Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in 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) 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. Kenya’s 2018 national framework for YSW service provision offers an opportunity - via a pragmatic and rights-based paradigm shift in health services - to reduce vulnerabilities at the intersection of adolescence and sex work.

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

10.21203/rs.2.19715/v2 ◽

2020 ◽

Author(s):

Elizabeth Roberts ◽

Huiting Ma ◽

Parinita Bhattacharjee ◽

Helgar K Musyoki ◽

Peter Gichangi ◽

...

Keyword(s):

Reproductive Health ◽

Condom Use ◽

Young Women ◽

Sex Workers ◽

Sub Saharan Africa ◽

Cross Sectional Survey ◽

Inconsistent Condom ◽

Cross Sectional ◽

Sub Saharan ◽

Inconsistent Condom Use

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

10.21203/rs.2.19715/v3 ◽

2020 ◽

Author(s):

Elizabeth Roberts ◽

Huiting Ma ◽

Parinita Bhattacharjee ◽

Helgar K Musyoki ◽

Peter Gichangi ◽

...

Keyword(s):

Reproductive Health ◽

Condom Use ◽

Young Women ◽

Sex Workers ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Age Group ◽

Inconsistent Condom ◽

Female Sex ◽

Inconsistent Condom Use

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.

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Retrospective analysis of the prevalence of and factors associated with condom use among young HIV-infected women in Cameroon

SAGE Open Medicine ◽

10.1177/2050312115626432 ◽

2016 ◽

Vol 4 ◽

pp. 205031211562643 ◽

Cited By ~ 3

Author(s):

Mariecel Pilapil ◽

Lee Morris ◽

Kohta Saito ◽

Francine Kouya ◽

Vivian Maku ◽

...

Keyword(s):

Public Health ◽

Confidence Interval ◽

Condom Use ◽

Young Women ◽

Odds Ratio ◽

Interquartile Range ◽

Sub Saharan Africa ◽

Inconsistent Condom ◽

Factors Associated ◽

Inconsistent Condom Use

Objectives: Young women are more likely to be infected with HIV globally, in sub-Saharan Africa, and in Cameroon. Despite its clear clinical and public health benefits, condom use among HIV-infected women continues to be low. The objective of this study was to describe the prevalence of inconsistent condom use among HIV-infected women in Cameroon and the factors associated with it. Methods: We conducted a cross-sectional study of HIV-infected young women aged 17–26 years from three semi-urban HIV clinics in the Northwest Region of Cameroon. This study was a subgroup analysis of a previously reported study on inconsistent condom use in HIV-infected and -uninfected youth. Inconsistent condom use was defined as reporting “sometimes” or “never” to questions regarding frequency of condom use. Logistic regression modeling was used to determine factors associated with inconsistent condom use. Results: A total of 84 participants were recruited and submitted completed questionnaires for analysis. Median age was 24 years (interquartile range = 22–25) and the median age at HIV diagnosis was 21 years (interquartile range = 20–23). Fifty percent of the participants reported no prior schooling or only primary school education. Overall, 61/84 (73%) reported inconsistent condom use. After adjusting for potential confounders, education to the secondary school level was protective against inconsistent condom use (odds ratio = 0.19; confidence interval: 0.04–0.95), and having ≥2 pregnancies was associated with inconsistent condom use (odds ratio = 7.52; confidence interval: 1.67–34.00). Conclusion: There is a high prevalence of inconsistent condom use among young HIV-infected women in Cameroon, which appears to be associated with lower levels of educational attainment and higher parity. Further larger studies assessing the factors associated with poor condom use in this population are warranted and may inform public health policy in resource-limited settings with high HIV prevalence.

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