Collections > Electronic Theses and Dissertations > Interpersonal Violence and Hiv Sexual Risk Behaviors: The Influence of Alcohol Harm Reduction and Early Initiation of Sex Work Among Female Sex Workers in Mombasa, Kenya
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Female sex workers (FSWs) are at high risk of interpersonal violence and HIV infection. The first paper investigated whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or HIV sexual risk behaviors among FSWs in Mombasa, Kenya. The sample was comprised of 818 FSWs in Mombasa, Kenya who were 18 years or older, associated with HIV prevention drop-in centers and moderate risk drinkers. General linear mixed models examined associations between intervention assignment (alcohol harm reduction or nutrition intervention) and recent violence from paying and non-paying sex partners and HIV sexual risk behavior (engagement in sex work, total number of sex partners) at 6 and 12 months post-enrollment. The alcohol intervention was associated with statistically significant decreases in engagement in sex work and sexual violence from paying partners at 6 and 12 months post-enrollment and physical violence from paying sex partners at 12 months post-enrollment. Future research should explore mechanisms through which alcohol reduction leads to reduced violence among FSWs (i.e., reduced risk-taking, economic empowerment). More research is needed to understand whether alcohol reduction leads to reduced violence among FSWs who continue to engage in sex work or through discontinuation of sex work. Between 20-40% of FSWs worldwide began sex work before age 18. The second paper investigates whether early initiation of sex work (sex work at 17 or younger) was associated with recent interpersonal violence or HIV sexual risk behaviors. Logistic regression was performed, adjusting for drop-in center, current age, HIV status, and childhood abuse. Twenty percent of the sample reported early initiation of sex work. Early initiators were significantly more likely to experience recent physical and sexual violence from paying partners and less likely to report consistent condom use with paying partners. Early initiation was not associated with violence or HIV sexual risk with non-paying partners. FSWs who initiated sex work early are at particularly high risk of violence from paying partners. Interventions to prevent violence and reduce HIV sexual risk behaviors among adolescent FSWs and adult FSWs who initiated sex work early are needed. More work is needed to prevent early initiation of sex work.