The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial

Abstract

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.

An intimate partner violence prevention intervention for men, women, and couples in Ethiopia: Additional findings on substance use and depressive symptoms from a cluster-randomized controlled trial

“…The Raising HIV Awareness in Non-HIV-Infected Indian Wives (RHANI) Wives intervention targeted women in urban Mumbai experiencing IPV and heavy spousal alcohol use, and the intervention included a focus on alcohol as a point of spousal conflict; however, changes in substance use patterns were not measured or reported [ 19 ]. A recent evaluation reported that an alcohol harm reduction intervention reduced exposure to interpersonal violence and engagement in sex work among a population of sex workers in Mombasa, Kenya [ 20 ]. Other evaluations of IPV-focused interventions have not analyzed substance use.…”

Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda

“…Most countries do not mention alcohol reduction interventions in their HIV/AIDS control programs [ 33 ]. In addition, only a few studies on alcohol reduction for HIV prevention have been done in SSA, the majority of which demonstrated short term reductions in alcohol consumption but inconsistent changes in sexual behavior and HIV risk [ 6 , 34 , 35 , 38 – 40 ].…”

Effectiveness of a multilevel intervention to reduce violence and increase condom use in intimate partnerships among female sex workers: cluster randomised controlled trial in Karnataka, India

“…We know from the evaluation of the earlier Avahan programme that engagement with the CBO and visits from peer educators were associated with a reduction in violence experienced by sex workers from clients and the police 19 34. The positive engagement of the CBO during Avahan’s non-randomised implementation and the problematic engagement of the same CBO during Samvedana Plus implementation raise the question of whether it is wise to undertake a randomised trial in collaboration with a community-based group whose loyalty falls naturally with the well-being of its members.…”

“…One trial showed some effect of a brief alcohol intervention on reducing client violence but not IPV at 6 months. The authors attribute this differential outcome to the more complex relationships that sex workers have with their non-paying partners, which make them harder to change 19. The second used motivational interviewing to reduce client violence in the context of an HIV/sexually transmitted infection (STI) intervention.…”