Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

Abstract

Female sex workers and their clients remain a high risk core group for HIV in Africa. We measured sexual behavior of a snowball sample of female sex workers (FSW) along the Trans Africa highway from Mombasa, Kenya to Kampala, Uganda and surveyed the availability of male condoms at 1,007 bars and lodgings in Kenya along the highway trucking stops where transactional sex occurs. There were 578 FSW one month sex diaries analyzed, 403 from Kenya and 175 from Uganda. Kenyan FSW had a median of 45 sexual acts per 28 days compared to 39 sex acts per 28 days by Ugandan FSW (P < 0.05). Condom use by FSW for all sexual liaisons was 79% in Kenya compared to 74% in Uganda. In multivariate analysis, adjusting for repeated measures, Kenyan FSW were more likely to use a condom by an adjusted odds ratio of 2.54 (95% confidence interval 1.89-3.41) compared to Ugandan FSW. Condom use with regular clients was 50.8% in Uganda compared with 68.7% in Kenya (P < 0.01). The number of sex workers reporting 100% condom use was 26.8% in Kenya and 18.9% in Uganda (P < 0.01). Bars and lodges in Kenya compared to Uganda were more likely to: have condom dispensers, 25% versus 1%, respectively (P < 0.01); distribute or sell condoms, 73.9% versus 47.6% (P < 0.01); and have more weekly condom distribution, 4.92 versus 1.27 condoms per seating capacity (P < 0.01). Our data indicate that in both countries condom use for FSW is suboptimal, particularly with regular partners, and greater condom use by Trans African highway FSW in Kenya compared to Uganda may be related to availability. Targeted interventions are warranted for FSW and truck drivers to prevent transmission in this important core group.

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

“…In 27 of 87 countries included in the UNAIDS global report on HIV/ AIDS for 2010, data indicate that 90% or more of FSWs report condom use with their last client 1 . Despite this progress, consistent condom use among FSWs remains low in most settings, with the proportion reporting 100% condom use reported at 26.8% in Kenya and 18.9% in Uganda 2 . The prevalence of HIV and other sexually transmitted infections (STIs) among FSWs remains high in most settings, with HIV prevalence of 33-37% reported among Ugandan FSWs 3,4 .…”

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use

“…In this study in northern Uganda, the association between working in a brothel/lodge may reflect a lack of supportive physical or social features within sex workers' venues. A study among sex workers who worked along the TransAfrican Highway in Uganda and Kenya found that having access to condoms on-site increased condom use by clients 27 . The study suggests that Ugandan sex workers have lower condom use due to less access to condoms in their workplaces compared to Kenyan sex workers.…”

“…The study suggests that Ugandan sex workers have lower condom use due to less access to condoms in their workplaces compared to Kenyan sex workers. Specifically, in Uganda, sex workers have less access to peer outreach services that distribute condoms, less condom availability in the workplace, and less HIV/STI education 27 . Widespread condom shortages have also been reported in Gulu and across northern Uganda by community-based organizations (CBOs) and AIDS service organizations during the post-conflict phase, with community concerns that sex workers bear the brunt of this public health crisis 28 .…”

“…In Kampala, sex workers' alcohol use has been found to be independently associated with HIV infection 36 , 37 and violence 38 , similar associations have been consistently documented across settings in Sub-Saharan Africa 39 . In Mombasa, Kenya, alcohol use in sex work transactions was linked to higher rates of sexual violence, which increased HIV acquisition risk for sex workers 27 . Of concern, alongside the high rates of unintended pregnancy (43%), our study demonstrated a high burden of HIV among sex workers'; a rate considerably higher compared to the general population in northern Uganda (37.2% versus 8.5%) 13 .…”

“…This includes implementing and evaluating strategies to reach and educate brothel/lodge owners and managers on HIV/pregnancy prevention. The current criminalization and punitive approaches to sex work have a strong potential to undermine efforts for structural interventions that promote sex workers' health and human rights, such as educating managers and increasing access to HIV and violence prevention services or venue features 27,28 . Qualitative narratives by sex workers across East Africa have shown denial of health services to be a major concern and the production of a criminalized and stigmatized environment 45 .…”