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

Abstract

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 related to health and gender equality) 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 with any partner in the previous week (no difference by age-group, p=1.00) . 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 who are not currently reached by programs designed for female sex workers.

A decade and beyond: learnings from HIV programming with underserved and marginalized key populations in Kenya

“…The case‐finding rates have remained steady between 1% to 1.5%, probably because the programme is still not reaching specific high‐risk subpopulations. Considering the country's geographic diversity, it would be important to assess the at‐risk KP subpopulations missed by the testing and treatment programmes like the adolescent and young KP who constitute 9% to 12% of the estimated KP [12,27]. Kenya also needs to develop KP differentiated care models linking community outreach and clinical efforts and scaling up community ART initiation and dispensation for KP to address the gaps related to the second 90 target.…”

“…In the last five years, these forums have been decentralized at the county level, where stakeholders engage quarterly, review their local programme and devise local solutions. Development of policy guidance early in the programme scale‐up phase [30] and setting standards and operating procedures for the KP programme helped provide an enabling environment and maintain quality and consistency during the scale‐up phase [16,27,31]. As addressing legal barriers through law change takes time, the national KP programme prioritized developing a conducive policy environment to ensure that constitutional rights of KP to access the highest quality health care are protected.…”

How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis

“…1 Among this population, young women who sell sex (YWSS) are at particularly high risk of HIV, reporting higher numbers of partners and less condom use than their peers not involved in sex work and having poorer access to health services than older female sex workers (FSWs). 2 – 4 Reducing HIV incidence among YWSS requires combination prevention that is responsive to their needs and addresses barriers to their service use. 5 …”