The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective

• DOI: 10.1371/journal.pgph.0001529
• Publication Date: 2024-01-08T18:21:56Z
• Authors: Tara S. Beattie; Wendy Adhiambo; Rhoda Kabuti; Alicja Beksinska; Pauline Ngurukiri; Hellen Babu; Mary Kung’u; Chrispo Nyamweya; Anne Mahero; ; Erastus Irungu; Peter Muthoga; Janet Seeley; Joshua Kimani; Helen A. Weiss; Rupert Kaul
• Keywords: Sex Work; Life course approach; Cross-sectional study

High HIV prevalence among female sex workers (FSWs) is heavily influenced by structural determinants (e.g. criminalisation of work; violence) and significant life events orphanhood, teenage pregnancy). This study aims to understand the epidemiology FSWs in Nairobi, Kenya using a life-course perspective. Baseline cross-sectional survey data were collected June–December 2019 for Maisha Fiti with 1003 (aged 18–45 years). Odds ratios 95% confidence intervals estimated multivariable logistic regression hierarchical modelling approach. was 28.0%, increased age (<25 years 5.7%, 25–34 19.0%, ≥35 40.6%). In adjusted analyses, seroprevalence associated childhood adolescence including violence from militia or soldiers (AOR = 1.60; 95%CI:1.00–2.53), young at sexual debut (≤15 old vs. ≥18 AOR 0.57; 95%CI:0.39–0.84) pregnancy 1.37; 95%CI:1.00–1.88). For adulthood factors included lower SES score (lowest highest tertile 0.63; 95%CI:0.40–0.98); reduced housing insecurity 0.52; 95%CI:0.54–0.79); alcohol/drug use 0.44; 95%CI:0.31–0.61); longer duration selling (0–5 ≥11 2.35; 95%CI:1.44–3.82). Among HIV-negative FSWs, risk high (recent hunger 32.3%; internalised 67.7% experienced 66.0% work stigma; recent police arrest 30.1%; physical 65.6%, condomless last intimate partner 71.1%; harmful alcohol substance 49.1%). Only 24.6% reported taking PrEP. Taken together, adverse odds living HIV, more strongly serostatus than behavioural factors. remain acquisition. highlights importance addressing throughout course reduce risk, need continue multi-level prevention treatment efforts.