Abstract
ObjectivesTo assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.DesignCohort study with quarterly follow-up visit over 12-months.MethodsFour hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.ResultsFour or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use.ConclusionsHigh-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
Highlights
In sub-Saharan Africa an estimated 0.7% to 4.3% of women exchange sex for money, goods or favours [1]
The analysis presented here compared sexual behaviour of female sex workers (FSWs) with different partner types within this cohort, emotional partners, and regular and casual clients
Field workers were familiar with their respective areas and responsible for inviting women to enrol in the study and maintain contact with them throughout the study period
Summary
In sub-Saharan Africa an estimated 0.7% to 4.3% of women exchange sex for money, goods or favours [1]. Though the exact extent of the contribution is contested, sex workers, their clients and emotional partners play an important role in HIV transmission in sub-. HIV prevention initiatives in sex work settings overwhelming focus on sex workers, with few efforts to target sex worker clients, and virtually none addressing their emotional partners [6]. This is mostly because sex workers are easier to locate than their sexual partners, but reinforces notions of sex workers as disease vectors. Additional evidence for the role played by emotional partners of FSWs, and the often complex interaction between FSWs and these partners may stimulate research and programmatic interventions in this area
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