Factors associated with alcohol use before sex among HIV-negative female sex workers in Zambia

Int J STD AIDS. 2020 Feb;31(2):119-126. doi: 10.1177/0956462419886159. Epub 2020 Jan 16.


Female sex workers (FSW) are at high risk of HIV infection. Alcohol use prior to sex can compound this risk. We investigated the factors associated with having sex under the influence of alcohol among Zambian FSW. Community health workers and peer FSW recruited 331 HIV-negative FSW in Lusaka and Ndola. In a cross-sectional survey, we asked FSW how often they had sex under the influence of alcohol in the previous month, and categorised responses as ‘always’ and ‘not always’. The adjusted odds ratios (AOR) of always having sex under the influence of alcohol were higher among FSW who: charged clients medium (AOR: 2.20, 95% confidence interval (CI): 1.04–4.68) and low fees (AOR: 2.65, 95% CI: 1.26–5.60) for sex versus high fees; received 9–19 (AOR: 2.37, 95% CI: 1.15–4.91) and 20 or more clients per month (AOR: 3.06, 95% CI: 1.47–6.37) versus up to eight clients per month; and never used condoms versus always used condoms with clients (AOR: 4.21, 95% CI: 1.53–11.55). FSW who always used alcohol before sex appeared more likely to engage in riskier sex and charge clients lower fees. Interventions for financial empowerment and alcohol risk reduction should complement existing HIV prevention interventions for FSW.

Keywords: Female sex workers; HIV; Zambia; alcohol.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / psychology*
  • Cross-Sectional Studies
  • Female
  • HIV Infections
  • HIV Seronegativity*
  • Humans
  • Male
  • Risk-Taking
  • Sex Work / statistics & numerical data
  • Sex Workers / psychology*
  • Sex Workers / statistics & numerical data
  • Sexual Partners*
  • Unsafe Sex
  • Zambia / epidemiology