Changes in context, typology and programme outcomes between early and recent periods of sex work among young female sex workers in Mombasa, Kenya: A cross-sectional study

Introduction The sex work context and typology change continuously and influence HIV related risk and vulnerability for young female sex workers (YFSW). We sought to describe changes in the context and typology of sex work between the first (early) and past month (recent) of sex work among YFSW to inform HIV prevention programming for sex workers. Methods We used data from a cross-sectional survey (April-November 2015), administered using physical location-based sampling to 408 cis-women, aged 14–24 years, who self-identified as sex workers, in Mombasa, Kenya. We collected self-reported data on the early and recent month of sex work. The analysis focused on changes in a) sex work context and typology (defined by setting where sex workers practice sex work) where YFSW operated, b) primary typology of sex work, and c) HIV programme outcomes among YFSW who changed primary typology, within the early and recent month of sex work. We analysed the data using a) SPSS27.0 and excel; b) bivariate analysis and χ2 test; and c) bivariate logistic regression models. Results Overall, the median age of respondents was 20 years and median duration in sex work was 2 years. Higher proportion of respondents in the recent period managed their clients on their own (98.0% vs. 91.2%), had sex with >5 clients per week (39.3% vs.16.5%); were able to meet > 50% of living expenses through sex work income (46.8% vs. 18.8%); and experienced police violence in the past month (16.4% vs. 6.5%). YFSW reported multiple sex work typology in early and recent periods. Overall, 37.2% reported changing their primary typology. A higher proportion among those who used street/ bus stop typology, experienced police violence, or initiated sex work after 19 years of age in the early period reported a change. There was no difference in HIV programme outcomes among YFSW who changed typology vs. those who did not. Conclusions The sex work context changes even in a short duration of two years. Hence, understanding these changes in the early period of sex work can allow for development of tailored strategies that are responsive to the specific needs and vulnerabilities of YFSW.

[1]  L. McKinnon,et al.  HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing , 2023, AIDS.

[2]  J. Edwards,et al.  A framework for descriptive epidemiology. , 2022, American journal of epidemiology.

[3]  M. Pickles,et al.  Exploring the dynamics of workplace typologies for sex workers in Eastern Ukraine , 2021, Global public health.

[4]  N. Galai,et al.  Mobility for sex work and recent experiences of gender-based violence among female sex workers in Iringa, Tanzania: A longitudinal analysis , 2021, PloS one.

[5]  S. Moses,et al.  Transitions: Novel Study Methods to Understand Early HIV Risk Among Adolescent Girls and Young Women in Mombasa, Kenya, and Dnipro, Ukraine , 2020, Frontiers in Reproductive Health.

[6]  U. Tamoufé,et al.  High HIV prevalence and low HIV-service engagement among young women who sell sex: A pooled analysis across nine sub-Saharan African countries. , 2020, Journal of acquired immune deficiency syndromes.

[7]  Wang Xiaotao,et al.  African countries , 2020, BRI and International Cooperation in Industrial Capacity.

[8]  M. Hester,et al.  The Current Landscape of Prostitution and Sex Work in England and Wales , 2020, Sexuality & Culture.

[9]  S. Baral,et al.  Facilitators and barriers to incorporating digital technologies into HIV care among cisgender female sex workers living with HIV in South Africa. , 2020, mHealth.

[10]  M. Becker,et al.  Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya , 2019, BMC Public Health.

[11]  M. Becker,et al.  Venue-Based HIV Testing at Sex Work Hotspots to Reach Adolescent Girls and Young Women Living With HIV: A Cross-sectional Study in Mombasa, Kenya , 2019, Journal of acquired immune deficiency syndromes.

[12]  N. Persaud,et al.  Programmatic Mapping: Providing Evidence for High Impact HIV Prevention Programs for Female Sex Workers , 2019, JMIR public health and surveillance.

[13]  M. Pickles,et al.  Informing HIV Prevention Programs for Adolescent Girls and Young Women: A Modified Approach to Programmatic Mapping and Key Population Size Estimation , 2019, JMIR public health and surveillance.

[14]  T. Chiyaka,et al.  Changes Over Time in HIV Prevalence and Sexual Behaviour Among Young Female Sex-Workers in 14 Sites in Zimbabwe, 2013–2016 , 2019, AIDS and Behavior.

[15]  N. Galai,et al.  Community Savings Groups, Financial Security, and HIV Risk Among Female Sex Workers in Iringa, Tanzania , 2018, AIDS and Behavior.

[16]  M. Pickles,et al.  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 , 2018, Journal of acquired immune deficiency syndromes.

[17]  A. Montoliu,et al.  A typology of female sex work in the Metropolitan Region of Santiago, Chile , 2018, Culture, health & sexuality.

[18]  T. Sanders,et al.  Behind the screen: commercial sex, digital spaces and working online , 2017 .

[19]  D. Wilson.  HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs , 2015, PLoS medicine.

[20]  S. Mishra,et al.  Differentiated Typology of Sex Work and Implication for HIV Prevention Programs among Female Sex Workers in Nepal , 2015, Front. Public Health.

[21]  R. Baggaley,et al.  Young key populations and HIV: a special emphasis and consideration in the new WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations , 2015, Journal of the International AIDS Society.

[22]  Chris Beyrer,et al.  Human rights violations against sex workers: burden and effect on HIV , 2015, The Lancet.

[23]  Elizabeth Mziray,et al.  An Appraisal of Female Sex Work in Nigeria - Implications for Designing and Scaling Up HIV Prevention Programmes , 2014, PloS one.

[24]  C. Garcia-Moreno,et al.  A systematic review of the correlates of violence against sex workers. , 2014, American journal of public health.

[25]  S. Moses,et al.  Circumstances, experiences and processes surrounding women's entry into sex work in India , 2014, Culture, health & sexuality.

[26]  S. Moses,et al.  Demographic changes and trends in risk behaviours, HIV and other sexually transmitted infections among female sex workers in Bangalore, India involved in a focused HIV preventive intervention , 2013, Sexually Transmitted Infections.

[27]  Naeem Akhtar,et al.  The organisation, operational dynamics and structure of female sex work in Pakistan , 2013, Sexually Transmitted Infections.

[28]  T. Patterson,et al.  HIV/STI Risk Among Venue-Based Female Sex Workers Across the Globe: A Look Back and the Way Forward , 2013, Current HIV/AIDS Reports.

[29]  E. Coast,et al.  Transactional Sex Risk across a Typology of Rural and Urban Female Sex Workers in Indonesia: A Mixed Methods Study , 2012, PloS one.

[30]  B. Mahapatra,et al.  HIV Risk Behaviors among Female Sex Workers Using Cell Phone for Client Solicitation in India , 2012 .

[31]  M. Chersich,et al.  Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review , 2012, AIDS and Behavior.

[32]  N. Saggurti,et al.  The Extent and Nature of Fluidity in Typologies of Female Sex Work in Southern India: Implications for HIV Prevention Programs , 2012, Journal of HIV/AIDS & social services.

[33]  G. Henderson,et al.  Systematic Differences in Risk Behaviors and Syphilis Prevalence Across Types of Female Sex Workers: A Preliminary Study in Liuzhou, China , 2012, Sexually transmitted diseases.

[34]  S. Aral,et al.  Emergent properties and structural patterns in sexually transmitted infection and HIV research , 2010, Sexually Transmitted Infections.

[35]  S. Moses,et al.  Devising a female sex work typology using data from Karnataka, India. , 2010, International journal of epidemiology.

[36]  J. Mantell,et al.  A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China , 2010, Psychology, health & medicine.

[37]  F. Cowan,et al.  The female sex work typology in India in the context of HIV/AIDS , 2009, Tropical medicine & international health : TM & IH.

[38]  S. Moses,et al.  Sex work, Syphilis, and Seeking Treatment: An Opportunity for Intervention in HIV Prevention Programming in Karnataka, South India , 2009, Sexually transmitted diseases.

[39]  H. Ward,et al.  Globalisation, the sex industry, and health , 2006, Sexually Transmitted Infections.

[40]  J. S. St. Lawrence,et al.  Sex work in Tallinn, Estonia: the sociospatial penetration of sex work into society , 2006, Sexually Transmitted Infections.

[41]  H. Ward,et al.  What happens to women who sell sex? Report of a unique occupational cohort , 2006, Sexually Transmitted Infections.

[42]  B. Donovan,et al.  The many faces of sex work , 2005, Sexually Transmitted Infections.

[43]  R. Kaul,et al.  Associations of Sexual Risk Taking Among Kenyan Female Sex Workers After Enrollment in an HIV-1 Prevention Trial , 2005, Journal of acquired immune deficiency syndromes.

[44]  J. S. St. Lawrence,et al.  The Social Organization of Commercial Sex Work in Moscow, Russia , 2003, Sexually transmitted diseases.

[45]  L Jackson,et al.  Varied potential risks of HIV infection among prostitutes. , 1992, Social science & medicine.

[46]  A. Verster,et al.  HIV and young people who sell sex. , 2015 .

[47]  S. Moses,et al.  A systematic approach to the design and scale-up of targeted interventions for HIV prevention among urban female sex workers , 2012 .