Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya's Coast Province: findings from a behavioural monitoring survey.

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction.

Concurrent Sexual and Substance-Use Risk Behaviours Among Female Sex Workers in Kenya's Coast Province: Findings from a Behavioural Monitoring Survey

While many studies confirm the association between HIV; alcohol and injecting drug use by female sex workers (FSWs); little is known about their use of marijuana; khat and other substances and the association of these substances with HIV; risky sexual behaviour; and sexual violence. To better understand this association; data were analysed from a cross-sectional; behavioural survey of 297 FSWs in Mombasa; a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs; lifetime use of different substances was reported by 91 for alcohol; 71 for khat; 34 for marijuana; and 6 for heroin; cocaine; glue or petrol. The majority (79) used more than one substance; and multiple-substance use was reported by all respondents who ever used marijuana; heroin; cocaine; glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41 of respondents; 75 of whom attributed this risk to multiple partners. Sexual violence was reported by 48 of respondents; and 30 indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa; most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction

Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections.

This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (> or =5 alcoholic drinks on > or =1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR)=1.59, 95% confidence interval [CI]=1.00-2.53; P=0.047) and sexual violence (AOR=1.85, 95% CI=1.27-2.71; P=0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR=1.56, 95% CI=1.00-2.41; P=0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%; P<0.001), but was not associated with drinking patterns. Interventions are needed to assist female sex workers adopt safer drinking patterns. Investigation is needed for the effectiveness of such interventions in reducing unprotected sex, sexual violence and sexually transmitted infections.

Condom use during a community intervention trial in Kenya.

We conducted a cluster-randomized community intervention trial at Kenyan agricultural sites to measure the impact of female condom introduction on sexually transmitted infection (STI) prevalence. We present male and female condom use data here. Six Intervention sites received a community risk-reduction campaign and distribution of female condoms and male condoms, while 6 Control sites received the same campaign with male condoms only. Male and female condom distribution increased throughout follow-up. Self-reported male condom use increased substantially during follow-up to over 60% of the participants. The proportion of consistent male condom users at Control sites was higher than at Intervention sites, 23% vs 14% at 6 months and 24% vs 22% at 12 months. At Intervention sites, 11% and 7% of women used the female condoms all the time at 6 and 12 months, respectively, while the percentage of female condom non-users grew. Male and female condom use was hindered by male partner objections; suspicion of the study and the devices among residents; and bias against condoms by clinic service providers. A large proportion of coital acts remained unprotected during the trial. Our female condom intervention did not reduce STI prevalence, compared with male condom promotion only.

Differences in counseling men and women: family planning in Kenya.

A comparison of family planning sessions with male and female clients in Kenya found distinct gender differences. Most men came for information, while women wanted to adopt, continue, or change contraceptive methods. Consultations with men and couples were more than twice as long as consultations with women. Men communicated actively (for example, by volunteering extra information, asking questions, and expressing worries) during 66% of their turns to speak, compared with 27% for women. Providers offered men more detailed information than women, asked them fewer questions, issued fewer instructions, and responded more supportively. These communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. Kenyan providers need to improve the quality of their interactions with women. They also need to anticipate men's outspokenness and understand the male agenda if they are to counsel men effectively.

PIP: This study analyzes and compares transcripts of family planning consultations collected from two different family planning associations in Kenya to explore the possible differences in counseling women and men. A comparison of 358 family planning sessions at 25 service delivery sites in urban and rural areas found distinct gender differences. Most men came for information, while women opted to adopt, continue, or change contraceptive methods. Men participated more actively in the sessions during 66% of their turns to speak, compared with 27% for women. Men were offered more detailed information than women, were asked fewer questions, were issued fewer instructions, and were given more support by the providers. Such communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. The findings indicate that Kenyan providers need to improve the quality of their interactions with women, and that they also need to anticipate men's outspokenness and understand the male agenda for effective counseling.