-conditional social transfers (30).

7. 5
2.2 HIV prevention & care programs that target sex workers
These support NGO partners to distribute condoms & promote sexual health and, in addition, to
conduct income generating activities for some of the program beneficiaries. The activities are
similar to those performed within Edirs, although the shorter funding cycles mean that they do not
typically involve complex infrastructure or complex capital investment. The number of these
projects & their outcomes are not collated but individual results are monitored & included in
reports to donors. For example, anti-HIV, anti-trafficking & faith-based organizations, organize
sex workers into Edirs or other groups that can access local & international resources (32).
The enterprises these groups undertake are referred to as ‘income generating activities’ (IGAs).
Income from them is directed to both the individual beneficiaries and, in some cases, to an NGO
that has organized the group or activity. Findings suggest that financial literacy & formalized
savings activities, with life skills & empowerment training, have potential to build Female Sex
Workers economic resilience, mitigating a structural driver of sex work & HIV risk (32,33).
Commercial Sex Work has serious problems of physical & psychological injury in Ethiopia, such
as the spread of HIV/AIDS, other sexually transmitting disease, drug addiction, unwanted
pregnancy, crimes, cultural & religious confusion, & behavioral changes. Many teenagers &
children are leaving school & joining sex-work by economic & social problems. These all can
open door for sex tourism, & increase the magnitude of problem (34).
2.3 Factors Contributes to Engage in Commercial Sex Work
At its core, the commercial sex industry targets on vulnerable populations including those with
mental health issues. In other words, systems of Commercial Sex Work have a predatory
dependence on people with vulnerabilities such as economic insecurity, barriers to higher
education, family factors (divorce, conflict), peer pressure, seeking better ways of living in city,
socio-economic factors (unemployment, social perception) or with histories of adverse childhood
experiences such as child sexual abuse (35).
Children who engaged in commercial sex work by many reasons such as, running away from
home, child abuse & neglect, psychological & emotional difficulties, family related risk factors,
child -specific risk factors, socio-economic related risk factors, environmental -related risk factors,
poverty, personal life style & illiteracy. Some girls as young as 11 years of age are engaged in sex
workers (SW). 20 % of children in began their Commercial Sex Work career before the age of 11

8. 6
years. Studies also indicate that an increasing number of teenage girls come to Addis Ababa to
involve in SW because of poverty (35,36).
3. PsychologicalImpacts of Commercial SexWork on Its Workerin Ethiopia
Research on the psychological impact associated with sex work, particularly when there is
exposure to situations of violence, has demonstrated that this activity is related to the development
of psychological stress. as well as with the onset of many other negative consequences, both short
& medium to long term: polarization of affection in the field of sadness with high possibility of
evolving into depressive disorders, post-traumatic stress disorders, anxiety & addictive disorders
related to substance use (26,37).
Commercial Sex Work has serious problems of physical & psychological injury in Ethiopia, such
as the spread of HIV/AIDS, other (STI), drug addiction, unwanted pregnancy, crimes, cultural &
religious confusion, & behavioral changes. Sexual violence & physical assault are the normative
experience for sex workers in Commercial Sex Work, but there is more than just physical harm
done to a person in the sex trade. There are also emotional, physical, social, spiritual, &
psychological effects bestowed upon sex workers (26,37,38).
3.1 Emotional Effects
Sex Workers will experience levels of “depression, [suicidal thoughts], flashbacks of childhood
abuse, anxiety & extreme tension, terror regarding a relationship with a pimp, lack of self-esteem
or no self-esteem, & mood swings (26,37,38)..
3.2 Physical Effect
A physical effect common in prostituted women is the spread of HIV & other STD‟s. In most
cases the prostitute is judged to be the one who carries & spreads HIV; however, extensive medical
research on the spread of HIV has been clearly noted that men are the carriers of HIV & women
are the recipients of the disease (26,37,38)..
3.3 Spiritual Effects
Not much is reported on the spiritual effects of the sex worker except that there is a loss of faith &
hope that things will ever get better. There lies an “unremitting sense of despair (26,37,38)..

9. 7
3.4 Mental Effects
There is however, much to be reported on the psychological effects which include post-traumatic
stress disorder, depression, anxiety, disassociation disorder, insomnia, irritability, flashbacks,
emotional numbing, & hyper alertness extensive research on the psychological effects of women
in the sex trade as noted: Complex posttraumatic stress disorder (CPTSD), which includes changes
in consciousness & self-concept, changes in the ability to regulate emotions, changes in systems
of meaning, includes changes in perception of the perpetrator of abuse (26,37,38)..
3.5 Some Elements That NegativelyImpacts Psychological Well-Being ofSex
Worker
3.5.1 Attitudes of the profession
The studies showed that most sex workers have somewhat negative attitudes about their
profession. Many of them have guilty, fearful, sinful, & immoral feelings towards their profession
3.5.2 Self - Viewpoint of Societal Attitudes
Sex workers are well aware of the stigmas attached to their profession & these stigmas are
significant stressors for sex workers. These things affect the psychological wellbeing of sex
workers. They have displeasure & anger with society; how society treats them. The workers have
always tried to hide their profession from the whole society & that causes a major stress for them.
They are willing to hide their profession & manage the negative conditions within the profession.
Those negative conditions make stressors for them & it negatively impacts their psychological
wellbeing (26,37,38)..
3.5.3 Work/Life Conflicts
Commercial sex workers kept the nature of their work secret from people in their private life. The
majority have had to hide everything connected with their work. This double life is a huge stress.
They have difficulty finding child care & in fulfilling other responsibilities & duties. Commercial
sex workers have no husbands & hence male protection in their private life, they miss their
husband’s love & affection & the ability to get sexual desires fulfilled from their husband. These
issues cause them emotional & psychological distress (26,37,38).

10. 8
3.5.4 Personal Growth
sex workers worry about their life & profession. They have feelings of guilt, worry, shame, &
sadness about their life & employment. They value themselves negatively & have low self-esteem.
3.5.5 Effects on Mental Status
The profession of sex work or Commercial Sex Work has a very negative impact on the mental
status of sex workers. The workers incur stress due to health risks, physical violence, societal
stigmas, & hazards from other persons involved in the profession. Most of the studies also indicate
that sex work has a huge negative impact on the mental status (26,37,38)..
Other studies evaluating the presence of psychological alterations in prostitutes, compared to non-
prostitutes, also documented difficulties with concentration & memory as well as sleeping
problems, irritability, anxiety, phobias, panic attack, compulsions, obsessions, fatigue & concerns
with physical health. It should also be noted that in the work by, of the sample reported a suicide
attempt (26,37,38)..
3.5.6 Self-Acceptance
Most of the sex workers have negative attitudes towards themselves & their profession. They don’t
feel positive about their past & present life. They feel dissatisfied with self & their employment.
Most of them have low self-esteem, self-confidence, & negative attitudes about themselves
(26,37,38)..

11. 9
4. Conclusion
Women in Ethiopia are engaged to commercial sex worker as an ultimate income source option.
Yet massive numbers of women lead their life in sex work & children are still engaging to this
work due to several factors like childhood abuse, lack of income, being street child & other socio-
economic factors. But generally, poverty is the comprehensive factor which includes listed factors
that pushed women to lead their life in commercial sex work.
According to recent researches enormous number of females are living as a commercial sex
worker. Especially major cities are the reaching destination for women to engage to commercial
sex work, but there are no available relevant quantitative studies on the numbers of commercial
sex workers in Ethiopia.
Because of commercial sex work considered as adultery form of life in the society, the women’s
engaged to this work faced a lot of challenges from the society & their own customers. Most of
the women develop psychological crisis & other consequential crisis from psychological
disturbances & physical violence. Like emotional instability, physical effect, social stigmatization,
& mental disorders are some of the several factors that leads women’s to loses their psychological
well beingness.

12. 10
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