Alcohol consumption and high risk sexual behaviour among female sex workers in Uganda

Abstract

Alcohol consumption has been associated with high risk sexual behaviour among key populations such as female sex workers. We explored the drivers of alcohol consumption and its relationship to high risk sexual behaviour. Participants were drawn from a cohort of 1027 women selected from 'hot spots' in the suburbs of Kampala city. We conducted 3 in-depth interviews with 40 female sex workers between 2010 and 2011. Data were analysed thematically, focusing on alcohol use within the context of sex work. Alcohol consumption was very high with only seven women reporting that they did not drink. Alcohol consumption was driven by the emotional and economic needs of the participants, but also promoted by clients who encouraged consumption. Many sex workers only started drinking alcohol when they joined sex work on the advice of more experienced peers, as a way to cope with the job. Alcohol was blamed for unsafe sex, acts of violence and poor decision making which increased sexual and physical violence. Alcohol was reported to affect medication adherence for HIV-positive women who forgot to take medicine. The findings suggest that the drivers of alcohol consumption are multifaceted in this group and require both individual and structural interventions. Alcohol reduction counselling can be supportive at the individual level and should be an integral part of HIV prevention programmes for female sex workers and others such as patrons in bars. The counselling should be addressed in a sensitive manner to bar owners and managers.

Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study

“…The risk of violence and unprotected sex with alcohol use among FSW has been well-documented globally (Chersich et al, 2007; El-Bassel, Witte, Wada, Gilbert, & Wallace, 2001; Li, Li, & Stanton, 2010; Mbonye, Rutakumwa, Weiss, & Seeley, 2014; Onyango et al, 2015; Wechsberg, Luseno, & Lam, 2005). Yet, knowledge has been limited on how FSW understand these risks within the context of their own alcohol use.…”

“…Several countries in the region have implemented alcohol control policies to reduce hazardous alcohol consumption more widely. Zambia has banned the packaging of liquor in sachets to reduce the availability small and affordable quantities of high alcohol content liquor (Mbonye, Rutakumwa, Weiss, & Seeley, 2014). Additionally, Botswana implemented a 30% alcohol tax in 2008, which was later increased in 2010 (Sebego et al, 2014).…”

“…Additionally, Botswana implemented a 30% alcohol tax in 2008, which was later increased in 2010 (Sebego et al, 2014). In both South Africa and Kenya restrictions on alcohol advertisement (Carrasco, Esser, Sparks, & Kaufman, 2016; Mbonye, Rutakumwa, Weiss, & Seeley, 2014). The potential effectiveness of similar alcohol policies must be further explored within Malawi.…”

Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala

“…Debriefs were conducted after each interview, which helped to inform the focus of subsequent interviews. This is a tried and tested approach and we have successfully conducted interviews without tape recorders with this population in our previous work (Mbonye, Nakamanya, Nalukenge, et al, 2013;Mbonye et al, 2012;Mbonye, Rutakumwa, Weiss, & Seeley, 2014). All personal identifiers were excluded from the detailed accounts.…”

Review of Sexuality Studies in Africa: Setting a New Post-2015 Research Agenda

“…Among sex workers, unsafe sex practices were associated with alcohol consumption as revealed by a recent study in Uganda 25 . Also, there are speculations that initiation of antiretroviral treatment promotes risky sexual behaviour in HIV positive persons 26 .…”