Participant characteristics (Table 1)
Of the 1,419 women invited to participate, 1,304 were eligible, and of whom 1,299 provided consent and completed the interview (91.5% of those screened, 99.6% of those eligible). Four hundred and eight self-identified as sex workers, of whom 95.8% (N=391) identified as current sex workers, and the remaining (N=17) identified as past sex workers.
The median age of participants was 20 years (inter-quartile range [IQR] 18 – 22); and 28.7% (N=117/408) were between the ages of 14 – 18 years (Table 1). Few (6.6%, N=27/408) were ever married. More than half (59.8%, N=244/408) reported having sex with a non-paying sexual partner in the past month, with a median of 2 (IQR 1 – 4) non-paying sexual partners in the past month. The median age of first sex was 15 years (IQR 14 – 17). The median age at which participants self-identified as a sex worker was 18 years (IQR 16 - 20), with a median duration in formal sex work of 2 years (IQR 1 – 3). Four out of five (80.4%, N=328/408) participants had at least one paying sexual clients in the past month. The median number of paying partners in the previous month was 7 (IQR 4 – 15). Over half of the participants (57.4%, N=234/408) had been pregnant at least once.
Table 1: Characteristics of women age 14-24 years who sell sex in Mombasa, Kenya (2015)
Characteristics
|
N=408
|
Median (IQR)
|
% (95% CI)
|
Current age (years)
|
Median age (IQR)
|
---
|
20 (18 – 22)
|
---
|
Age-group
|
|
|
|
14-18
|
117
|
---
|
28.7 (24.3 – 33.1)
|
19-24
|
291
|
---
|
71.3 (66.9 – 75.7)
|
Characteristics of sexual partnerships outside of sex work
|
Ever married
|
27
|
---
|
6.6 (4.2 – 9.0)
|
Had at least one non-paying sexual partner in past month
|
244
|
---
|
59.8 (55.0 – 64.6)
|
Median number of non-paying sexual partners in past month (IQR)a
|
---
|
2 (1 – 4)
|
---
|
Characteristics of sex work
|
Age of first sex, years
|
---
|
15 (14 – 17)
|
---
|
Age of first paid sexb, years
|
---
|
18 (16 – 20)
|
---
|
Duration in sex work, years
|
---
|
2 (1– 3)
|
---
|
Had at least one paying sexual clients in past month
|
328
|
|
80.4 (76.5 – 84.2)
|
Median number of paying sexual partners in past month (IQR)c
|
---
|
7 (4 – 15)
|
---
|
Reproductive History
|
Ever pregnant
|
234
|
---
|
57.4 (52.6 – 62.2)
|
Currently has >=1 childd
|
188
|
---
|
46.1 (41.2 – 50.9)
|
CI (confidence interval)
IQR (inter-quartile range)
|
Program engagement by age (Figure 1)
Overall, program awareness and program contact were low (Figure 1). One quarter of participants (25.7%, N=105/408) were aware of at least one program. 13.7% (N=56/408) were ever contacted by a program, 9.1% (N=37/408) were registered in a program, and 8.8% had ever used a program clinic (N=36/37; 97.3% of those who were registered). Only 1.2% (N=5/37; 13.5% of those registered) were peer workers. In general, program awareness (29.2% vs. 17.1%, p=0.01) and program contact (15.8% vs. 8.5%, p=0.06) were higher among participants aged 19 – 24 years compared to those aged 14 – 18. 3.4% (N=4/117) of participants aged 14 – 18 and 11.3% (N=33/291) of participants aged 19 – 24 were registered with a local program. With respect to later elements of program engagement, among YSW, 2.6% of those aged 14 – 18 years and 11.3% of those aged 19 – 24 years had ever used a program clinic (p<0.01).
Figure 1: Program engagement among women age 14-24 years who sell sex in Mombasa, Kenya (2015)
-Insert Figure 1 graphic file here -
Figure 1 Footnote
1Program defined as a non-governmental organization /community-based organization
2Peer worker of a non-governmental organization /community-based organization
Sexual vulnerabilities by age (Table 2)
Nearly half of the participants who had sex with any partner in the previous week (47.3%, N=160/338) reported inconsistent condom use. With respect to inconsistent condom use with at least one sexual encounter, 29.6% (N=86/291) and 55.8% (N=115/206) of participants reported this behaviour with any paying partner and with any non-paying partner respectively. The prevalence of inconsistent condom use was similar across the two age-groups, irrespective of partner type (Table 2).
Table 2: Inconsistent condom use in the past week among YSW by age group and program contact in Mombasa, Kenya (2015)
|
Inconsistent condom use in previous week, by partner typea
|
|
Overall population
|
Age group
|
Program contactb
|
Sexual engagement in previous week, by partner type
|
|
|
14-18,
N=117
|
19-24,
N=291
|
|
No, N=352
|
Yes, N=56
|
|
|
n/N
|
% (95% CI)
|
% (95% CI)
|
% (95% CI)
|
p-value
|
% (95% CI)
|
% (95% CI)
|
p-value
|
With paying partner
(N=291)
|
86/291
|
29.6
(24.3 – 34.8)
|
32.5
(22.2 – 42.8)
|
28.4
(22.3 - 34.5)
|
0.56
|
29.8
(24.1-35.5)
|
28.3
(15.2-41.3)
|
0.97
|
With non- paying partner (N=206)
|
115/206
|
55.8
(49.0 – 62.6)
|
57.7
(44.3 - 71.1)
|
55.2
(47.3 - 63.0)
|
0.87
|
56.0
(48.6-63.4)
|
54.8
(37.3-72.4)
|
1.00
|
With any partnerc (N=338)
|
160/338
|
47.3
(42.0 – 52.7)
|
47.2
(36.8 - 57.6)
|
47.4
(41.2 - 53.6)
|
1.00
|
47.7
(42.0-53.5)
|
45.1
(31.4-58.8)
|
0.84
|
YSW (young women who sell sex, age 14-24 years)
aInconsistent condom use defined as at least one encounter (vaginal and/or anal sex) without a condom with any partner of a given type in the previous week
b Program contact defined as ever contacted by peers of a non-governmental organization /community-based organization
cDefined as inconsistent condom use during vaginal and/or anal sex with >=1 sexual partner in the previous week
|
Socioeconomic structural vulnerabilities by age (Table 3)
Most (83.6%, N=341/408) participants did not have a regular source of income; 82.4% (N=336/408) reported they could not independently cover their living expenses last month; although only 13.5% (N=55/408) reported they did not keep all their wages. Few participants (2.7%, N=11/408) could not read and/or write and 30.4% (N=124/408) had not completed primary school. There was little variability in socioeconomic vulnerabilities by age, although there was a trend towards lower educational attainment among younger participants (Table 3).
Violence-related structural vulnerabilities by age (Table 3)
Findings show that 29.9% (N=122/408), 29.2% (N=119/408), and 44.9% (N=183/408) of participants reported ever experiencing physical violence, sexual violence, and police harassment respectively (Table 3). Of those, 64.8% (N=79/408), 48.7% (N=58/408), and 76.0% (N=139/408) experienced physical violence, sexual violence, and police harassment, respectively in the previous year. The prevalence of physical (30.2% [N=88/291] vs. 29.1% [N=34/117], p=0.90) or sexual violence (30.9% [N=90/291] vs. 24.8% [N=29/117], p=0.23) did not vary by age and 29.1% and 24.8% of participants had experienced physical and sexual violence at least once by age 18. The prevalence of police harassment was higher among older participants (lifetime experience, 51.2% [N=149/291] vs. 29.1% [N=34/117], p<0.01).
Alcohol-related structural vulnerabilities by age (Table 3)
Most (79.4%, N=324/408) participants consumed alcohol in the past month (Table 3). Of those who consumed alcohol in the past month, 47.5% (N=154/408) were inebriated at least once in the past month; and 72.7% (N=112/154) reported they were inebriated at least once during sex in the past month. Most (69.4%, N=283/408) also reported that at least one partner was inebriated during sex in the past month. As with the other structural vulnerabilities, the prevalence of alcohol-related vulnerabilities was similar in the two age-groups (p>0.05 for each of the five measures, Table 3).
Reproductive health vulnerabilities by age (Table 4)
About one in four participants (26.5%, N=108/408) reported a history of at least one pregnancy during their adolescence. There was a higher prevalence of adolescent pregnancy among younger participants (37.6% [N=44/117] vs. 22.0% [N=64/291], p=0.002). Among the 234 participants with a history of pregnancy, 23.9% (N=56) reported at least one induced abortion in their lifetime. There was little variability by age such that by the age of 18 years, nearly a quarter of participants with a history of pregnancy reported at least one induced abortion. Two-thirds (66.1%, N=37/56) of the most recent abortions were unsafe; with similar proportions across the age groups. Among those who were using contraception, 18.5% (N=62/336) used a non-reliable form; with little variability by age group.
Table 4: Vulnerabilities in reproductive health by age and program contact among YSW in Mombasa, Kenya (2015)
|
Overall population
|
Age group
|
Program contacta
|
|
|
|
14-18,
N=117
|
19-24,
N=291
|
|
No,
N=352
|
Yes,
N=56
|
|
|
n/N
|
% (95% CI)
|
% (95% CI)
|
% (95% CI)
|
p-value
|
% (95% CI)
|
% (95% CI)
|
p-value
|
Adolescent pregnancyb
|
108/408
|
26.5
(22.3-31.0)
|
37.6
(28.8-47.0)
|
22.0
(17.4-27.2)
|
<0.01
|
25.3
(20.8-30.2)
|
33.9
(21.8-47.8)
|
0.19
|
Ever had abortionc
|
56/234
|
23.9
(18.6-29.9)
|
23.9
(12.6-38.8)
|
23.9
(18-30.7)
|
1.00
|
23.5
(17.8-30.0)
|
26.5
(12.9-44.4)
|
0.67
|
Most recent abortion was unsafe d, e
|
37/56
|
66.1
(52.2-78.2)
|
81.8
(48.2-97.7)
|
62.2
(46.5-76.2)
|
0.30
|
66.0
(50.7-79.1)
|
66.7
(29.9-92.5)
|
1.00
|
Currently using unreliable forms of contraceptionf, g
|
62/336
|
18.5
(14.4 – 23.0)
|
18.1
(10.9-27.4)
|
18.6
(13.9-24.1)
|
1.00
|
17.4
(13.1-22.3)
|
24.1
(13.5-37.6)
|
0.25
|
CI (confidence interval)
YSW (young women who sell sex, age 14-24 years)
a Program contact defined as ever contacted by peers of a non-governmental organization /community-based organization
bAdolescent pregnancy refers to the first pregnancy that occurred before age of 18
cAmong participants who had a history of pregnancy (N=234)
dAmong participants who had a history of abortion (N=56)
eUnsafe abortion defined as any abortion not performed in public/government/private/non-governmental organization /community-based organization/ faith-based organization facility
fAmong participants who are currently using any forms of contraception (N=336)
gUnreliable forms of contraception are defined as inconsistent and non-modern forms of contraception such as rhythm method, withdrawal, and emergency contraception
Vulnerabilities by program contact (Tables 2, 3 and 4)
In general, there was little variability in the prevalence of sexual, structural and reproductive vulnerabilities by whether or not participants were contacted by local programs (Tables 2, 3, 4; p>0.05 across each measure). For example, the prevalence of inconsistent condom use with any partner in the previous week was almost same among participants with and without program contact (28.3% vs 29.8%, p=0.97). There were however a few notable differences with a suggestion of a trend towards higher or lower prevalence of structural and reproductive health vulnerabilities by program contact. For example, participants without program contact were more likely to report a lifetime history of sexual violence (30.4% vs 21.4%, p=0.21) but those with program contact were more likely to report a lifetime history of police harassment (55.4% vs 43.2%, p=0.11). Within the reproductive health domain, there was a trend towards higher prevalence of adolescent pregnancy (33.9% vs 25.3%, p=0.19) among the small subset of participants who had been contacted by programs versus those who had not.