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

Parcesepe, Angela M.; L’Engle, Kelly; Martin, Sandra L.; Green, Sherri; Suchindran, Chirayath; Mwarogo, Peter

doi:10.1136/sextrans-2016-052549

Cited by 35 publications

(40 citation statements)

References 21 publications

(30 reference statements)

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“…In this study, 20.0% (142/710) of FSW study participants sampled in Maseru and Maputsoe, Lesotho were sexually exploited as children. This is comparable to estimates from Kenya [15,39], Mozambique [14], and Sudan [40]. HIV prevalence was extraordinarily high among this sample of FSW in Lesotho compared to that reported in other settings.…”

Section: Discussionsupporting

confidence: 80%

“…One reason for this elevated risk may be challenges in using condoms. In Kenya, FSW who were sexually exploited as children had lower condom use self‐efficacy and were less likely to use condoms consistently with clients . In Burkina Faso, reporting that clients removed condoms or paid more not to use condoms was more common among FSW who were sexually exploited as children than FSW who were not .…”

Section: Introductionmentioning

confidence: 96%

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HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

et al. 2018

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IntroductionSustainable Development Goals (SDGs) about gender equality; decent work; and peace, justice, and strong institutions include a focus on eradicating trafficking and sexual exploitation of and violence against women and children. In Lesotho, 86% of women have experienced gender‐based violence. In addition, overall HIV prevalence is among the highest globally, and higher among adolescent girls than boys. Moreover, nearly three quarters of female sex workers (FSW) are estimated to be living with HIV in Lesotho. In this context, sexually exploited children may be particularly vulnerable to violence and HIV acquisition risks. This study's objective is to examine the prevalence and correlates of experiencing sexual exploitation as a child among FSW in Lesotho.Methods FSW (≥18 years) recruited through respondent‐driven sampling in Maseru and Maputsoe from February to September 2014 completed HIV and syphilis testing and an interviewer‐administered survey, including a question about the age at which they started providing sex for money. This study examined correlates of experiencing sexual exploitation as a child (<18 years) through multivariable logistic regression analyses for each city, controlling for current age.ResultsAcross both cities, 20.0% (142/710) of participants were sexually exploited as children. Among them, 65.5% (93/142) tested positive for HIV and 31.0% (44/142) for syphilis, which was similar to those who started selling sex as adults, after adjusting for current age. Participants who experienced child sexual exploitation were more likely to have been forced to have sex before age 18 than those who started selling sex as adults (Maseru‐adjusted odds ratio (aOR): 3.52, 95% Confidence Interval (CI): 1.61 to 7.66, p = 0.002; Maputsoe‐aOR: 4.39, 95% CI: 1.22 to 15.75, p = 0.023). In Maseru, participants who were sexually exploited as children were more likely to avoid carrying condoms to prevent trouble with police (aOR: 3.18, 95% CI: 1.50 to 6.75, p = 0.003).ConclusionsRisk determinants for HIV and violence among sexually exploited children can be studied retrospectively through research with adult FSW. Further research working directly with sexually exploited children will improve understanding of their needs. Preventing commercial sexual exploitation of children and addressing the social and healthcare needs of those who are exploited are necessary to fully achieve SDGs 5, 8 and 16 and an AIDS‐Free Generation.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 96%

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

et al. 2018

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“…Migrant FSWs with short-term work in their current location were more likely to be under 18 years old when they first engaged in commercial sex work, which was also a risk factor for HIV infection in our study. Beginning sex work earlier would affect their risk behaviour in adulthood [23,24], and FSWs who initiated sex work at an early age endorsed less condom negotiation self-efficacy [23], leading to unprotected sex. There is a need for more professional health education and peer education for this group to improve their awareness of condom use and skills of condom negotiation.…”

Section: Discussionmentioning

confidence: 99%

Migrant female sex workers working at the Sino-Vietnamese border for a short time have a higher risk of HIV transmission: a consecutive cross-sectional study

et al. 2020

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Objectives: For migrant female sex workers (FSWs) at the Sino-Vietnamese border, the impact of work time in their current location on the spread of HIV/AIDS is not clear.Methods: Data were collected from the Sino-Vietnamese border cities of Guangxi, China. Migrant FSWs working in these cities were studied. FSWs who worked less than 6 months in their current location were assigned to the shortterm work group (ST FSWs), and FSWs who worked equal to or longer than 6 months in their current location were assigned to the long-term work group (LT FSWs). Logistic regression was performed to examine the impact of work time in the current location and factors associated with HIV infection. Results:Among the 1667 migrant FSWs, 586 (35.2%) and 1081 (64.9%) were assigned to the ST FSW and LT FSW groups, respectively. Compared to LT FSWs, ST FSWs were more likely to be of Vietnamese nationality, be less than 18 years old when they first engaged in commercial sex work, and have a low-level of HIV-related knowledge and had higher odds of using condoms inconsistently, having more male clients, having no regular male clients, and having a history of male clients who used aphrodisiacs but lower odds of receiving free condoms distribution and education/ HIV counselling and testing programme. The analysis of factors associated with HIV infection revealed that Vietnamese FSWs, less than 18 years old when they first engaged in commercial sex work, having no regular male clients, and having lower average charge per sex transaction were correlated with HIV infection. Conclusion:FSWs with short-term work at the Sino-Vietnamese border had a higher risk of risky sex and were correlated with HIV risk factors. Vietnamese FSWs were at higher risk of HIV infection, and they were more likely to have short-term work. More targeted HIV prevention should be designed for new FSWs who recently began working in a locality to further control the spread of HIV, particularly cross-border FSWs. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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“…(3)(4)(5)(6)(7)(8) In Kenya, the median age of AGYW self-identifying as a sex worker or entering sex work ranges from 14 -18 years, which means the first years of formal sex work occur during adolescence. (9,10) Many sexual, structural, and reproductive health vulnerabilities reported by YSW in Kenya start as early as first sex and are often associated with entry into sex work at an earlier age (11)(12)(13)(14)(15). Emerging data also suggest that YSW experience higher rates of violence and substance use compared with older women who sell sex.…”

Section: Introductionmentioning

confidence: 99%

Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya

Roberts

Bhattacharjee

et al. 2020

Preprint

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Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14 – 24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs) and program contact among YSW. Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14 – 24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14 – 18 years, N=117; 19 – 24 years, N=291) and by program contact (ever contacted by local program for sex workers). Results: 47.3% reported inconsistent condom use in the previous week with little variability by age. Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9% and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14 – 18 years; and 15.8% of those aged 19 – 24 years, p=0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact. Conclusions: SDG-related vulnerabilities begin early in the lives of YSW and current programs are not reaching them.

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

Cited by 35 publications

References 21 publications

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho

Migrant female sex workers working at the Sino-Vietnamese border for a short time have a higher risk of HIV transmission: a consecutive cross-sectional study

Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya

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