Introduction UNAIDS has identified female sex workers (FSW) as a key HIV at‐risk population. FSW disproportionately experience gender‐based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre‐exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client‐perpetrated violence against FSW, mental health outcomes and PrEP use. Methods An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client‐perpetrated violence, and the Patient Health Questionnaire‐9 (PHQ‐9) and Generalized Anxiety Disorder‐7 (GAD‐7) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use. Results Of the total 220 women (median [IQR] age 32 [27‐39]), 56.8% (125/220) reported depression (PHQ‐9 ≥ 10) and 39.1% (86/220) reported anxiety (GAD‐7 ≥ 10). Only 41.4% (91/220) reported optimal use of PrEP (taken correctly six to seven days/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12 months (90%, 198/220). Any recent IPV was frequent (78.7%, 129/164), particularly emotional IPV (66.5%, 109/164), as was any client‐perpetrated violence in the past 12 months (80.9%, 178/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, p = 0.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, p = 0.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client‐perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, p = 0.01) was associated with decreased PrEP use, whereas client‐perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, p = 0.02). Conclusions There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client‐perpetrated emotional violence was associated with PrEP non‐use. Interventions to reduce gender‐based violence may independently enhance HIV prevention and reduce the mental health burden in this community.

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Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. Methods An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. Results Of the total 220 women (median [IQR] age 32 [27–39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64–2.94], p < 0.01), PrEP use (OR 1.54 (1.25–1.91), < 0.01), and client HIV status (OR 1.35 (1.02–1.69), p < 0.01). Conclusions Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED’s.

Nonverbal expressions of emotion can vary in intensity, from ambiguous to prototypical exemplars: for instance, facial displays of happiness may range from a faint smile to a full-blown grin. Previous work suggests that the accuracy with which facial expressions are recognized as the intended emotion increases with emotional intensity, although this pattern depends on the displayed emotion. Less is known about the association between emotional intensity and the recognition of vocal emotional expressions (affective prosody), which also convey information about others' socioemotional intent but are perceived and interpreted differently than facial expressions. The current study examined listeners' ability to recognize emotional intent in morphed vocal prosody recordings that varied in emotional intensity from neutral to prototypical exemplars of basic emotions (anger, disgust, fear, happiness, sadness) and social expressions (friendliness, meanness). Results suggest that listeners' accuracy in identifying the intended emotional intent in each recording increased nonlinearly with emotional intensity. This pattern varied by emotion type: for instance, accuracy for anger rose steeply with increasing emotional intensity before plateauing, whereas accuracy for happiness remained unchanged across low-intensity exemplars but increased thereafter. These findings highlight emotion-specific ways in which dynamic changes in emotional intensity inform perceptions of socioemotional intent in emotional prosody. Moreover, these results also point to potential challenges in emotional communication in social interactions that rely primarily on the voice, with many low-intensity expressions having a higher probability of being misinterpreted.