Objectives Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.
Methods In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.
Results FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.
Conclusions Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.
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Handling editor Jackie A Cassell
Contributors AMP developed the research question, designed and conducted the analyses and wrote the initial draft of the manuscript. KLL designed and directed the parent study and contributed to the development of the research question and manuscript writing. SLM contributed to the development of the research question, manuscript writing and critical revision. CS contributed to statistical analyses and manuscript writing. SG contributed to manuscript writing and critical revision. PM assisted with implementation and management of the parent study. All authors contributed to the writing and have approved the final manuscript.
Funding This study was supported by the Public Health Evaluation (PHE) component of the President's Emergency Plan for AIDS Relief (PEPFAR), PHE #KE09.0235. Funding was provided through the US Agency for International Development (USAID), under the terms of AID-623-A-11-00007. The project was also supported by Award Number T32 MH019139 (Principal Investigator, Theodorus Sandfort, PhD) from the National Institute of Mental Health.
Competing interests None declared.
Ethics approval University of North Carolina at Chapel Hill's Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.