Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya’s Coast Province: Findings from a behavioural monitoring survey

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to highby 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents,and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction

Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya\u27s Coast Province: findings from a behavioural monitoring survey

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction

Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya's Coast Province: Findings from a behavioural monitoring survey [Les comportements à risques liés à la concomitance de partenaires sexuels et à la consommation de substances chez les travailleuses du sexe dans la Province de la côte du Kenya: Les conclusions d'une étude sur les comportements]

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction. © 2010 Taylor & Francis Group, LLC. All rights reserved

Are sex workers propagating one or two HIV epidemics in Kenya? Findings from a behavioral monitoring survey in Coast Province

Background: Kenya's Coast Province has high prevalence for commercial sex and substance abuse. While many studies have confirmed the association between HIV and alcohol and injection drug use among female sex workers (FCSWs), little known of HIV risk from other substances such as miraa (Catha edulis alias 'khat') and bhang (cannabis) among FCSWs. Despite numerous adverse consequences of miraa, Kenyan law silent on miraa sale and use. To estimate the burden of khat and bhang use and contribution toward risky sexual behaviour, we conducted a behavioural survey targeting FCSWs in Mombasa. Method: Cross-sectional survey recruited 297 FCSWs using time location sampling. Structured questionnaires administered using Personal Digital Assistants (PDA). Outcome measures: prevalence of substance abuse, sexual violence and perceived HIV risk. Results: 46% FCSWs aged 15-24 years, 68% attained primary level education, 66% full time sex workers. 96% percent used at least one substance: Alcohol most popular (91%) (P 5 years more likely to smoke cigarettes than those in the trade shorter duration (p< 0.05; df=1; OR=1.65). 47.5% (141/297 reported sexual violence. Although 40.8% of FCSWs perceived risk of HIV acquisition as medium to high, majority (75%) due to multiple partners, rather than rape (1%). Conclusions: Study confirmed high miraa and bhang use among FCSWs, in addition to alcohol and cigarettes. Combined use of alcohol and miraa associated with more sexual partners, increased risk of sexual violence and moderate-high perception of HIV infection. Further research needed on substance careers, networks and causes to determine how to control miraa and bhang use among FCSWs

Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya's Coast Province: Findings from a behavioural monitoring survey [Les comportements à risques liés à la concomitance de partenaires sexuels et à la consommation de substances chez les travailleuses du sexe dans la Province de la côte du Kenya: Les conclusions d'une étude sur les comportements]

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction. © 2010 Taylor & Francis Group, LLC. All rights reserved

Early Sex Work Initiation and Violence against Female Sex Workers in Mombasa, Kenya

Between 20 and 40 % of female sex workers (FSWs) began sex work before age 18. Little is known concerning whether early initiation of sex work impacts later experiences in adulthood, including violence victimization. This paper examines the relationship between early initiation of sex work and violence victimization during adulthood. The sample included 816 FSWs in Mombasa, Kenya, recruited from HIV prevention drop-in centers who were 18 years or older and moderate-risk drinkers. Early initiation was defined as beginning sex work at 17 or younger. Logistic regression modeled recent violence as a function of early initiation, adjusting for drop-in center, age, education, HIV status, supporting others, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Although both early initiators and other FSWs reported commonly experiencing recent violence, early initiators were significantly more likely to experience recent physical and sexual violence and verbal abuse from paying partners. Early initiation was not associated with physical or sexual violence from non-paying partners. Many FSWs begin sex work before age 18. Effective interventions focused on preventing this are needed. In addition, interventions are needed to prevent violence against all FSWs, in particular, those who initiated sex work during childhood or adolescence