Unprotected sex, sexually transmitted infections and problem drinking among female sex workers in Ethiopia

Abstract

Background: A description of the pattern of use of alcohol and other substances among female sex workers (FSWs) is particularly important because of the high prevalence of HIV in this particular group and their potential for transmitting HIV infection to other groups. However, there is currently lack of systematic studies from developing countries like Ethiopia regarding alcohol use visa vis unprotected sex and STIs. Objective: To describe the association of risky sexual behaviour with alcohol use and problem drinking among female sex workers in Ethiopia. Methods: A total of 2,487 female sex workers aged between of 15 and 49 years were randomly sampled from seven urban centres in Ethiopia and interviewed regarding their sexual behavior and substance use. Results: About 12% of FSWs included in this study reported having unprotected sex during the 12 months prior to the interview. A history of vaginal ulcer or discharge experienced by the FSWs was reported by 5% of the study subjects. Those who reported occasional use of alcohol were found to have a two-fold increase in the odds of having unprotected sex compared to non-users: adjusted OR (95% CI) = 2.06 (1.28, 3.33). Those who responded positively to at least one question from the four -item questionnaire known as CAGE, and which is used as an indicator for problem drinking, had a 50% increased odds of unprotected sex compared with zero scorers: adj. OR (95% CI) = 1.48 (1.07, 2.05). Those who reported alcohol use on a daily basis were found to have a two-fold increased odds of having sexually transmitted infections (STIs) compared to the non-users of alcohol: adj. OR (95% CI) = 2.50 (1.35, 4.64).

Sexually transmitted diseases among female commercial sex workers in Finote Selam town, northwest Ethiopia: a community-based cross-sectional study

“…This is higher than the findings of another study, where the magnitude of drug use during sex was 10.7% 4. In the current study, it was found that inconsistent condom use and condom breakage were significantly associated with the occurrence of STDs.…”

“…Chronic pelvic pain from untreated bacterial STDs is an important reason for health care visits among females. STDs are also among the leading causes of disability-adjusted life years lost for females of reproductive age in the developing countries 4,8…”

How Inexpensive Does an Alcohol Intervention in Kenya Need to be in Order to Deliver Favorable Value by Reducing HIV-Related Morbidity and Mortality?

“…The effect size of unhealthy alcohol use on increasing condom nonuse was assumed to be 1.72, based on two sub-Saharan studies. 6,25 Other inputs to the simulation (e.g. costs, utilities) are described elsewhere.…”

Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia

“…CAGE is a widely-used alcohol abuse screening tool, shown to have high test-retest reliability, adequate correlations with other instruments, and high validity in medical and surgical inpatients, psychiatric inpatients, and ambulatory medical patients [47]. While created for the U.S. population, the CAGE screening tool has been used successfully in studies of alcohol abuse in both urban and rural regions of Ethiopia, including FSW populations [31,48,49]. …”

“…Though FSWs operate in highly diverse environments, the association between alcohol use and increased odds of inconsistent condom use and STIs has been found in studies among FSWs in many developing countries [24,26,27,31-33]. In qualitative work conducted in Ethiopia and Cambodia, FSWs explained how alcohol use created a barrier to ensuring condom use with clients; it reduced their level of control [29] and intoxicated clients tended to refuse to use condoms [9,34].…”