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

PLoS One. 2013 Aug 7;8(8):e68855. doi: 10.1371/journal.pone.0068855. eCollection 2013.

Abstract

Objectives: To 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.

Design: Cohort study with quarterly follow-up visit over 12-months.

Methods: Four 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.

Results: Four 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.

Conclusions: High-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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Condoms / statistics & numerical data
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / prevention & control
  • HIV Infections / transmission
  • Humans
  • Kenya
  • Male
  • Risk Factors
  • Risk-Taking
  • Safe Sex / statistics & numerical data
  • Sex Education / methods
  • Sex Workers / psychology
  • Sex Workers / statistics & numerical data*
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners
  • Spouses
  • Time Factors
  • Unsafe Sex / statistics & numerical data*
  • Violence / statistics & numerical data*
  • Young Adult

Grant support

Financial support for this study was provided by the International Partnership for Microbicides (IPM). Funding from European Union Seventh Framework Programme, through the DIFFER project, grant agreement number Health-F3-2011-282542 supported the contribution of MF Chersich to this research. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.