Interpersonal violence and HIV sexual risk behaviors among female sex workers in Mombasa, Kenya: Associations with early initiation of sex work

Background: Between 20-40% of female sex workers (FSW) worldwide began sex work before age 18. Little is known about the relationship between early initiation of sex work and interpersonal violence or HIV sexual risk behaviors among adult FSW.

Methods: The sample was comprised of 816 FSW in Mombasa, Kenya who were 18 years or older, associated with HIV prevention drop-in centers and moderate risk drinkers. Early initiation of sex work was defined as beginning sex work at 17 or younger. In-person interviews assessed recent violence (physical and sexual violence) and HIV sexual risk (consistent condom use) with paying and non-paying partners. Logistic regression was performed, adjusting for drop-in center, current age, HIV status, and childhood abuse.                        

Results: Twenty percent of the sample reported early initiation of sex work. Early initiators were significantly more likely to experience recent physical and sexual violence from paying partners and less likely to report consistent condom use with paying partners. Among early initiators, 44% reported sexual violence and 41% reported physical violence with paying partners compared to 29% and 23%, respectively, among those who did not initiate sex work early. Early initiation was not associated with violence or HIV sexual risk with non-paying partners.

Conclusions: FSW who initiated sex work early are at particularly high risk of violence from paying partners. Interventions to prevent violence and reduce HIV sexual risk behaviors among adolescent FSW and adult FSW who initiated sex work early are needed. More work is needed to prevent early initiation of sex work.