Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Becker, Marissa; Bhattacharjee, Parinita; Blanchard, James; Cheuk, Eve; Isac, Shajy; Musyoki, Helgar; Gichangi, Peter; Aral, Sevgi O.; Pickles, Michael; Sandstrom, Paul; Ma, Huiting; Mishra, Sharmistha

doi:10.1097/qai.0000000000001826

Cited by 47 publications

(54 citation statements)

References 66 publications

(74 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This important heterogeneity often gets missed when examining programme “averages” or overall outcomes. Our findings are similar to an analysis conducted in the “Transitions” study in Mombasa, which identified that only 26% of young FSWs reported being contacted by any programme . This “programme access gap,” when examined further, showed that by the second year in sex work, only 15% of young FSWs had been contacted by programmes .…”

Section: Discussionsupporting

confidence: 88%

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya. Methods Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub‐national and implementing partner level cascades. Results At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy‐nine per cent of the HIV‐positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub‐national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub‐population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level. Conclusions HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision‐making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.

show abstract

Section: Discussionsupporting

confidence: 88%

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another reason for the difference in police harassment by age may be the potential for increased visibility of older sex workers to law enforcement. Finally, the high and similar prevalence of recent physical or sexual violence, and of police harassment among those who ever experienced it, across age-groups may be due to ongoing or repeated experience of these vulnerabilities over the sexual life-course of YSW -as previously shown with female sex workers in general across SSA (11,34). The potential reasons for the high burden of vulnerabilities among YSW, especially among those aged 14 -18 years, are complex and inter-related.…”

mentioning

confidence: 81%

“…(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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…current or former sex workers engaged with local HIV prevention programs) invited potential participants for eligibility screening and consent as detailed previously. (11) Trained interviewers used structured questionnaires to conduct face-to-face interviews in English or Kiswahili. The questionnaire included information on sociodemographic characteristics, sexual behaviours, structural factors, reproductive behaviours and program engagement.…”

Section: Study Design and Data Collectionmentioning

confidence: 99%

“…(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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

Cited by 47 publications

References 66 publications

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

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

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

Contact Info

Product

Resources

About