This paper identifies barriers to HIV risk reduction among women street sex workers in Cape Town. To gain access to the study population, investigators undertook observational fieldwork for 9 months. This initial trust‐building period allowed for the mutual identification of issues to guide the remainder of the research. Twenty‐five individual interviews and four focus groups were then conducted. The following were identified as barriers to the uptake of risk reduction: the role of regular partners and ‘special clients’ in determining condom use; client resistance to condom use; accessibility of condoms and lubricants; client violence and forced unprotected sex; police violence and lack of protection; substance use among workers; access to health care services; inappropriate genital hygiene practices; inappropriate assessment by workers for sexually transmitted diseases in themselves and clients; and, the role of gatekeepers. Future interventions need to better understand the social context in which street‐based sex workers are exposed to HIV risk. They need to be designed and implemented in partnership to develop sex workers' capacity to reduce the risk of HIV transmission among themselves, and their clients.
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Pauw et al. (2003) studied this question.