The Contribution of Emotional Partners to Sexual Risk Taking and Violence among Female Sex Workers in Mombasa, Kenya: A Cohort Study

Abstract

ObjectivesTo assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.DesignCohort study with quarterly follow-up visit over 12-months.MethodsFour hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.ResultsFour or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use.ConclusionsHigh-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.

Sex with sweethearts: Exploring factors associated with inconsistent condom use among unmarried female entertainment workers in Cambodia

“…However, this study found that the rate of consistent condom use with sweethearts remains unacceptably low among FEWs (31.4% of those having sex with sweethearts in the past three months). This finding is in line with findings in several studies in other countries, which found that the rates of consistent condom use with regular, non-commercial partners are consistently lower than the rates in commercial relationships [30, 31]. In this situation, partners of FEWs may potentially become a bridging population for HIV/STI transmission [12, 13].…”

Prevalence and correlates of sexual and gender-based violence against Chinese adolescent women who are involved in commercial sex: a cross-sectional study

“…Similar to other studies,11 12 28 47 our study documents that these adolescent FSWs who were exposed to SGBV are at risk for poorer SRH outcomes including high rates of unwanted pregnancy (52%), abortion (53%) and self-reported symptom of STI (84%). Previously our study identified that only 50% of abortions were performed at safer health facilities, and, importantly, nearly three-quarters (74%) of adolescent FSWs who reported undergoing an abortion had experienced complications from the procedure.…”

“…Participants who are married, cohabiting or currently living with a male partner, had an intimate partner in the past year, or ever have had a drug-using intimate male partner were more likely to report SGBV. A cohort study with FSWs in Kenya suggested that the level of relationship control, particularly if those emotional partners dominate the drug supply and/or economic gains, can contribute to unwanted sex or difficulty in negotiating contraception 12. Individual-based, or group-based strategies that could be used to prevent SGBV perpetrated by intimate partners include: training workshops, peer education sessions, creation of safe spaces or improved referral services for clinical care.…”

Sexual Violence, Condom Negotiation, and Condom Use in the Context of Sex Work

“…21 Intimate partners also play a critical role in sexual behaviors and research from South Africa demonstrates that violence perpetrated by intimate partners is associated with women's high-risk sexual behaviors with intimate partners, as well as with clients. 42 Less than 5% of FSWs who experienced sexual violence in Burkina Faso and Togo reported the event to an authority figure, giving evidence to the lack of power that FSWs have to seek justice for such a violation. Likewise, low reporting of violence to health workers suggests failed access to post-exposure prophylaxis and other HIV prevention methods.…”