Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya
Objective To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya.Design Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi.Participants and measures FSWs aged 18...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/4/e068886.full |
| _version_ | 1797847748373905408 |
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| author | Karen Devries Helen Anne Weiss Janet Seeley Mitzy Gafos Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Graham F Medley Rhoda Kabuti Hellen Babu Mary Kung'u Jennifer Liku Zaina Jama Emily Nyariki |
| author_facet | Karen Devries Helen Anne Weiss Janet Seeley Mitzy Gafos Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Graham F Medley Rhoda Kabuti Hellen Babu Mary Kung'u Jennifer Liku Zaina Jama Emily Nyariki |
| author_sort | Karen Devries |
| collection | DOAJ |
| description | Objective To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya.Design Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi.Participants and measures FSWs aged 18–45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural–biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management.Results 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency.Conclusions This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options. |
| first_indexed | 2024-04-09T18:17:09Z |
| format | Article |
| id | doaj.art-2123d24c6fd64ea7bfcc793f5c9a475f |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-09T18:17:09Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-2123d24c6fd64ea7bfcc793f5c9a475f2023-04-13T00:00:06ZengBMJ Publishing GroupBMJ Open2044-60552023-04-0113410.1136/bmjopen-2022-068886Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, KenyaKaren Devries0 1Helen Anne Weiss2Janet Seeley3Mitzy Gafos4Rupert Kaul5Nambusi Kyegombe6Joshua Kimani7Tara S Beattie8Pooja Shah9Graham F Medley10Rhoda Kabuti11Hellen Babu12Mary Kung'u13Jennifer Liku14Zaina Jama15Emily Nyariki16Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKRadboudumc, Nijmegen, The NetherlandsEpidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKMRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda3 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK1University of Toronto, Toronto, CanadaDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKDepartment of Medical Microbiology, University of Nairobi, Nairobi, KenyaFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK1 Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKPartners for Health and Development, Nairobi, KenyaPartners for Health and Development, Nairobi, KenyaPartners for Health and Development in Africa, Nairobi, KenyaPartners for Health and Development in Africa (PHDA), Nairobi, KenyaPartners for Health and Development in Africa (PHDA), Nairobi, KenyaPartners for Health and Development in Africa (PHDA), Nairobi, KenyaObjective To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya.Design Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi.Participants and measures FSWs aged 18–45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural–biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management.Results 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency.Conclusions This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options.https://bmjopen.bmj.com/content/13/4/e068886.full |
| spellingShingle | Karen Devries Helen Anne Weiss Janet Seeley Mitzy Gafos Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Graham F Medley Rhoda Kabuti Hellen Babu Mary Kung'u Jennifer Liku Zaina Jama Emily Nyariki Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya BMJ Open |
| title | Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya |
| title_full | Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya |
| title_fullStr | Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya |
| title_full_unstemmed | Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya |
| title_short | Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya |
| title_sort | syndemic of factors that shape the early lives of women who enter into sex work a qualitative methods study from nairobi kenya |
| url | https://bmjopen.bmj.com/content/13/4/e068886.full |
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