Background: Structural vulnerabilities are important facilitators of HIV infection among women. The Transitions study examines young women’s HIV risk and the context of HIV transmission as they progress through their sexual life course from first sex and casual sex to transactional and formal sex work. This presentation focuses on substance use and experience of violence among young Kenyan women who engaged in casual sex (CS), transactional sex (TS) and formal sex work (SW).
Methods: Young women aged 14-24 years in Mombasa, Kenya were sampled “proportional-to-population-size” from hotspots (where female sex workers congregated to seek sex partners) for a cross-sectional survey which solicited information about their sexual and other risk behaviours. Substance use and experience of violence among women who engaged in CS, TS and SW were analyzed using descriptive statistics.
Results: 714, 177 and 408 women who engaged in CS, TS and SW, respectively, participated in the study. While 80.4%, 50.2% and 20.4% women respectively have never had alcoholic beverages, 0.1%, 3.4% and 16.7% consumed alcohol everyday in the last month (p=0.00). Injection drug use was highest among female sex workers (0.1% CS, 0.0% TS, 1.5% SW; p=0.01); they also more commonly experienced physical violence by a sex partner (10.1% CS, 18.39% TS, 28.2% SW; p=0.00). Report of being forced by their first sex partner to have sex while not willing was marked across all groups (13.6% CS, 28.9% TS, 29.6% SW; p=0.00).
Conclusions: Although variability exists, young women who engage in casual and transactional sex are exposed to similar types of structural facilitators of HIV infection compared to female sex workers. To be effective and relevant, HIV prevention programs that are targeted to female sex workers only need to consider expanding their scope of service to those who engage in transactional sex and other forms of high-risk sex.