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Research article
Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya
Sharmistha Mishra
University of Toronto
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8492-5470
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14 – 24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW.
Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14 – 24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14 – 18 years, N=117; 19 – 24 years, N=291) and by program contact (ever contacted by local program for sex workers).
Results: 47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p=1.00) . Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9% and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14 – 18 years; and 15.8% of those aged 19 – 24 years, p=0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact.
Conclusions: SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.
Keywords
sex work, Kenya, Sustainable Development Goals, HIV, sexual health, reproductive health, sexual violence, physical violence, adolescence, youth
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CURRENT STATUS: Under Review
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Posted 17 May, 2020
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Editor assigned
On 04 May, 2020
Editor invited
On 03 May, 2020
Submission checks complete
On 23 Dec, 2019
No comments provided
Review #1 received
Received 20 Apr, 2020
Editorial decision: Minor revision
On 20 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 17 Mar, 2020
Editor assigned
On 04 Mar, 2020
Submission checks complete
On 03 Mar, 2020
Editor invited
On 03 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 29 Feb, 2020
Review #2 received
Received 21 Feb, 2020
Reviewer #3 agreed
On 19 Feb, 2020
Review #1 received
Received 02 Jan, 2020
Reviewers invited
Invitations sent on 30 Dec, 2019
Reviewer #1 agreed
On 30 Dec, 2019
Reviewer #2 agreed
On 30 Dec, 2019
Editor assigned
On 24 Dec, 2019
Submission checks complete
On 23 Dec, 2019
Editor invited
On 23 Dec, 2019
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya
Sharmistha Mishra
University of Toronto
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8492-5470
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 17 May, 2020
No community comments so far
Editor assigned
On 04 May, 2020
Editor invited
On 03 May, 2020
Submission checks complete
On 23 Dec, 2019
No comments provided
Review #1 received
Received 20 Apr, 2020
Editorial decision: Minor revision
On 20 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 17 Mar, 2020
Editor assigned
On 04 Mar, 2020
Submission checks complete
On 03 Mar, 2020
Editor invited
On 03 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 29 Feb, 2020
Review #2 received
Received 21 Feb, 2020
Reviewer #3 agreed
On 19 Feb, 2020
Review #1 received
Received 02 Jan, 2020
Reviewers invited
Invitations sent on 30 Dec, 2019
Reviewer #1 agreed
On 30 Dec, 2019
Reviewer #2 agreed
On 30 Dec, 2019
Editor assigned
On 24 Dec, 2019
Submission checks complete
On 23 Dec, 2019
Editor invited
On 23 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14 – 24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW.
Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14 – 24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14 – 18 years, N=117; 19 – 24 years, N=291) and by program contact (ever contacted by local program for sex workers).
Results: 47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p=1.00) . Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9% and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14 – 18 years; and 15.8% of those aged 19 – 24 years, p=0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact.
Conclusions: SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.
Figure 1