Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya
Objective To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya.Background Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use pr...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/12/e078618.full |
| _version_ | 1797370035805618176 |
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| author | Karen Devries Helen Anne Weiss Janet Seeley Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Alicja Beksinska Graham F Medley Rhoda Kabuti Mary Kungu Hellen Babu Zaina Jama Emily Nyariki Pauline Ngurukiri Demtilla Gwala Daisy Oside Ruth Kamene Agnes Watata Agnes Atieno Faith Njau Mary Akinyi |
| author_facet | Karen Devries Helen Anne Weiss Janet Seeley Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Alicja Beksinska Graham F Medley Rhoda Kabuti Mary Kungu Hellen Babu Zaina Jama Emily Nyariki Pauline Ngurukiri Demtilla Gwala Daisy Oside Ruth Kamene Agnes Watata Agnes Atieno Faith Njau Mary Akinyi |
| author_sort | Karen Devries |
| collection | DOAJ |
| description | Objective To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya.Background Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation.Design Building on previous qualitative research with this cohort, analysis of behavioural–biological cross-sectional data using hierarchical logistic regression.Participants and measures FSWs aged 18–45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural–biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling.Results Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66).Conclusions Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences. |
| first_indexed | 2024-03-08T17:56:37Z |
| format | Article |
| id | doaj.art-c67a554b11274f199fca094eec731210 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-08T17:56:37Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-c67a554b11274f199fca094eec7312102024-01-02T04:50:08ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2023-078618Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, KenyaKaren Devries0 Helen Anne Weiss1Janet Seeley2Rupert Kaul3Nambusi Kyegombe4Joshua Kimani5Tara S Beattie6Pooja Shah7Alicja Beksinska8Graham F Medley9Rhoda Kabuti10Mary Kungu11Hellen Babu12Zaina Jama13Emily Nyariki14Pauline Ngurukiri15Demtilla GwalaDaisy OsideRuth KameneAgnes WatataAgnes AtienoFaith NjauMary Akinyi4 Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UKEpidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK3 Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada3LSHTM, London, UKPartners for Health and Development in Africa (PHDA), Nairobi, KenyaFaculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UKDepartment of Anaesthesia, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK1 Department of Global Health and Development, 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, Kenya2 Partners for Health and Development in Africa, Nairobi, KenyaObjective To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya.Background Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation.Design Building on previous qualitative research with this cohort, analysis of behavioural–biological cross-sectional data using hierarchical logistic regression.Participants and measures FSWs aged 18–45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural–biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling.Results Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66).Conclusions Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.https://bmjopen.bmj.com/content/13/12/e078618.full |
| spellingShingle | Karen Devries Helen Anne Weiss Janet Seeley Rupert Kaul Nambusi Kyegombe Joshua Kimani Tara S Beattie Pooja Shah Alicja Beksinska Graham F Medley Rhoda Kabuti Mary Kungu Hellen Babu Zaina Jama Emily Nyariki Pauline Ngurukiri Demtilla Gwala Daisy Oside Ruth Kamene Agnes Watata Agnes Atieno Faith Njau Mary Akinyi Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya BMJ Open |
| title | Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya |
| title_full | Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya |
| title_fullStr | Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya |
| title_full_unstemmed | Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya |
| title_short | Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya |
| title_sort | childhood and adolescent factors shaping vulnerability to underage entry into sex work a quantitative hierarchical analysis of female sex workers in nairobi kenya |
| url | https://bmjopen.bmj.com/content/13/12/e078618.full |
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