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      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

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          Abstract

          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.

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          Most cited references50

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          A systematic review of the correlates of violence against sex workers.

          We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally. We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks. This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.
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            Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review.

            Sex work remains an important contributor to HIV transmission within early, advanced and regressing epidemics in sub-Saharan Africa, but its social and behavioral underpinnings remain poorly understood, limiting the impact of HIV prevention initiatives. This article systematically reviews the socio-demographics of female sex workers (FSW) in this region, their occupational contexts and key behavioral risk factors for HIV. In total 128 relevant articles were reviewed following a search of Medline, Web of Science and Anthropological Index. FSW commonly have limited economic options, many dependents, marital disruption, and low education. Their vulnerability to HIV, heightened among young women, is inextricably linked to the occupational contexts of their work, characterized most commonly by poverty, endemic violence, criminalization, high mobility and hazardous alcohol use. These, in turn, predict behaviors such as low condom use, anal sex and co-infection with other sexually transmitted infections. Sex work in Africa cannot be viewed in isolation from other HIV-risk behaviors such as multiple concurrent partnerships-there is often much overlap between sexual networks. High turn-over of FSW, with sex work duration typically around 3 years, further heightens risk of HIV acquisition and transmission. Targeted services at sufficiently high coverage, taking into account the behavioral and social vulnerabilities described here, are urgently required to address the disproportionate burden of HIV carried by FSW on the continent.
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              Human rights violations against sex workers: burden and effect on HIV.

              We reviewed evidence from more than 800 studies and reports on the burden and HIV implications of human rights violations against sex workers. Published research documents widespread abuses of human rights perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts. Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing. Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law. Protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing. Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 July 2023
                2023
                : 18
                : 7
                : e0288717
                Affiliations
                [1 ] Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
                [2 ] Partners for Health and Development in Africa, Nairobi, Kenya
                [3 ] National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
                [4 ] International Centre for Reproductive Health- Kenya, Mombasa, Kenya
                [5 ] St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
                [6 ] Department of Public Health, Erasmus MC, Rotterdam, Netherlands
                [7 ] Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
                [8 ] Institute of Medical Sciences, University of Toronto, Toronto, Canada
                [9 ] Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
                University of California San Diego, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ¶ Complete membership of the author group can be found in the Acknowledgments.

                Author information
                https://orcid.org/0000-0003-3277-7693
                https://orcid.org/0000-0002-9235-0547
                https://orcid.org/0000-0001-8492-5470
                Article
                PONE-D-22-24072
                10.1371/journal.pone.0288717
                10368250
                83d94f3f-ffbe-448c-ae5a-4f632503c265
                © 2023 Bhattacharjee et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 September 2022
                : 4 July 2023
                Page count
                Figures: 2, Tables: 5, Pages: 15
                Funding
                Funded by: Canadian Institutes of Health Research (CIHR)
                Award ID: MOP 13044
                Funded by: CIHR
                Award ID: FDN 13455
                Funded by: BMGF
                Award ID: INV006613
                Award Recipient :
                The study was funded by an operating grant (MOP-13044) from the Canadian Institutes of Health Research (CIHR) and analyses funded via CIHR grant FDN 13455. MB, SM were supported by CIHR grants - MOP 13044 and FDN13455. PB was supported by BMGF grant - INV006613. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. There was no additional external funding received for this study.
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                Custom metadata
                The data contain information related to locations where young women who sell sex conduct sex work. Sex work and sex workers are criminalised in Kenya, hence the data is sensitive. Data are available on request from the IGPH - University of Manitoba Data Manager, Stella Leung, Stella.Leung@ 123456umanitoba.ca .

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