Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: A cross-sectional analysis

OBJECTIVES:

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.

METHODS:

In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.

RESULTS:

FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.

CONCLUSIONS:

Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.

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By:  Parcesepe AM¹, L'Engle KL², Martin SL³, Green S³, Suchindran C⁴, Mwarogo P⁵.

¹Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA.

²FHI 360, Durham, North Carolina, USA Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA.

³Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁴Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁵FHI 360, Nairobi, Kenya.

Sex Transm Infect. 2016 May 23. pii: sextrans-2016-052549. doi: 10.1136/sextrans-2016-052549. [Epub ahead of print]

  

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A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. 

IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). 

Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. 

The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

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By:  Wilson KS1,2, Wanje G3, Yuhas K4, Simoni JM5, Masese L6, Vander Stoep A7, Jaoko W3, Hughes JP8, Richardson BA4,8, Scott McClelland R4,7,6,3.

• 1Department of Global Health, University of Washington, Seattle, 98104, USA. ksw@uw.edu.
• 2Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.
• 3Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 4Department of Global Health, University of Washington, Seattle, 98104, USA.
• 5Department of Psychology, University of Washington, Seattle, USA.
• 6Department of Medicine, University of Washington, Seattle, USA.
• 7Department of Epidemiology, University of Washington, Seattle, USA.
• 8Department of Biostatistics, University of Washington, Seattle, USA. 
• AIDS Behav. 2016 May 3. 

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A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya

We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. 

Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner ('index partner'). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. 

Recent IPV was associated with significantly higher risk of unprotected sex after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. 

Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.

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By:  Wilson KS^1,2, Deya R³, Yuhas K³, Simoni J⁴, Vander Stoep A⁵, Shafi J^6,7, Jaoko W⁶, Hughes JP⁸, Richardson BA^3,8, McClelland RS^3,5,9,6.

Author information

¹Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA. ksw@uw.edu.

²Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.

³Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA.

⁴Department of Psychology, University of Washington, Seattle, USA.

⁵Department of Epidemiology, University of Washington, Seattle, USA.

⁶University of Nairobi, Nairobi, Kenya.

⁷Coast Province General Hospital, Mombasa, Kenya.

⁸Department of Biostatistics, University of Washington, Seattle, USA.

⁹Department of Medicine, University of Washington, Seattle, USA.

AIDS Behav. 2016 Apr 19. [Epub ahead of print]

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The Impact of an Alcohol Harm Reduction Intervention on Interpersonal Violence & Engagement in Sex Work among Female Sex Workers in Mombasa, Kenya

Highlights

• This study evaluated whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers in Mombasa, Kenya.
• The alcohol harm reduction intervention was associated with statistically significant decreases in having been robbed or not paid as agreed to by a client immediately post-intervention, verbal abuse from paying partners immediately and 6 months post-intervention and physical violence from paying partners 6 months post-intervention.
• Those assigned to the alcohol intervention had significantly lower odds of engaging in sex work immediately and 6 months post-intervention.
• Findings demonstrate the potential for brief alcohol harm reduction interventions to positively influence the health and safety of female sex workers.

Aims

To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya.

Design

Randomized controlled trial.

Setting

HIV prevention drop-in centers in Mombasa, Kenya.

Participants

818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively).

Intervention

6 session alcohol harm reduction intervention.

Comparator

6 session non-alcohol related nutrition intervention.

Measurements

In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days.

Findings

The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention.

Conclusions

The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.

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By:  Angela M. Parcesepe¹, Kelly L. L’Engle, Sandra L. Martin, Sherri Green, William Sinkele, Chirayath Suchindran, Ilene S. Speizer, Peter Mwarogo,

Affiliations

University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Gillings School of Global Public Health, CB# 7445, Rosenau Hall, Chapel Hill, NC 27599, United States

Nzioki Kingola

¹Present address: HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1501 Riverside Drive, New York, NY 10032, United States.

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Women Who Have Sex with Women in Kenya and Their Sexual and Reproductive Health

Purpose: To describe sexual and reproductive health characteristics of women who have sex with women (WSW) in Kenya's three most populous cities: Kisumu, Mombasa, and Nairobi. Although the last decade has shown an upsurge of health-related research studies in African sexual minority populations, these studies have generally concentrated on the health status of men who have sex with men to the exclusion of WSW. This study presents the first findings on Kenyan WSW's sexual and reproductive health.

Methods: A community-based, cross-sectional survey was conducted among 280 women who were at least 18 years old, had at least one female sexual partner in the past three years, and were Kenyan residents.

Results: A significant proportion of participants reported that they had at least one male sexual partner in the past three years (38.9%), ever had an abortion (13.2%), been infected with at least one sexually transmitted infection (STI) in the past three years (33.9%), and been tested for HIV at least once (88.9%). Of the women who reported having been tested for HIV, 9.4% (7.5% of the total sample) received a positive test result. Some women noted that they were open with their doctors about their sexual orientation, and that their doctors had not reacted negatively to this information.

Conclusion: WSW in Kenya are at risk for negative sexual and reproductive health outcomes, including HIV, STIs, unplanned pregnancy, and unsafe abortion, positioning these women as a critical population for public health efforts. Some WSW actively exercise their agency in making important health decisions. Therefore, this study indicates a need to incorporate WSW's health concerns within Kenyan national health policy programming.

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By:   Sidra S. Zaidi, MA,^1,2 Akinyi M. Ocholla, MA,³ Rena A. Otieno,⁴ and Theo G.M. Sandfort, PhD^1,2

¹Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University, New York, New York.

²New York State Psychiatric Institute, New York, New York.

³Minority Women in Action, Nairobi, Kenya.

⁴Women Working with Women, Kisumu, Kenya.

Address correspondence to:

Theo G.M. Sandfort, PhD

Division of Gender, Sexuality and Health

Department of Psychiatry

Columbia University and New York

State Psychiatric Institute

1051 Riverside Drive, Unit 15

New York, NY 10031

E-mail: tgs2001@cumc.columbia.edu

 

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Prevalence & Correlates of Intimate Partner Violence in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We evaluated the prevalence and correlates of intimate partner violence in the past year by a regular male partner in HIV-positive female sex workers in Mombasa, Kenya. 

This cross-sectional study included HIV-positive women ≥18 years old who reported engagement in transactional sex at the time of enrolment in the parent cohort. We asked 13 questions adapted from the World Health Organization survey on violence against women about physical, sexual, or emotional violence in the past year by the current or most recent emotional partner (index partner). 

We used standardised instruments to assess socio-demographic and behavioural characteristics as possible correlates of intimate partner violence. Associations between intimate partner violence and these correlates were evaluated using univariate and multivariate logistic regression. 

Overall, 286/357 women (80.4%) had an index partner, and 52/357 (14.6%) reported intimate partner violence by that partner in the past year. In multivariate analysis, women with severe alcohol problems and those experiencing controlling behaviours by the index partner  were significantly more likely to report recent intimate partner violence. Recent intimate partner violence was common in HIV-positive female sex workers. 

Interventions targeting risk factors for intimate partner violence, including alcohol problems and partner controlling behaviours, could help to reduce recurrent violence and negative health outcomes in this key population.

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By: Wilson KS1, Deya R2, Masese L2, Simoni JM3, Vander Stoep A4, Shafi J5, Jaoko W6, Hughes JP7, McClelland RS8.

• 1Department of Epidemiology, University of Washington, Seattle, USA ksw@uw.edu.
• 2Department of Global Health, University of Washington, Seattle, USA Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 3Department of Global Health, University of Washington, Seattle, USA Department of Psychology, University of Washington, Seattle, USA.
• 4Department of Epidemiology, University of Washington, Seattle, USA.
• 5Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya Coast Province General Hospital, Mombasa, Kenya.
• 6Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 7Department of Biostatistics, University of Washington, Seattle, USA.
• 8Department of Epidemiology, University of Washington, Seattle, USA Department of Global Health, University of Washington, Seattle, USA Department of Medicine, University of Washington, Seattle, USA.  

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Monitoring HIV Prevention Programme Outcomes among Key Populations in Kenya: Findings from a National Survey

In preparation for the implementation of the Kenya AIDS Strategic Framework 2014/15-2018/19, the Kenya National AIDS and STI Control Programme facilitated a national polling booth survey as part of a baseline assessment of HIV-related risk behaviours among FSWs, MSM, and PWID, and their utilization of existing preventive interventions, as well as structural factors that may influence KPs’ vulnerability to HIV. The survey was conducted among “key populations” (female sex workers, men who have sex with men, and people who inject drugs) to understand current HIV risk and prevention behaviours, utilization of existing programmes and services, and experiences of violence. 

In total, 3,448 female sex workers, 1,308 men who have sex with men, and 690 people who inject drugs were randomly selected to participate in polling booth survey sessions from seven priority sites. Survey responses were aggregated and descriptive statistics derived. 

In general, reported condom use among all key populations was quite high with paying clients, and lower with regular, non-paying partners. Many participants reported unavailability of condoms or clean injecting equipment within the past month. Exposure to, and utilization of, existing HIV prevention services varied significantly among the groups, and was reported least commonly by female sex workers. 

Encouragingly, approximately three-quarters of all key population members reported receiving an HIV test in the past three months. All key population groups reported experiencing high levels of physical and sexual violence from partners/clients, and/or arrest and violence by law enforcement officials. Although some of the findings are encouraging, there is room for improvement in HIV prevention programmes and services for key populations across Kenya.

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