Addressing Broader Reproductive Health Needs of Female Sex Workers Through Integrated Family planning/ HIV Prevention Services: A Non-Randomized Trial of a Health-Services Intervention Designed to Improve Uptake of Family Planning Services in Kenya

PLoS One. 2019 Jul 24;14(7):e0219813. doi: 10.1371/journal.pone.0219813. eCollection 2019.


Background: Despite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC.

Methods: We conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use.

Results: The intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners.

Conclusions: Self-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW.

Trial registration: NCT01957813.

Publication types

  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / prevention & control*
  • Adolescent
  • Adult
  • Contraception / standards*
  • Facilities and Services Utilization / statistics & numerical data
  • Female
  • Humans
  • Kenya
  • Middle Aged
  • Pregnancy
  • Preventive Health Services / methods
  • Preventive Health Services / standards*
  • Preventive Health Services / statistics & numerical data
  • Reproductive Health
  • Sex Education / standards*
  • Sex Workers / education
  • Sex Workers / statistics & numerical data*

Associated data


Grant support

This research was funded through the United States Agency for International Development Prevention Technologies Agreement, grant number GHO-A-00-09-00016-00. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.