Abstract
The overall objective of this study is to characterize the effects of substance use and violence on HIV/STI risk among female sex workers in Kisumu, Kenya. Worldwide, female sex workers have 13 times the odds of being HIV+ compared to the general population, and the majority of infection is concentrated in sub-Saharan Africa. Female sex workers are a priority or “key population” for prevention interventions in Kenya due to their vulnerability to HIV, sexually transmitted infections (STIs), and other reproductive health harms. In Kisumu, western Kenya, survey research has documented an extraordinary HIV prevalence of 56.5% among female sex workers. Our preliminary ethnographic work at a health clinic serving key populations in Kisumu suggests that alcohol and drug use and sexual violence (perpetrated by intimates, clients, and police) are all prevalent and may interact to significantly contribute to the heightened HIV prevalence among sex workers.
We will draw on syndemic theory to examine these interrelated issues that contribute to high morbidity and mortality among sex workers in Kenya. A syndemic is two or more linked epidemics that synergistically interact to intensify suffering and create poor health outcomes for vulnerable populations. We propose an exploratory, qualitative study as a first step toward understanding the syndemic of substance use, violence, and HIV/STI risk among female sex workers in Kisumu, Kenya, pursuant to the following aims: 1) To characterize the social context, types, and perpetrators of violence experienced by female sex workers who use alcohol and drugs, and 2) To examine the feasibility, acceptability, and potential content and format of an intervention to reduce violence and improve HIV/STI and other health outcomes. To achieve these aims, we will conduct in-depth, qualitative interviews with ~40 female sex workers who use alcohol and drugs. Applying a syndemic framework to understand heightened HIV/STI risk among sex workers invites a more comprehensive approach to women’s health and will help us identify critical factors to target in a future health intervention.
Publications resulting from this seed grant
2019. Syvertsen, et al. “You can't do this job when you are sober: Heroin use among female sex workers and the need for comprehensive drug treatment programming in Kenya” Drug Alcohol Depend. 2019 Jan 1;194:495-499. doi: 10.1016/j.drugalcdep.2018.10.019. PMCID:PMC6334295