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Exploring the challenges of female sex workers who are heads of households and the survival strategies they adopt in Johannesburg.

A research report presented to

The Department of Social Work
School of Human and Community Development
Faculty of Humanities
University of the Witwatersrand

In partial fulfilment of the requirements
for the degree Bachelor of Social Work

by

Kaylee Rodrigues
November, 2017








 ACKNOWLEDGEMENTS
First and foremost, I would like to thank God Almighty, without whom none of this would be possible. It is with his love that I was able to draw the necessary strength to complete this study. 
Secondly, this report would not have been possible without my supervisor, Ms. Naledi Selebano who stayed up many late nights going through my work and making sure it was perfect. Your guidance is deeply appreciated. 
I owe my deepest gratitude to all my lecturers who inspired me to take on this study and to ensure that the voice of female sex workers in South Africa were heard. 
It is a pleasure to thank WRHI for their assistance in helping me recruit participants and for providing me with office space to conduct the interviews. Without your kindness, this study would not have been possible. I am indebted to you.  
To the participants who took part in this study, I thank you for your honesty and willingness to share your experiences with me. Your assistance is deeply appreciated. 
To my parents, thank you. Your constant support and encouragement has been a rock throughout this journey. 
To Ricardo and Gugu, I owe my deepest gratitude for your constant reassurance and cheer. Thank you. 


ABSTRACT
South Africa, along with many other countries in the world have economic and social systems that predominantly undermine women and disempower even those who have managed to gain independence. The effects seem to be more significant and more advanced for female sex workers in South Africa. Economic injustice and social injustice, including, but not limited to, stigma, HIV/AIDS, financial exclusion and physical violence have substantial effects and seem to be worse for those female sex workers who are heads of households. It is for this reason that this study sought to explore challenges related to the work of female sex workers and the extent of those challenges linked to the breadwinner role. This study unravelled the strategies adopted by female sex workers to ensure not only their own survival, but the subsequent survival of the family as well. This study utilised the qualitative research approach, and the case study design. Purposive sampling, which is a non-probability sampling technique was used. Individual semi-structured interviews were conducted with ten (10) participants and an interview guide was developed to guide the interviews. The interviews were recorded and transcribed and data emanating from the interviews was analysed using thematic analysis. It is hoped that the study will contribute to social workers’ critical understanding of challenges faced by female sex workers who are breadwinners when developing practice interventions. The study further hopes to contribute to current debates on sex work decriminalisation, as well as studies on the livelihoods of female sex workers who are heads of households. 
Key Words: Female sex workers, challenges, survival strategies, heads of households. 









TABLE OF CONTENTS

                                                                                                            
Acknowledgments                                                                                    (II)
Abstract                                                                                                    (III)
Table of Contents                                                                                     (IV)
Chapter One                                                                                              5-10
Chapter Two                                                                                             11-20
Chapter Three                                                                                           21-32
Chapter Four                                                                                             33-62
Chapter five                                                                                              63-67
References                                                                                                 68-74
Appendix A                                                                                               75-76
Appendix B                                                                                               77
Appendix C                                                                                               78
Appendix D                                                                                               79
Appendix E                                                                                                80







CHAPTER ONE
INTRODUCTION
According to Zarhani (2011), female headed households are households where either no adult males are present, owing to divorce, separation, migration, non-marriage or widowhood, or where men, although present, do not contribute to the household income. However, household members often unknowingly redefine gender roles as they take action to adapt to changing environments. For some women, sex work has come to act as a means for financial support for the family and may be seen as something which the woman can take pride in, especially as a mother. Despite the stigma which surrounds the sex work industry, it cannot be denied that sex work is how women who are the heads of households ensure the economic survival of the family.  Johannesburg is a key location for the operation of female sex workers with an estimated 29 733 sex workers who are currently operating in Gauteng, with the majority being black women (Alfreds, 2017). 
For the past decade, Zimbabwe has been experiencing an economic decline that has resulted in an inflation rate of two-hundred and thirty million percent and an unemployment rate of over ninety percent which has prompted an estimated two to three million people to leave the country in search of work which will support them and their families (Phiri, 2017). With the economic downfall of Zimbabwe, it was found that many Zimbabwean women who are the head of the household have come to Johannesburg in search of employment to financially support their families, however, due to the lack or employment opportunities in South Africa many Zimbabwean women turn to sex work (Balfour & Allen, 2014). Although, it was not planned, most women who participated in this study were Zimbabwean.  
Female sex workers in Johannesburg still find it challenging to access readily available resources, especially those pertaining to health care.  They are also often faced with challenges related to violence, discrimination and are taken advantage of by clients, the police and civil society (SWEAT, 2013). Challenges related to violence, health risks, financial exclusion as well as emotional trauma for female sex workers are not uncommon. It is not unusual that the challenges faced by female sex workers in Johannesburg who have the responsibility to head a household are strife, however, it became clear that the survival strategies adopted by female sex workers who are heads of households have not been clearly understood and documented. Thus, this study sought to discover the challenges which female sex workers in Johannesburg face and how sex workers have adopted survival strategies to cope with these challenges. 
1.2. RATIONALE FOR THE STUDY 
Poverty is a factor that is strongly correlated to the gender disparities that exist in South Africa. Women are often severely affected by the economic injustice that is created as a result of gender biased norms (Commission for Gender Equality, 2014). This has led to a greater feminisation of poverty in which more than one in eight women, (up to 30% of women) are poorer than men (NIDS, 2008). At the household level, there is an even larger poverty gap as households headed by women are between 38% and more than 100% poorer than households headed by men (NIDS, 2008). Poverty, thus, could be seen as one of the main factors which influence women’s decisions to become sex workers (Levy, 2015). This has led to other challenges such as a lack of education amongst girl children and high rates of unemployment amongst women. High rates of unemployment have also encouraged many women to get married at a young age which they feel will offer them some financial security, however, many women are at risk of experiencing domestic violence which may require that they find other means of financial income (Brents & Sanders, 2010). 
For many women, sex work is a choice which is made of their own accord. Female sex workers are however, often considered by society as a vulnerable group rather than strong women who are making a means to an end, as a way to ensure the end of their poverty (Empower Foundation, 2016). The criminalization of sex work tends to decrease any empowering factors as police threaten sex workers with arbitrary arrest, demand bribes, and abuse and sexually violate them as a criminalized group. Sex workers have felt powerless to confront abuse by both clients and police, and in turn, unable to rely on police when they need help (Kohn, 2014). The challenges faced by sex workers in terms of violence and health risks due to the criminalization of sex work in South Africa are strife. Survival strategies are needed in order to ensure the health and safety of every sex worker. For those sex workers who are also heads of households, this is vital if the survival of the family structure is to be ensured.
The intersectional feminist theory aims to support sex worker’s rights and to understand the diversity and complexity of the lives of sex workers in contrast to the monolithic abolitionist discourse which portrays all sex workers as ‘prostituted women’ without agency (ICRSE, 2016). In a context such as South Africa, with a vastly diverse population, the intersectional perspective may be vital in ensuring that the complexities of a sex worker’s reality are considered in an attempt to understand not only the challenges experienced by female sex workers, but also how they have adopted strategies to cope with these challenges as the head of a household.
1.3. RESEARCH QUESTIONS
1. What are the social factors which have led female sex workers to the choice of sex work?
2. What are the range of challenges experienced by female sex workers in Johannesburg?
3. What kinds of households do sex workers live in?
4. What does the sex workers role as the head of a household entail?
5. Do challenges faced by female sex workers impact on their head of household roles and responsibilities?
6. What are the survival strategies employed by female sex workers to avoid or overcome challenges they face with sex work?
1.4. AIM OF THE STUDY 
The aim of the study is to explore challenges related to the risks and dangers of sex work experienced by female sex workers who are also heads of households in Johannesburg as well as the survival strategies they adopt to overcome or avoid those challenges.
1.5. THE OBJECTIVES OF THE STUDY ARE 
1. To identify factors which have led female sex workers to an occupation in sex work.
2. To describe the range of challenges experienced by female sex workers in Johannesburg.
3. To explore how challenges faced by female sex workers affect their functioning as the head of a household.
4. To explore strategies adopted by female sex workers in Johannesburg to overcome or avoid challenges they face.
1.6. THE REPORT STRUCTURE 
This report is structured in the following way: Chapter two encompasses a literature review which has been divided into four sections. The first section focuses on female sex workers as heads of households in terms of how women have redefined gender roles in taking financial responsibility for the family structure as there have been an increasing number of women headed households in developing countries that are emerging as a result of economic changes, economic downturns and social pressures, rather than as a product of cultural patterns (Zarhani, 2011). The next section focuses on sex workers and their challenges and provides a detailed account of the recorded challenges experienced by sex workers such as violence in relation to the decriminalisation of sex work, health risks, and stigma. The third section concentrates on the survival strategies employed by female sex workers and emphasises the importance of survival strategies for sex workers who are heads of households as often the family structure is dependent on the financial income provided through the sex work industry. The final section attentions to the theoretical framework and how the intersectional feminist theory is appropriate for the study. 
Chapter three consists of the methodology and contains seven main sections. The first section describes the qualitative approach and emphasises its relevance for the study as it is concerned with developing explanations of social phenomena and aims to help us to understand the social world in which we live and why things are the way they are (Hancock, Ockleford & Windridge, 2009). The second section specifies that purposive sampling, which is a non-probability sampling technique was utilized for the study. A sample size of ten (10) participants was obtained through a partnership with Esselen Clinic. The third section consists of the instrumentation in terms of how an interview guide with nine (9) questions was utilised as it acts as a guideline to direct interviews into answering the aim, research questions and objectives of the study (Farooq, 2013). This section considered pre-testing and how it assisted the researcher to deduce which questions prompted more detailed responses and to develop a series of probes and alternative questions which encouraged the participants to provide more information on their unique experiences. This section quantified that face-to-face semi-structured interviews were utilized with participants and emphasized the importance of communication skills when conducting interviews. This section also gave a detailed account of the researcher’s experiences with the interviews and the importance of understanding the nature of the situation and interpersonal relationships. The subsequent section consists of the researcher’s characteristics in terms of the importance of being reflexive so as to avoid researcher biasness throughout the study. Section five describes the research site by contextualising Johannesburg as a city, as well as perceptions of sex workers at Esselen Clinic in terms of a lack of stigma experienced in a context which caters specifically for sex workers. The sixth section consists of the data analysis and specifies that thematic analysis was utilized for the study as it is a comprehensive process where researchers are able to identify numerous cross-references between the data and the research’s evolving themes by providing flexibility for approaching research patterns (Alhojailan, 2012). The final section within chapter three consists of the ethical considerations and gives focus to the importance of voluntary participation, the necessity of informed consent, ensuring that no harm is done to participants and ensuring that confidentiality and anonymity are upheld. 
Chapter four encompasses the findings and discussion of the research and is divided into four main sections. The first section is termed female headed households and the loss of the male head. This section suggests that many families who have in some way lost the male head, experience economic decline. This often forces the women to take on the role of head of the household to ensure its economic survival, often earning her the title ‘deviant mother’ (Roman, 2011). This section contains a subsection which incorporates the breadwinner role and the responsibilities of female sex workers in which it is emphasised that women who are single mothers have been forced to generate income for their families which has offered them some dignity in being able to do so. The second section is termed factors leading to sex work as the choice of work and includes the weakening of the economy and lack of jobs which elucidates the hardships of finding employment which is sufficient to sustain the family structure. This section also expands on the role which domestic violence and a lack of education has played in the decision to become a sex worker. This section further expands on the dire economic state of Zimbabwe and how this has influenced the immigration of Zimbabwean women to South Africa and their decision to financially sustain the family through sex work. The third section focuses on the challenges experienced by female sex workers with their work in terms of violence from clients and the police, health challenges in terms of preventing pregnancies and the transmission of sexually transmitted diseases, emotional trauma and financial exclusion as they are unable to open a bank account. How these challenges affect a female sex worker who is the head of a household and her ability to provide for those financially dependent on her are given emphasis. The fourth section focuses on the survival strategies employed by female sex workers to overcome daily challenges of their work. These include strategies for violence, strategies to ensure health care and strategies which involve coping with the emotional trauma experienced by women in the sex work industry. 
The final chapter, chapter five includes the conclusion in which the study is summarised and concludes the main findings of the study as a whole. Furthermore, recommendations are made in line with the main findings of the study. The recommendations highlight the importance of government intervention, development in socio-cultural norms and practices, support for female headed households as well as for future research to take place. 























CHAPTER TWO
REVIEW OF THE LITERATURE AND THEORETICAL FRAMEWORKS
2.1. INTRODUCTION 
The following chapter will discuss the emerging role of female sex workers as heads of households due to economic pressures and driving circumstance, the role which female sex workers play as the head of a household, the challenges which sex workers face and how the criminalization of sex work still limits the rights of sex workers as well as the survival strategies which are employed by female sex workers to ensure not only their own survival, but the survival of their family structure alike. 
2.2. FEMALE SEX WORKERS AS HEADS OF HOUSEHOLDS 
Homes headed by women have become a more significant phenomenon in recent decades (Department Women, 2015).  A more recent occurrence in this direction is the increasing number of women headed households in developing countries that are emerging as a result of economic changes, economic downturns and social pressures, rather than as a product of cultural patterns (Zarhani, 2011). 
Female headed households have been defined as a household where either no adult males are present, owing to divorce, separation, migration, non-marriage or widowhood, or where men, although present, do not contribute to the household income (Zarhani, 2011). Household members often unknowingly redefine gender roles as they take action to adapt to changing environments. These actions and opportunities are influenced by the broader institutional environment in which households exist and interact such as the state, the market, and the community and may be easier for women to step outside their traditional roles for the sake of their children (Narayan, 2000). In Africa, it is not uncommon for the male head of the family to become unemployed, ill, die or abandon the family to find work in another province, etc. (Horrell & Krishnan, 2006). Therefore, many women have resumed the role of primary breadwinner for the family.
It was found that sex workers in Butare, Rwanda generally went into sex work for economic survival in the face of events like unexpected pregnancy, often exacerbated by a withdrawal of support by family and community as premarital sex and pregnancy are considered to bring shame to a whole family (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). When caught in such situations, some girls may be excluded from their families and previous social networks which may put them in financially desperate situations. 
In Rwanda, the social vulnerability that can force women into sex work is compounded by patterns of gender bias in access to formal education (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). Similarly, in South Africa, due to the perceived gender roles which exist as well as the prevalence of poverty, often girl-children receive less education or a lower quality of education as it is seen as more beneficial for male children to receive education (Commission for Gender Equality, 2014).  For women who are uneducated and who lack skills, unemployment is common. With no other means of income to ensure the survival of the family, many women turn to sex work in order to provide for themselves and those who are dependent on them (Wright, 2015). Compromised educational success is especially dangerous for the female children of sex workers, as it may continue the cycle of poor, uneducated women who join the underground work of sex work to survive (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). 
Global estimates published by WHO indicate that about 1 in 3 (35%) women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime (WHO, 2016). This violence can negatively affect women’s physical, mental, sexual and reproductive health, and may increase vulnerability to HIV (WHO, 2016). South Africa has one of the highest incidences of domestic violence in the world. Every day, women are murdered, physically and sexually assaulted, threatened and humiliated by their male partners within their own homes and it is estimated that 1out of every 6 women in South Africa is regularly assaulted by her partner (Preller, 2017). Women in such circumstances also depend on their male partners economically and thus, have fewer options to become independent. Many women in South Africa experience economic abuse which involves preventing a victim from resource acquisition, limiting the amount of resources available to her, or exploiting the victim’s economic resources. The motive behind preventing a victim from acquiring resources is to diminish his/her capacity to support him/herself, thus forcing the victim to depend on the perpetrator financially (Preller, 2017). 
Often women stay in abusive relationships as they feel they have no support and would not be able to financially provide for themselves and their families. Alternatively, women who become sex workers and breadwinners have, to an extent, become empowered as they are able to choose the type of lives which they live and do not need to depend on others for financial independence. It is clear that many women in South Africa choose sex work as a means to an end of poverty and financial dependence. 
2.3. FEMALE SEX WORKERS AND THEIR CHALLENGES 
Most violence against sex workers is a manifestation of gender inequality and discrimination directed at women who do not conform to gender norms (WHO, 2005). When a woman challenges the dominance of the male, often he sees it as necessary to push the female back into her gender role with the use of violence (McKenzie, 2011). When a woman defies the predominant gender role of being sexually conservative placed on her by society by choosing to become a sex worker, this is often seen as a challenge on the power and dominance possessed by the male (Tietcheu, 2006). As a result, female sex workers are often at the risk of physical violence, sexual violence as well as emotional violence. 
Uganda has proposed a legislation which reinforces criminal penalties for homosexuality (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). This has emphasised the importance of grappling with sex work issues from a human rights perspective as many policies still target groups and practices which are seen as sexually deviant or subversive of public morals. In South Africa, sex workers are often targeted in acts of violence as perpetrators blame them for societal problems such as HIV/AIDS and want to punish them in the name of social morals. Sex workers also face violence from people in positions of power such as policemen, landlords, health care professionals, prison guards and other such people who take advantage of sex workers as sex work is still criminalised in South Africa (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2017). Its criminalisation has reduced neither the supply nor the demand for sex work and has only wasted government money and fuelled human rights abuses against sex workers (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). Sex work is criminalised not only through prohibitions on selling sexual services, but also through laws that prohibit the solicitation of sex, living off of the earnings of sex work, brothel-keeping, or the purchase of sexual services (Open Society Foundations, 2015). In addition, criminalization creates an enormous power imbalance between sex workers and police. This results in police abuse against sex workers in the form of improper arrests and detention, as well as economic, sexual, and physical abuse (Mgbako et al, 2013). The criminalisation of sex work has allowed violence and abuse to grow in severity as sex workers cannot report any violence due to fear of arrest. 
Furthermore, the criminalisation of sex work in South Africa has led to a lack of labour rights which has forced sex workers to operate in isolation and impedes efforts to collectively organize sex workers (Mgbako et al, 2013). Without this collective action, a large power imbalance exists between sex workers and brothel owners or pimps, who may abuse sex workers by demanding they work long hours and forcing them to work in unsafe conditions (Mgbako et al, 2013). 
Indoor brothel-based sex workers in South Africa report that they generally have little control over their earnings, working hours, leave time, or the agency fees that owners charge them (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). In Johannesburg, where much of the sex work industry takes place in hotels, sex workers often face abusive demands and are threatened with fines, homelessness and arrest (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). Outdoor sex workers have more control over their hours and wages, but in return, they face a much greater risk of violence and arrest (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013).
With the use of the New Zealand Prostitution Reform Act (PRA) sex work was fully decriminalised in New Zealand in 2003, which made it legal for any citizen over 18 years old to sell sexual services (Crichton, 2015). It was feared that the decriminalisation of sex work would lead to an explosion of brothels and of human trafficking, however, it was found that the sex industry has not increased in size, and many of the social evils predicted by some who opposed the decriminalisation of the sex industry have not been experienced (Crichton, 2015). It may, therefore, be seen that the decriminalisation of sex work in South Africa would offer a chance at receiving justice for the violent abuse and rape which takes place against sex workers on a daily basis in South Africa, as well as eradicate stigma, police abuse and a lack of access to health services (Mgbako et al, 2013). The decriminalisation of sex work would not only help guard against violence and abuse, but would also challenge police violence and abuse, improve access to justice, challenge the consequences of having a criminal record which acts as a source of stigma and limits  opportunities in the future, improve access to health services, reduce the risk of HIV/AIDS and sexually transmitted infections, promote safe working conditions, allow for effective responses to trafficking and challenge state control over bodies and sexuality (Open Society Foundations, 2015). Ultimately, one of the main purposes of the decriminalisation of sex work is to ensure that the human rights and dignity of sex workers are respected. 
The key objective of the Prostitution Reform Act (PRA) in New Zealand is to improve sex workers’ safety (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). It was concluded that the decriminalization of sex work had a marked effect in safeguarding the right of sex workers to refuse particular clients and practices, chiefly by empowering sex workers through removing the illegality of their work, and that there was an increase in better working conditions and improved access to health services (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). Evidence from the effects of decriminalization in New Zealand proves that decriminalisation improves sex worker-police relations and empowers sex workers to protect themselves from violence by refusing dangerous clients, negotiating safer sex practices, and seeking police assistance if they are the victims of crime (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). 
In the Netherlands where sex work was also decriminalised, the quality of life of sex workers has shown significant improvement (Garcia, 2015). Despite the persistence of stigma, infrastructure has emerged to provide physical and mental health care, tools for STI prevention and ways to report abuse or violence (Garcia, 2015). 
Evidence from these examples, thus, suggests that the decriminalisation of sex work in South Africa could benefit South African sex workers as the decriminalisation of sex work removes all criminal penalties associated with sex work, and the government regulates it like other forms of employment (Mgbako, Bass, Bundra, Jamil, Keys & Melkus, 2013). Therefore, sex workers, clients, and others involved in the sex industry would no longer be criminals under the law. 
Violence against sex workers is associated with inconsistent condom use or lack of condom use which increases the risk of STI and HIV infection while gender power inequities are believed to play a key role in the HIV epidemic through their effects on women’s power in sexual relationships (Pettifor, Measham, Rees & Padian, 2004). By limiting sex workers’ freedom to negotiate condom use with clients, sex worker’s vulnerability to violence, extortion, and health risks is dramatically increased (Open Society Foundations, 2015). It has, thus, been seen that resistant clients often undermine the ability of the sex worker to insist on condom use in sexual encounters (Campbell, 2000). Violence often plays an important role in this disempowerment and where there is no violence, where sex workers are able to insist on condom use, it results in a decrease in earnings and a loss of clients (Sarkar, 2008). This may be detrimental for sex workers as this will result in poor health and potentially death if not treated. Furthermore, there may be an increase in the prevalence of HIV/AIDS and other STI’s. For many sex workers, this may lead to an inability to work, thus, resulting in further poverty. 
Sex workers are often subject to physical violence, sexual violence and emotional or psychological violence (WHO, 2005). These forms of violence result in human rights violations such as being denied basic necessities, being forced to consume drugs or alcohol, being refused payment for services, being refused or denied health care services, being subjected to coercive health procedures such as forced STI and HIV testing, sterilization and abortions, being publicly shamed or degraded and being deprived of sleep by force (WHO, 2005).
Not only do sex workers face workplace violence, but also from intimate partners and family members due to the stigmatization of sex workers which has led partners and family members to believe that it is acceptable to punish women who have sex with other men (WHO, 2005). Sex workers also often face violence from extortion groups, militias, religious extremists or “rescue” groups due to the stigma which surrounds sex work which is often ignored by state officials such as the police as laws often act as a cover for this violence (WHO, 2005). 
It is clear that violence plays a significant role in creating challenges for sex workers; it is a considerable concern not only for all sex workers, but specifically for sex workers who are heads of households and have the responsibility of ensuring the survival of the family as this may affect their ability to care for the family. 
Since the 1880’s sex workers have been globally blamed for the transmission of syphilis in a similar way to the way they were later scapegoated for HIV (Mattson, Mattson & Mattson, 2016). Stigma exists and persists today for sex workers throughout the world, and creates barriers to pursuing compassionate care for fear of judgement and the denial of care (Mattson et al, 2016). Sex workers are severely stigmatised and as a result are denied health care; they are also discriminated against and isolated from society. This poses a challenge to all sex workers as it becomes problematic in everyday functioning.
In Sydney, Australia, it has been seen that due to the stigma which surrounds sex work, sex workers are often denied access to goods and services, housing and accommodation, employment opportunities and justice (Stardust, 2017). Stigma acts as social isolation for sex workers and reduces options available to sex workers for support and often acts as a means for discrimination to take place against sex workers. But one of the most insidious consequences of stigma is its ability to curtail the capacity of sex workers to fight for basic human rights as both external and internalised stigma impacts the mental health and emotional resilience of sex workers to engage in advocacy, organising and activism (Stardust, 2017). 
In 2016 in South Africa, Deputy President Cyril Ramaphosa launched a three-year campaign called South African National Sex Worker HIV Plan which aimed to reduce the rate of transmission as it was found that there is an almost 60% HIV infection rate amongst women sex workers in South Africa (Law for All, 2017). However, this plan is seen to be less effective amongst sex workers as sex work is still regarded as immoral and stigmatized (Law for All, 2017). 
Often, a sex worker who is living with HIV/AIDS is constantly stigmatized and discriminated against which may have a negative effect on their mental health and wellbeing as they may come to believe that they deserve to be HIV positive (nswp, n.d.). Furthermore, due to the severe stigma experienced by sex workers who are HIV positive, sex worker communities may distance themselves from sex workers living with HIV/AIDS to resist the stereotype that sex workers are sexually dangerous. Stigma has resulted in discrimination from individuals in society and within institutions, policy and law. Stigma results in the creation of laws and policies that harm sex workers and people living with HIV while creating barriers to HIV prevention and treatment services as sex workers living with HIV may be denied access to antiretroviral therapy (ART) (nswp, n.d.).
These risks may be detrimental for sex workers. It is vital that sex workers who are also the head of the household ensure that they are not at risk of contracting HIV/AIDS or other STD’s as this may potentially lead to illness or death, and ultimately the loss of the breadwinner for the family. This becomes problematic for sex workers who are heads of households as often they have to make the hard decision of exposing themselves to the risk of contracting HIV and STI’s or to face violence and earn less money which again affects the overall functioning of the family. 
2.4. SURVIVAL STRATEGIS EMPLOYED BY FEMALE SEX WORKERS 
Survival strategies are needed in order to ensure the health and safety of every sex worker. For those sex workers who are also heads of households, this is vital if the survival of the family structure is to be ensured. Successful and promising harm-reduction strategies are available in terms of education, empowerment, prevention, care, occupational health and safety, decriminalization of sex workers, and human-rights-based approaches while successful interventions include peer education, training in condom-negotiating skills, safety tips for street-based sex workers, male and female condoms, the prevention-care synergy, occupational health and safety guidelines for brothels, self-help organisations and community-based child protection networks (Rekart, 2005). In Malawi, it has been found by Chikaphupha et al, (2009) that 71% of commercial sex workers have knowledge about the available HIV prevention and treatment services, however, health workers felt that sex workers faced very high barriers to using health care services that they may know about. In South Africa, despite an attempt by self-help organisations and community-based child protection networks to promote health and human rights to sex workers, it seems that these organisations have been unable to take any such evaluative research project to measure the impact of their programs and interventions such as in Malawi. 
It is clear that there is a need for strengthened prevention efforts addressing the sex work population and the application of rights-based approaches informed by an understanding of the social roots of health and disease as UNAIDS has calculated that historically, less than 1% of global funding for HIV prevention has been spent on issues related to sex work (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). In South Africa, the South African National Sex Worker HIV Plan launched by Deputy President Cyril Ramaphosa in 2016 claims to affirm the right of all South Africans to life, dignity, and health regardless of their occupation and regardless of their circumstances by ensuring that public health care will not be denied to sex workers (South African Government, 2016).Despite the belief that such interventions may be utilized to ensure the safety of sex workers, it is important to consider challenges surrounding such suggested interventions. 
Survival strategies are often aimed at establishing a comprehensive agenda of medical and social support to improve sex workers access to health care, reduce their social isolation, and expand their economic options by receiving support from human rights laws (Binagwaho, Agbonyitor, Mwananawe, Mugwaneza, Irwin & Karema, 2010). Despite this, it may be seen that there is limited knowledge and literature on the survival strategies adopted by sex workers, thus, the unique perspective of sex workers must be utilized in determining what the challenges are regarding such interventions and what survival strategies are adopted in the face of violence, drug abuse, health risks and poverty. 
2.5 THEORETICAL FRAMEWORK 
In many societies, men are still taught to regard themselves as superior, and women are taught to accept this, which often leads to very little access to power and privilege except via their connection to a man (Smith, 2013). Most women in the paid labour force are subject to the double burden of domestic and wage slavery (Smith, 2013). Feminism is the theory which aims to ensure that men and women are equal politically, economically and socially (Speight, 2005). 
The intersectional feminist theory aims to support sex worker’s rights and to understand the diversity and complexity of the lives of sex workers in contrast to the monolithic abolitionist discourse which portrays all sex workers as ‘prostituted women’ without agency (ICRSE, 2016). The intersectional feminist perspective calls upon the feminist movement to consider the growing evidence in support of sex work decriminalisation, build an alliance with sex workers and their organisations, and actively support sex workers’ rights (ICRSE, 2016).
This perspective holds that sex work is a form of work and should be treated like any other form of labour as the only reasons it is treated differently is due to the illiberal moral approach towards sexuality (ICRSE, 2016). While this perspective agrees that prostitution is always work, all types of work are shaped by the classed, gendered and racialised social relations in which they take place. It has, thus, been agreed that sex work is complex and that sexuality and sexual activity can serve simultaneously as a site of exploitation and victimisation and as a site of agency (ICRSE, 2016). 
The intersectional perspective, thus, aims to explain a woman's varied experiences based on her race, class, sexual orientation or another identity she holds in addition to her sex and declares that the impact of sexism is qualitatively different depending on women's class or race identities (Gerassi, 2015). 
It is true that sex work is still highly stigmatised globally and in the South African context. The effects may be worse for women of a particular class or race. It is this stigma which criminalises sex work and creates challenges for women who support families as a sex worker. In a context such as South Africa, with a vastly diverse population, the intersectional perspective may be vital in ensuring that the complexities of a sex worker’s reality are considered. 
Thus, it may be seen that women who are sex workers still face vast and numerous challenges due to the moral approach towards sexuality amongst many societies worldwide, despite the call for the decriminalisation of sex work in many of these societies. Survival strategies are, thus, vital to assist female sex workers who are heads of households to not only ensure their own survival, but the survival of those dependent on them. 
2.6. CONCLUSION 
In conclusion, it may be seen that currently, the literature and knowledge which is available has focused largely on the challenges which female sex workers face. However, very little of this literature has focused on the role of a female sex worker as the head of a household and the survival strategies which are adopted to ensure not only her own survival, but the survival of the family structure as a whole. Thus, research conducted must focus on collecting data which not only focuses on the experiences of female sex workers in terms of the challenges which they face, but which also focuses on how they manage these challenges to ensure that they are able to work and generate an income for the family despite the many challenges which loom. 


















CHAPTER THREE
RESEARCH METHODOLOGY
3.1. OVERVIEW  
In order to conduct and evaluate any research, it is important to know what underlying philosophical assumptions about what constitutes 'valid' research and which research method(s) is/are appropriate for the development of knowledge in a given study (Thomas, 2010). This chapter will, thus, discuss the research approach and design strategies, as well as the sampling methods, instrumentation in terms of the use of an interview guide, pre-testing and how semi-structured interviews were utilised in the conduction of the study. In addition, this chapter discusses the stages and processes of the research and how it was conducted along with the experiences of the researcher, discussion of the research site and data analysis. Finally, the ethical considerations within the study are highlighted in this chapter.   
The interpretive paradigm does not regard the social world as something separate and isolated, but rather something which is constructed by human beings and is dependent on the creation of human beings (Phothongsunan, 2010). As it is people who give meaning to their social world, how human beings perceive and make sense of this world is what interpretive researchers seek to investigate, thus, out-ruling a truly objective position for the interpretive researcher as he/she becomes rooted in the research by becoming a meaning-maker of the experiences being sought (Phothongsunan, 2010). Therefore, the research becomes the construction of meanings between the participants, one of whom, the researcher is him/herself (Phothongsunan, 2010). This study adopted the interpretive paradigm as the researcher became entrenched in the experiences and social world of each participant by creating meanings of the social world being experienced by each participant. 
This study sought to uncover the experiences and challenges of female sex workers in Johannesburg and the survival strategies which they have adopted to cope with such challenges while fulfilling their role and responsibilities as heads of the households. Ten women between the ages of twenty-two (22) and forty (40) years of age who were residing in Johannesburg at the time of the study were interviewed. With the permission of each participant, each interview was recorded. Two separate consent forms were signed for permission to be interviewed (appendix A) as well as for permission to be recorded (appendix B). 
3.2. QUALITAIVE APPROACH  
Corresponding to the interpretive paradigm, the qualitative approach was utilised as it attempts to gain understanding of some aspect of social life by studying behaviour in natural settings and uses people’s accounts of data while focusing on descriptions and interpretations which may lead to the development of new concepts or theory (Hancock, Ockleford & Windridge, 2009). Ultimately, qualitative research is concerned with developing explanations of social phenomena and aims to help us to understand the social world in which we live and why things are the way they are (Hancock, Ockleford & Windridge, 2009). This approach was beneficial in the conduction of this research as it allowed for the experiences and personal perceptions of participants to be explored in terms of what their challenges are as female sex workers who are heads of households, how they cope with their challenges and what survival strategies they adopt to do so. The qualitative approach has allowed for the exploration of how each participant’s opinions and attitudes have been formed, how they have been affected by the processes and environments in which they function and how daily practices have affected their identities and who they are. 
Qualitative research involves an interpretive and naturalistic approach as qualitative researcher’s study things in their natural settings in an attempt to make sense of, or to interpret, phenomena in terms of the meanings people bring to them (Ospina, 2004). One advantage of the qualitative approach is that it provides flexibility to follow unexpected ideas during research and explore processes effectively (Ospina, 2004). This proved to be useful throughout the study as with each participant, new and unexpected ideas, challenges, experiences or strategies could be effectively explored to reveal unanticipated patterns amongst participants. 
In addition, the qualitative approach allows for sensitivity to contextual factors while still providing an opportunity to study symbolic dimensions and social meaning (Ospina, 2004). Throughout the study, sensitivity to the reality of each participant was essential while still ensuring that the social meaning and experience of each participant was uncovered, thus, making the qualitative research approach advantageous. 
Ultimately, the qualitative approach was most valuable in discovering the multidimensional views and unique experiences of each participant to best develop empirically supported new ideas and theories based on the responsibilities of female heads of households who are sex workers in Johannesburg.
3.3. SAMPLING 
For this study, purposive sampling which is a non-probability sampling technique was utilised. A core characteristic of non-probability sampling techniques is that samples are selected based on the subjective judgement of the researcher, rather than random selection (Lund Research Ltd, 2012). Purposive sampling was relevant for this study as it included selecting a sample based on the already available knowledge of the population’s characteristics (age, gender and locality) (Babbie & Mouton, 2001). A sample size of ten (10) participants was utilised for this study. The criteria for the selection of participants for this study included female sex workers who are economically supporting at least one other person, older than the age of 18, who have been in sex work for more than one year and reside in Johannesburg at the time of the interviews. 
A partnership was formed between the researcher and Esselen Clinic[footnoteRef:1] through the assistance of the WRHI[footnoteRef:2]. In order to form this partnership, the researcher was required to submit the research proposal to the ethics committee within WRHI and complete their suggested corrections, as well as meet with key role players within WRHI to provide a detailed explanation of the intended study before the researcher was given sanction to proceed with the study at Esselen clinic.  [1: Esselen Clinic-  a government/public organisation and a primary health care facility providing HIV, AIDS and TB-related treatment, care and support services. ]  [2:  WRHI- Wits Reproductive Health and HIV Institute- a leading African research institute focusing on sexual and reproductive health, HIV and vaccine preventable diseases.] 

Participants were identified by staff at Esselen street clinic in Hillbrow which runs a sex workers programme. Many sex workers who work and reside in Johannesburg attend the clinic in the morning for treatment as well as to attend programmes being run by the clinic. Thus, participants could be easily obtained through this programme. Each participant was screened by a nurse at the clinic who is familiar with many of the sex workers who receive treatment from the clinic. Thereafter, they were referred to take part in the study. Each participant received R50 to cover transportation costs as stipulated in the participant information sheet. 
3.4. INSTRUMENTATION (USE OF AN INTERVIEW GUIDE)
An interview guide acts as a guide-line to direct interviews into answering the aim, research questions and objectives of the study (Farooq, 2013). An interview guide with 9 questions, aimed at obtaining the necessary information which meets the objectives of the study was utilised (appendix C). The interview guide proved to be useful in ensuring that all the main points were addressed. Despite a set of probes which were used in order to encourage the participants to provide more detail in their responses, and to do so in their own words, the interview guide was beneficial for those participants who did not provide detailed responses. 
3.4.1. Pre-testing
A pre-test was conducted prior to the actual interviews with participants for the study. Pre-testing of a particular research instrument, such as an interview guide involves conducting interviews with participants fitting the criteria of the study before the actual data collection in order to test if the interview schedule contains relevant questions to answer the aims, objectives and research questions of the study (van Teijlingen & Hundley, 2001). For this study, pre-test interviews took place with two (2) individuals who met the required criteria. It was explained to each participant that the interview was for pre-testing purposes and they each gave permission to continue by signing the consent form to participate as well as the consent form requesting permission to audio-tape. Pretesting is a method of checking that questions within the interview guide work as intended and are under-stood by participants and reduces sampling error (Hilton, 2015). From these interviews, I was able to deduce which questions prompted more detailed responses. For those questions which were not open-ended, I was able to develop a series of probes and alternative questions which would encourage the participant to provide more information on their unique experiences. The pre-testing process allowed me to become comfortable in understanding the researcher-participant relationship and reduced my anxieties in terms of my expectations for the interviews. Initially I had expected a lack of participation from participants. The pre-tests were useful in that they allowed me to discover otherwise. 
3.4.2. Semi-structured Interviews 
Individual face-to-face semi-structured interviews were conducted with participants. The duration of each interview differed. The majority of interviews were between thirty and forty minutes. Two interviews were less than 15 minutes due to a language barrier between the researcher and the participant. These interviews were challenging and emphasised the importance of being able to communicate when conducting face-to-face interviews. It may have been beneficial to include that participants should be able to speak English relatively well in the criterion as this would have ensured rich content within interviews. One interview, unfortunately, had to be disregarded as the participant was unable to provide any personal experiences due to the language barrier, however, in the other interview, despite the language barrier, some relevant information was obtained through extensive probing which was utilised for the completion of the study. 
 The open-ended nature of semi-structured interviews defines the topic under investigation but provides opportunities for both interviewer and interviewee to discuss some topics in more detail. If the interviewee has difficulty answering a question or provides only a brief response, the interviewer can use cues or prompts to encourage the interviewee to consider the question further (Mathers, Fox & Hunn, 2002). With the use of probes and prompts, I was able to gain more detailed responses from participants and more understanding where answers were vague, thus, making semi-structured interviews favourable. 
Furthermore, semi-structured interviews not only assisted the researcher to gain detailed responses, but also allowed participants to respond with emotion when providing details of their experiences, realities and feelings. This was most beneficial for participants as it allowed them to cry when sharing their experiences and burdens as the provider for the family. Interviews took place at Esselen clinic. On warmer days, they would take place outside, however, on colder days a nurse’s office was provided. 
3.4.3. My experiences with the interviews
The conduct of interviews is not without difficulties and requires researcher acumen as the interview is commonly concerned with linking events and meanings during the construction of a social reality and involves description and understanding of actual human interactions, meanings and processes (Ryan & Dundon, 2008). It is, therefore, important that the interviewer understands the nature of the situation and the inter-personal relationships. 
Establishing rapport is recognized as particularly important as it involves the exchange of meaningful dialogue that captures how respondents interpret their social world (Ryan & Dundon, 2008). With the majority of the respondents, I was able to establish rapport with the participant. In most cases we engaged in casual dialogue which informed the participant that I was not here to judge her but rather to understand her experiences. This allowed a more comfortable environment to form. For those interviews in which rapport was established, participants were able to speak more freely about their experiences and the challenges which they face. Two participants were able to cry in the interview as a result of a comforting and safe environment. In those interviews, participants were given the opportunity to cry freely and were comforted by the researcher. 
One of the biggest challenges was the language barrier. Specifically, this language barrier was present in interviews with two participants from Zimbabwe who hardly spoke English. For those participants who spoke English poorly, establishing rapport became challenging, thus, resulting in a less comfortable environment and poor data collection. One of these interviews will be discarded as the participants English was not sufficient to gain useful data. South Africa is one of the most diverse nations in the world, thus, one needs to be cognizant that we live in a diverse society and that people are from diverse backgrounds (Faranani Facilitation Services Pty Ltd, 2013). Taking into account my own background as a white South African, I attempted to become fully engaged in the dialect of each participant. For two participants who are not foreign nationals, I found that I was able to understand some vernacular words which they used interchangeably throughout the interviews which I found enriched the content of the interviews. I would take it upon myself to ensure that I asked participants when I did not understand a specific word such as ‘Magosha’. I learned that this is a slang word used to describe sex workers. 
Initially, I had planned to do two interviews a day for five days, thus completing ten interviews in one working week. However, on the first day of interviews, without my knowledge, four participants quickly agreed to participate. While I was busy with interviews, the nurse came to ask if I could interview another three participants that day. I declined and asked her to request that they come the following day as I found the interviews to be quite tiresome.  The final interview on day one proved to be emotionally trying as the participant disclosed many distressing points all at once and began to cry early on in the interview. I quickly realised that she was intoxicated after she disclosed her addiction to nyaope[footnoteRef:3] and was falling asleep in the interview. I found her experiences to be quite distressing which led me to become emotional once she left. I reflected on each interview the same day and allowed myself to reflect on my own thoughts and feelings regarding each interview, which I found useful. I completed all ten interviews within three days. Reflection aims at understanding the forms of intelligibility by which the world is made meaningful; in the heuristic context of the research work, reflecting means to elucidate the epistemic acts developed in the midst of inquiry process (Mortari, 2015). Reflection was, thus, essential in ensuring that the researcher is placed as the subject of his/her own experience throughout the research process.  [3:  Nyaope- a street drug that has come into widespread use in South Africa since 2010. The substance is often described as a cocktail of various ingredients, and these may vary, but the principal active ingredient of the drug is heroin, often smoked with cannabis.] 

3.5. RESEARCHERS CHARACTERISTICS
When being reflexive, researchers should not try to simply ignore or avoid their own biases; instead, reflexivity requires researchers to reflect upon and clearly articulate their position and subjectivities (world view, perspectives, biases), so that readers can better understand the filters through which questions were asked, data were gathered and analyzed, and findings were reported (Sutton & Austin, 2015). I found that throughout the research I found myself having to reflect on my own feelings of guilt, especially considering that one participant is divorced, a mother and sex worker, while she is the same age as myself. It was challenging to try and relate to her experiences, despite the similarity in age as every aspect of her life differed to my own. This is perhaps why feelings of guilt emerged, the differences between a white South African female, and a black Zimbabwean female were vast. 
This emphasised how the educational and economic systems in which female’s function in Africa deeply affect the lives which women lead. It became inherently plain that women are deeply rooted in the physical and social context in which they function. Ultimately, the external systems of women deeply affect the choices which women make. 
3.6. RESEARCH SITE 
 3.6.1. Contextualising Johannesburg 
The physical context of an individual is not merely an interchangeable backdrop for human life, but is part of life (Cook, 2015). The term place identity is used to reflect the psychological significance a place can have in an individual’s life to a point of becoming the individual’s overall sense of self (Cook, 2015). An awareness of the physical environment is, thus, essential in understanding how an individual is identified and affected by that environment and how that individual has come to function in that particular environment. It was, therefore, essential to ensure that I understood the physical and social environment of Johannesburg and how it affects female sex workers who are heads of households. 
Johannesburg was altered economically, politically, demographically and socially as a city, following the discovery of payable gold on the Witwatersrand in 1886 (Cripps, 2012). Johannesburg’s growth from a mining camp to the largest city in southern Africa in its first decade created a market for commercial agriculture, the need for an effective transport network, and moved the South African centre of gravity from the coast to the interior with its most salient features remaining rooted in this permanent growth, the racial and cultural diversity of its new population and the extremes of both wealth and poverty (Cripps, 2012). Today, Johannesburg continues to attract many foreign nationals, thus, migrants constitute a relatively significant and sustained part of the population of Gauteng, and Johannesburg (Peberdy, Crush & Msibi, 2004). 
The City of Johannesburg continues to fight high unemployment, which is one of the major problems facing South Africa as a whole. Overall, the City’s unemployment in the third quarter of 2016 was 28.2% by a narrow definition whereas if the expanded definition is taken into account, unemployment in the City rises to approximately 40% (StatsSA, 2016). Johannesburg has had the highest level of inequality relative to other regions with the Gini coefficient, a measurement of income inequality in Johannesburg at 0.65 which has been traced to four factors: the region is regarded as the economic engine of the country and, thus, attracts people from different classes - people who have high education levels, unskilled or uneducated persons seeking low income jobs, as well as students who normally work part-time jobs for sustenance during their years of studying, a shift in earnings from labour to capital income, the rapid growth of the services sector with a consequent explosion in demand for skilled workers which cannot be met; and a drop in the rate of labour absorption during the democratic period (City of Johannesburg’s Socio-economic Development Status, 2016). It is estimated that there are between 121 000 and 167 000 sex workers in South Africa, with the majority being black South African women and a significant percentage from Zimbabwe (SWEAT, 2013). It seems that the majority of sex workers reside and work in Gauteng as it is estimated that 29 733 sex workers are currently operating in Gauteng (Alfreds, 2017). It is believed that sex workers in Gauteng can be mostly found in areas such as Randburg, Rosebank, Illovo, Sandton, Hyde Park and Rivonia (SWEAT, 2013). It is clear that sex workers in Johannesburg still find it challenging to access readily available resources, especially those pertaining to health as they are often still faced with discrimination and are often taken advantage of (SWEAT, 2013). 
The study was conducted at Esselen street clinic in Hillbrow. Hillbrow was a bustling middle-class neighborhood until the end of apartheid rule when it began to transform similar to many 20th-century American inner cities. Hillbrow’s white middle class fled to the suburbs, making way for poor black South Africans (who were previously barred from living in places like Hillbrow) and immigrants from across the continent. The population soared and crime grew rampant (Mason, 2011). Esselen clinic, located on Esselen Street in Hillbrow is a government/public organisation and is a primary health care facility providing HIV, AIDS and TB-related treatment, care and support services (info4africa, 2014). 
Before arriving in Hillbrow, I was told that I should be careful as I was a white female entering a predominantly ‘black’ area and as a result, was likely to be a victim of crime. I held a similar idea as I was hijacked just outside of Hillbrow in 2016. I was warned about the type of people who reside in the area as the area is considered to be crawling with thieves, murderers, sex workers, drug addicts and the like. As a result, I became quite nervous going into this area. I decided not to drive and opted instead, to travel each day to Hillbrow with an Uber. Each time I travelled with an Uber[footnoteRef:4], with a driver who I found regularly resided in Hillbrow himself, I found him to be friendly which often resulted in a good conversation. Almost all the trips resulted in a request for my number. One driver said that he would like my number as he would like to marry a white woman, and another opted to request that I join him for breakfast. I found that they did not see me as anyone other than a woman, despite being a white woman. This calmed a lot of my fears regarding entering Hillbrow which resulted in my questioning of the prevalent ideation of the ‘type’ of people who reside in Hillbrow. This forced me to reanalyse the context within which my participants function as human development is typically most influenced by those human life contexts closest to our everyday life, called proximal contexts (Cook, 2015).  [4:  Uber Technologies Inc. is a global transportation technology company operating in 633 cities worldwide. It develops, markets and operates the Uber car transportation and food delivery mobile apps. ] 

3.6.2. Perceptions about Sex Workers at Esselen Clinic
In many societies, stigma is an important obstacle that affects access to health resources for groups vulnerable to HIV, such as female sex workers (Rael, 2015). Considering the extent of stigma which female sex workers experience on a daily basis, I was curious to see how health care practitioners at the clinic interacted with the sex workers. I found that staff were friendly and helpful in their interaction with each of their patients. The head nurse, although seemingly busy and running around in a rush most of the time, always seemed to engage in an inviting and friendly manner with the sex workers. In one instance, I observed her comforting a sex worker who was not sure whether she wanted to participate in the study due to a fear of a lack of confidentiality, her response was “my baby, she is just going to ask you a few questions, you can see there is no camera here to see your face” (Rodrigues, field notes, October, 2017). 
The peer counsellors were often milling about, each of them bubblier than the next, debating whose supply box for distribution of condoms belonged to who.  I found it refreshing that they were discussing sex related topics with such ease and without fear of the topic which is normally influenced by stigma. This seemed to create a sense of ease within the clinic as it contributed to a safe and stigma free environment. 
3.7. DATA ANALYSIS 
Thematic analysis was utilised to analyse the data from the interviews. Thematic analysis is a comprehensive process where researchers are able to identify numerous cross-references between the data and the research’s evolving themes by providing flexibility for approaching research patterns (Alhojailan, 2012). Thus, each interview was carefully read and recurring themes were identified, whether they were similar or challenged previous themes.
Thematic analysis is appropriate for analysing the data when the research’s aim is to extract information to determine the relationship between variables and to compare different sets of evidence that pertain to different situations in the same study (Alhojailan, 2012). I found that it was easy to identify themes as each participant made a reference to each theme which allowed me to easily identify the differences and similarities amongst the participant’s challenges and experiences. This was done by transcribing each interview, reading and rereading the interviews several times while highlighting significant points which were both similar and different in each interview. Notes were made on the emerging categories. From the broader categories, more specific themes were identified which sufficiently described the data. This was done to ensure that the diverse and rich experiences of participants were appropriately presented in a way which would truly reflect their realities and how they have adopted strategies to cope with these challenges. 
3.8. ETHICAL CONSIDERATIONS 
3.8.1. Voluntary Participation
Voluntary participation requires that people not be coerced into participating in research (Trochim, 2006). Each participant volunteered to participate in the research of her own accord and was not coerced to do so. Once participants had volunteered, they were given consent forms to sign which clearly explained that they had agreed to participate in the study of their own free will and confirmed that they were not coerced into participating in the study in any way (Appendix B). 
They were also provided with a participant information sheet which informed that they would receive R50 for transportation costs and that they were allowed to withdraw from the study at any time without any consequences (Appendix A). 
3.8.2. Informed consent 
Informed Consent is a voluntary agreement to participate in research and is not merely a form that is signed but is a process, in which the participant has an understanding of the research and its risks (Shahnazarian et al, 2009). Each participant was given a participant information sheet which clearly outlined the credibility of the researcher, the aim of the study, the transportation cost, the expected procedures and their duration, as well as the necessary contact details. The content of the participant information sheet, as well as the consent forms were clearly explained to participants by the researcher before the interview commenced. They were given the opportunity to obtain clarity if needed and to ask any questions (Appendix A). 
3.8.3. Doing no harm
Social research investigations often involve a consideration of issues, data and perspectives that may impact on the feelings, views, attitudes and values held by people involved in the research process, thus, there is a need to be clear about the psychological safety of people involved (McCosker, Barnard & Gerber, 2001). I recognised that participants psychological safety needed to be upheld, thus, participants were informed and it was stipulated in the participant information sheet that should they feel the need to address any trauma or disturbance inflicted by the interview, I would connect them to a registered counselling psychologist based at the University of the Witwatersrand. For those participants who became emotional during the interview, it was strongly recommended by the researcher that they utilize this service as it may have assisted them in reflecting on these emotions in a deeper and more meaningful manner, however, no participants have come forward requesting to receive this service. 
3.8.4. Confidentiality and anonymity  
All participants were assured of confidentiality, specifically that what has been discussed will not be repeated, or at least, not without the participants permission (Wiles, Crow, Heath & Charles, 2006). Each participant was made aware prior to their agreement to participate in the study that the research report will be produced with the possibility of being published and would be available at the University of the Witwatersrand.  Furthermore, participants were assured that they would be given pseudonyms and that their identities would be kept strictly confidential. 
3.9. CONCLUSION 
This chapter highlighted the methodological processes that took place throughout the study. Qualitative research was evaluated in terms of how the researcher impacted the data collected and, in turn, how the study has affected the researcher thus far. It became clear that reflexivity when conducting qualitative research is essential. Special focus was given to ethical considerations and how they were applied within the research. 























CHAPTER FOUR
FINDINGS AND THE DISCUSSION
4.1. INTRODUCTION
With the criminalisation of the sex work industry in South Africa, female sex workers who function within this criminalised context, face several hardships on a daily basis. For female sex workers who fulfil the traditionally male role of head of household and breadwinner for the family, these challenges may be more severe. With the added burden of ensuring the economic survival of the family structure in a context in which the economy is deteriorating, female sex workers not only face economic and physical challenges, but psycho-social challenges as well. This chapter not only places focus on the challenges faced by female sex workers who are heads of households, but on the survival strategies adopted to ensure the economic and social endurance of their families. With the use of thematic analysis from the data gathered from the interviews with participants, four sub-themes were identified. These themes include: female headed households and the loss of the male head in which the perceptions of females who have taken on the ‘male’ role as the head of the household are explored within a socio-cultural context as well as the responsibilities which female heads of households need to fulfil while assuming the breadwinner role. The subsequent sub-theme looks at the factors which lead to sex work as the choice of work and takes into consideration how a weakening economy and a lack of jobs has influenced the decision made to enter the sex work industry. This theme in essence, highlights how factors such as domestic violence and a lack of education have affected the decision made by female sex workers to enter the sex work industry as a means of financially supporting the family. Factors such as the dire economic state of Zimbabwe are also considered for those sex workers who were forced to leave Zimbabwe in the hopes of finding employment in South Africa. The third sub-theme places focus on the challenges experienced by female sex workers with their work in terms of violence, health challenges, emotional trauma and financial exclusion. This leads to the final sub-theme which looks at the survival strategies employed by female sex workers to overcome daily challenges of their work. This includes strategies for violence, health care and emotional trauma. This theme reveals that survival strategies for female sex workers who are heads of households are necessary for the dynamic and extensive challenges faced in the sex work industry. 
    4.2. FEMALE HEADED HOUSEHOLDS AND THE LOSS OF THE MALE HEAD
Single mothers are stereotypically described as deviant, with married mothers perceived as the “standard” against which other mothers, such as, never married, widowed, or divorced mothers are rated, thus, many single mothers are challenged psychosocially in comparison to their married counterparts and are at a greater socioeconomic disadvantage in the society within which they function (Roman, 2011). All participants who took part in the study were single mothers. Thus, many of the participants themselves were seen to be deviant mothers, not only for being single mothers, but also for the way in which they financially supported their children. 
Furthermore, the expression ‘female headed household’ in the South African context has come to mean that households can only be headed by a woman if there are no men present within the household, thereby preserving a sexist and hierarchical notion that men should head the household if they are present, and that women should defer to that social order (Wright et al, 2013). This was a reality of many participants in this study, as most of them alluded to the fact that they had become heads of households because the male household heads were no longer taking on the responsibility of providing for their families. 
This was echoed by Sarah, who was a thirty-two (32) year old sex worker from the slums of Durban. Sarah was supporting her grandmother, her young brother and her son. Her family was residing in Durban while she was staying in a shelter in Johannesburg after being homeless for an estimated period of four months. Her child’s father was incarcerated at the time of the interview. She said: 
“Since he [the father of her child] is the one who was supporting us, now it’s me who must find the bread for those guys in the house, you understand?” (Interview, Sarah, 09 October 2017). 
According to Sarah, the responsibility of providing for her family had fallen on her since the male provider could no longer take on the role because of incarceration. Sarah was however, struggling to come to terms with this reality because she was raised with the notion that it is a man’s role to provide for the family. She was thus not coping as she was not emotionally, psychologically and economically equipped to be a household head. But as a single mother and an older sister, she felt compelled to take on the role. 
Lerato, a thirty-eight (38) year old sex worker from Zimbabwe supporting her two children, her mother and three of her siblings recalled a similar experience. She was a social work student but was forced to put her studies on hold as she was unable to financially support her family while financing her studies. She recollected: 
“I was supposed to go to college to do a teaching diploma for primary school, but I was taking care of my kids because when we separated, the father of my kids didn’t want anything to do with the kids. Financially, it was me. I was the only one” (interview Lerato, 09 October 2017). 
It became clear that for these participants, becoming a head of household was associated with the loss of a male head. Thus, despite common preconceptions of the role of a woman as the nurturer and caregiver, and the man as the breadwinner and provider, for these women, the role of breadwinner and provider had fallen to the female. It became necessary for the women who could no longer rely on a male head to financially sustain the family. 
Worldwide, female headed households are perceived as vulnerable as it has been found to be directly related to some of the major economic and policy issues confronting developing countries (Rajaram, 2009) Without the male head, each participant had come to face financial struggles as the burden to ensure the financial survival of the family structure had been placed on their shoulders. This may be seen from Kate, a thirty-year (30) old sex worker from Zimbabwe who, after divorcing her husband, was given custody of one child while her husband was given custody of the other. Kate came to Johannesburg in search of employment to support her child who stayed with her parents in Zimbabwe. Kate is able to do so through sex work:
“I got married, I had problems with my husband so our marriage didn’t work out. So, I had no other jobs to do, that’s when my friend told me about this job in South Africa. Then I came here and start working, up to now, that’s what I’m doing” (interview Kate, 10 October 2017). 
Gugulethu was a thirty-one (31) year old sex worker originally from Durban. She was residing in Johannesburg after her spouse was murdered and she had witnessed the murder. She financially supported her son who resided in Durban with her mother. Gugulethu had also become a head of household because of the loss of a male head. This is what she said: 
“Because one of my friends told me, because one of those boys who killed my child father, they wanted me also because they knew that I know everything, I will tell the police… He got no father, I’m the one who must support” (interview Gugulethu, 11 October 2017). 
Without the financial support of a male counterpart, the women were compelled to take on the role of being a household head and became sex workers in order to make this happen. 
Despite being a sex worker, which is often marred by stigma and shame, Gugulethu alluded to the dignity which she felt in being able to financially support her child:
“I’m proud. I don’t care what people said. You talk, you talk for your side. Me, I know what I’m doing” (interview Gugulethu, 11 October 2017). 
Thus, regardless of the stigma which surrounds sex work, it could be seen that Gugulethu felt a sense of pride and dignity in being able to support her child, regardless of it being through sex work. 
 However, this sense of pride was not felt by all participants. Despite being able to support those dependent on them, some participants felt a deep sense of shame and humility in the way that they supported their families. This was emphasised by Sarah who communicated that although she had become a sex worker to support her family, she did not wish for her young brother to find out the kind of work that she was doing to support them due to the shame and stigma of being a sex worker:
“Even my brother, this year he is doing matric, so, I think it will disturb him, he will feel sad and hurt from me, because he will be knowing ‘I’m taking this money to my sister and my sister had to sleep with a fucking stranger so that she can give me this money.’ So, no, I don’t want to disturb his studies, he must just know, until he go to college, and choose whatever he wants to do, when he’s working here, maybe the truth can come out, I was doing this, I’m sorry, it was the best for you…I just wish he can understand what I’m doing, is only the best, not that I like thing or what. I just want the best for them” (interview Sarah, 09 October 2017). 
Notwithstanding Sarah’s own understanding of the role she plays in her family and her reasoning for being a sex worker, she felt that sex work is a ‘dirty’ industry which has disgraced her as a woman. In her opinion, her family could feel proud of how she earns a living if she was cleaning floors, however, there was a deep sense of shame in being a sex worker. She made this plain in this way:
“I hate myself. Sometimes I feel I’m giving my family dirty money. Plus, if I got that money by cleaning this floor, maybe I was going to be proud” (interview Sarah, 09 October 2017). 
This shame was accentuated by Samantha, a widowed forty-year (40) old sex worker from Zimbabwe, supporting her three children, her granddaughter and her mother. Samantha came to Johannesburg five years after her husband had passed away as she could no longer provide for her family. Samantha became emotional when asked why she refuses to tell her family that she is a sex worker: 
“It’s embarrassing. This is not a job…no, I don’t want to tell them” (interview Samantha, 11 October 2017). 
According to scholars, there are specific social and cultural influences that shape the process of stigmatising in a given context (Balfour & Allen, 2014). The stigmatisation of female sex workers still stems from the deeply rooted notions of how women are expected to behave in any given social context (Wong, Holroyd, & Bingham, 2011). When a woman displays behaviour which deviates from those notions and expected behaviours, such as having sex with multiple strangers, asking for money in exchange for sex and specifically, a woman taking the sexual initiative and controlling the sexual encounter, they are severely stigmatised. (Wong, Holroyd, & Bingham, 2011). Despite the stigma of being a woman who is surrounded by sexual connotations in a context with traditionally held norms for a black female, it became clear that this sense of shame stemmed from cultural beliefs which informed the participants’ knowledge that sex work is seen as a betrayal. With tears streaming down her face, Sarah revealed that she was betraying her culture by being a sex worker: 
“Since our culture, at home, we have this belief that you don’t give your body to a stranger and for an exchange of something, gold or silver. So, you see, I feel I am betraying my God. I am betraying everything. This job makes me to feel so, so dirty. But cleaning would be better because I won’t be giving my body. I won’t be like doing the thing that I grew up with, that I don’t give my body to just anyone. Whatever I must get, I must work hard for each and every slice of bread. I mustn’t steal, I mustn’t lie, I mustn’t cheat. But here I am doing all these things, I am betraying…” (interview Sarah, 09 October 2017). 
A study conducted within the Shona culture in Zimbabwe by Kambarami (2006) has shown that femininity, sexuality and culture are intricately interwoven, so much so that often attempts to separate them have been ineffective as culture and gender inequality within the Shona culture have stripped women of any form of control over their sexuality. Often this is due to the customs which prevail and remain dominant in cultures across Africa (Kambarami, 2006). Culture has also been largely incorporated into religion which increases the effect of cultural beliefs and practices within African society (Kambarami, 2006). This often allows religious institutions in deeply cultural and religious societies to continually discriminate against female sex workers and often refuse to offer them assistance of any kind, while repeatedly antagonising the manner in which they financially provide for themselves and their families. 
4.2.1. The breadwinner role and responsibilities of female sex workers.
Financial crisis remains strife within female headed households as often the financial burden falls on them to ensure that the basic needs of their children are met (Kotwal & Prabhakar, 2009). From the data gathered from the interviews, it cannot be denied that sex work gave the participants an opportunity to ensure the survival of their families. This is because financially providing for the family was a role closely linked with being heads of households.  Lerato emphasised how she was often forced to go to work to ensure that her children were fed: 
“But even with the kids, if they have a problem, they send me messages non-stop if I take long to send money. Then I tell them it’s tough this side because before, they know, before I used to buy groceries, they didn’t even have to demand. But now they keep sending me messages. You know kids will be kids, even if it’s tough they just remind you that they hungry, ‘I don’t have food to carry to school and I have to concentrate on my books, I can’t concentrate when I’m hungry’. But I try by all possible means when I have...You tell them ‘guys I’m not feeling well’. But still they want to eat also, they still expect you to send something” (interview Lerato, 09 October 2017). 
Casas (2009) conducted a study with Latin American sex workers which found that as the breadwinner in a transnational household, there is a pressure on the immigrant woman not only to ensure the families basic survival, but also to satisfy her family's consumer aspirations. For many of the participants from Zimbabwe, this seemed to be the case. It was clear that for some of the participants, the responsibility as the head of the household and the breadwinner acted as a tremendous burden as their families relied heavily on the income which they produced as sex workers. Debra was from Zimbabwe and had come to reside in Johannesburg after she divorced her husband in order to support her child and her parents who were still in Zimbabwe. Without her income, there were some detrimental effects on her family:
“They will struggle with my baby’s transport money and sometimes food” (interview Debra, 09 October 2017). 
A similar account was given by Kamogelo who was a twenty-eight (28) year old woman from Zimbabwe who had come to South Africa to find work to support her mother and child. She had been in the sex work industry for five years and mentioned that without the income she provided, her family was unable to survive:
“They not survive. Must put money every month” (interview Kamogelo, 10 October 2017). 
Many of the participants entered the sex work industry to financially support themselves and their families in order to fulfil their responsibilities as heads of households. The pressure was more pronounced for those women who were single mothers. Lerato highlighted this point: 
“They are paying school fees for the kids, they are providing a lot of things so it’s too much. Ladies, they are being put in a corner. It’s not like they want to do sex work” (interview Lerato, 09 October 2017).
Nearly one in four households in Africa are headed by a woman (Van de Walle, 2015). With an increase in female headed households, it has become essential for women who are heads of households to take on certain roles and responsibilities, often expected by a male head in traditional African societies to ensure that the family is financially catered for.  It was found that the majority of the participants decided to enter the sex work industry to avoid the poverty of their family and to further ensure that the family are able to function within their current socio-economic contexts without a male head. 
Although there was financial support offered by the sex work industry to the women, there was financial instability due to the degradation of the sex work industry. An interesting point made by many of the participants is that the sex work industry in South Africa has diminished in recent years. It was highlighted that the majority of female sex workers clients in Johannesburg are foreign nationals and that less locals are able to afford the services of a sex worker at the going rate of R50 for one round or five minutes. Lerato emphasised this point:
“When we started we used to make lots of money but now-a-days it’s tough, it’s very tough…it’s because there are too many of us in the industry. The customers are also complaining that financially South Africa is going down. If you compare five years ago and now, it’s totally different. They can’t really afford to enjoy the ladies because they are still earning the same salary that they were earning five years ago. So, they have to get their priorities right and put their families first. Because most of our clients are also foreign nationals so it’s also tough for them as well. They are also sending money back home. Most guys are from Lesotho, from Zimbabwe and a few from Nigeria… we do have locals but they are few. Like where I am staying there are a lot of Pedi’s in Thembisa. But they are few. Even Zulus because there is a taxi rank opposite so when the taxi drivers park their taxi’s they also come and do business. They pay R40. So, it’s tough” (interview Lerato, 09 October 2017). 
This was somewhat echoed by Tshepiso, a twenty-two (22) year old single mother from Zimbabwe who came to South Africa when she left her abusive husband. Her child lived with her parents in Zimbabwe. She emphasised that sometimes clients who were pleased with the service will leave more money, however, there are less clients and less money in the sex work industry:
“You know sometimes you can tell a person give me this money and you’ll find that person gives you more than that. Even if it’s a short time, and you tell him R100, but he was happy so maybe he’ll give you R150… But some of them are stingy, they’ll even say that R100 is too much…Sometimes, these days we are going, 15, 16, 17 [Clients]. There’s no money these days” (interview Tshepiso, 09 October 2017). 
The degradation of the sex work industry was emphasised by Kate when asked how much money she makes on average in a month:
“It just depends. Like now, the job is going down. Sometimes, it’s talk of a minimum of R5000. It depends on the month but the job is going down” (interview Kate, 10 October 2017). 
Recent decades have seen a sharp growth in the international sex industry which is attributable to the general phenomenon of globalisation, which has led to a rise not only in female migration but also in sex tourism (Casas, 2009). From the accounts given by participants, it seems as though the sex work industry has faced an economic downfall in recent years. This may be due to an increase in sex workers as the unemployment rate in South Africa hikes with 433 000 job seekers in South Africa in the first quarter of 2017 (Stats SA, 2017). With the degradation of the sex work industry, sex workers like Gugulethu were forced to find other means of income for those months where they were unable to make enough money from sex work to ensure that their families have enough money to survive the month. This was Gugulethu’s account on the amount of money she sent home on average in a month:
“Maybe, R800, R900. Sometimes I don’t get clients. Maybe for the whole month, you don’t get clients… I sometimes do piece jobs. Doing washing. Sometimes I clean somebody’s rooms. They pay me” (interview Gugulethu, 11 October 2017). 
Similarly, Samantha echoed that when she was ill and could not work for a period of three to four weeks, not only did it affect her as she had to borrow money for her own survival, but it also negatively affected her family who had to make other means of financial income to survive: 
“It affect a lot. It affect a lot. They end up have to borrow some money until I started working again” (interview Samantha, 11 October 2017). 
On the contrary, some of the sex workers in this study seemed to have some support in those cases where they were unable to work. In those months when they were unable to send enough money home, their boyfriends, siblings, parents or other significant individuals assisted them in supporting their children. This was the case for Kate who expressed that although she tries to send money or material goods each month for her children, if she has a bad month and is unable to do so, her parents will often help her in financially supporting her children: 
“My parents, if I tell them I am having problems, they understand. They are not that people that pressurise me, that ‘we are taking of your child you must do something!’ no, if I tell them I am not okay, they understand” (interview Kate, 10 October 2017).  
Tafadzwa, a twenty-seven (27) year old sex worker from Zimbabwe who supports her set of twins and one of her brothers who is unemployed and who was raised by her oldest sister after both her parents had passed away by the time she was five years old, had a similar experience in which she conveyed that her boyfriend assisted her and her family financially for three to four months when she was unwell and unable to work and generate an income for her family. She expressed that he would send her family money and ensure that she had food every day: 
“My boyfriend. Always. He used to come there and give me money for food. Almost every day (interview Tafadzwa, 09 October 2017). 
Although Tafadzwa’s boyfriend would assist in those months when she could not work, this did not mean that she was relieved of her duty and responsibility as a household head to provide for her family. This was only a temporary relief for those months when she could not provide. 
4.3. FACTORS LEADING TO SEX WORK AS THE CHOICE OF WORK
Many people who engage in sex work are subject to high levels of social exclusion in the form of being denied rights of employment, health care, secure housing and a decent standard of living as a result of impoverishment, discrimination and lack of adequate public services (Balfour & Allen, 2014). Due to the high levels of social exclusion experienced by women in traditionally biased societies, many women often turn to the sex work industry as a means of financially supporting both herself and her family alike.  
4.3.1. Weakening of the economy and lack of jobs
Brents and Sanders (2010) claim that with fewer well-paid jobs available and an ever-increasing cost of living, in particular, for single mothers and women who are often marginalised from the mainstream employment structure, the financial drive to engage in sex work is very strong. This study found that there were participants who had opted for sex work because of the weak economy where the salary offered for other jobs was not sufficient to financially sustain the family. This was stated by Tshepiso who initially came to South Africa in search of a job as a hair stylist. However, after realising that the salary working as a hair stylist could not sustain her and her child, she decided to opt for sex work as an alternative: 
“You know in salons, when you are working, you find that I am a professional hair dresser, and I was new in Joburg, I didn’t know places. The first salon I went to, they were giving me R2200. And that was small money for accommodation, my child at home. So, it was small. Then I started going to work, getting paid, so I just decided to quit and go full time” (interview, Tshepiso, 09 October 2017).
Tshepiso felt that she was making more money as a sex worker than as a hair stylist, and thus opted for sex work in order to meet her needs and those of her child. 
Regardless of the general desire amongst participants to obtain alternative work other than sex work, some participants stated that they would only do so if they were offered the right salary. This was made clear by Samantha who said that she would like to have another job, however, she would not accept one with a salary of less than R5000 a month:
“Hey, R3000 that’s too little. Maybe start at R5000 going up, it’s better” (interview, Samantha, 11 October 2017).
Sex workers often overwhelmingly indicate that they would like another occupation, particularly in very poor countries (Overs, 2014). Thus, it may be seen that while many women who are sex workers would like to work in an alternative occupation, financial factors have largely affected the choice which women have made to become sex workers as sex work has offered a more significant income in contrast to other menial jobs. 
 4.3.2. Domestic Violence 
The most common form of violence experienced by women globally is physical violence inflicted by an intimate partner, with women beaten, coerced into sex or otherwise abused (UN, 2011). For Tshepiso violence from her husband is one of the main contributing factors of how she came to be a sex worker. She recalls:
“I’m not strong, like seeing my husband cheating, even if I tell myself I can have boyfriend, I can have men, but the only thing I want is respect. If you respect me and you do your thing, if I ask you, if you see you’re wrong just apologise, not like when I ask you, you want to beat me. You beating me like why I ask you… that time I was not twenty-two, I was younger than that. I was around nineteen, twenty. He was dating a lady with four kids. Among those four, none of them were younger than the child. All of them, they were older than the child. The other thing, the lady was older than me, her kids they were older than my child, she was married. You see. She was cheating with a married man also. If I ask, I will get a beating” (interview, Tshepiso, 09 October 2017).
Many women in South Africa experience economic abuse which involves preventing a victim from resource acquisition, limi