Determinants and consequences of heavy episodic drinking among female sex workers in Ethiopia: A respondent-driven sampling study

Background Female sex workers (FSW), due to their working conditions, have an increased likelihood of heavy episodic drinking (HED), which is associated with risky sexual behavior. Nevertheless the specific contribution of HED to risky sexual behavior among FSWs in Ethiopia is not well documented for prevention activities. Objective The purpose of this study was to explore the determinants and consequences of HED among FSWs in Ethiopia. Methods A cross-sectional study using respondent-driven sampling was conducted among 4886 FSWs in 11 major towns in Ethiopia in 2014. A structured interview was performed, and data were examined using descriptive statistics and multiple logistic regression analyses. Results Most (66%) FSWs consumed alcohol, and the prevalence of HED was 29.1%. Compared to street-based FSWs, those who worked in bars/hotels and local drinking houses had 2.19 and 1.29 times higher odds of HED, respectively. FSWs who started selling sex when younger than 18 years (compared to those who started when older than 25 years) and those who were forced into selling sex had 1.48 and 2.91 times higher odds of HED, respectively. FSWs with more income from selling sex and FSWs who chewed khat reported increased odds of HED. Moreover, FSWs with experience of HED reported 1.27 and 1.44 times higher odds of physical beating and condom breakage/slippage, respectively. Furthermore, the population attributable risk fraction of HED among FSWs showed that 6.2% of physical beating and 8.9% of condom breakage/slippage could be attributed to HED. Conclusion In general, several factors increase the experience of HED, and HED in turn increases the likelihood of violence and condom breakage. These factors could inform programs and intervention activities among FSWs populations.

Penile implantation and risky sexual behaviour among male clients of female sex workers, Myanmar

Introduction: Male clients of female sex workers are at risk for sexually transmitted infections worldwide, yet their behaviours are seldom described in community-based samples. In addition, physical modifications to the penis, such as injections and implantations of objects to enhance sensation, have been noted in diverse cultures. The objective of the present study was to examine risk behaviours of male clients of female sex workers in Myanmar and assess associations between penile modifications and risk for sexually transmitted infections. Methods: A cross-sectional survey was conducted in 2010 in seven cities of Myanmar. The design used probability proportionate to size sampling of male clients at sex work venues (e.g., brothels, entertainment centres, streets) to approximate a representative sample. Results: Of 2,945 male clients at sex work venues, 2,740 (93.0%) enrolled. Overall, 9.9% reported penile injections and 10.7% reported implantations. Compared to male clients without penile modifications, those with penile injection or implantation had higher numbers of partners and more episodes of unprotected sex with casual and commercialpartners. Condom breakage and history of sexually transmitted disease symptoms were also higher among male clients with penile modifications. Conclusions: Modifications of the penis mark a constellation of risky behaviours among male clients of female sex workers in Myanmar and may also be causally related to sexually transmitted infections through condom breakage or physical effects on the penis. Health education and counselling on the potential increased risk should be considered for men with penile modifications.