Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya

• Published in: International journal of environmental research and public health Vol. 20; no. 11; p. 6046
• Main Authors: Beattie, Tara S, Kabuti, Rhoda, Beksinska, Alicja, Babu, Hellen, Kung'u, Mary, The Maisha Fiti Study Champions, Shah, Pooja, Nyariki, Emily, Nyamweya, Chrispo, Okumu, Monica, Mahero, Anne, Ngurukiri, Pauline, Jama, Zaina, Irungu, Erastus, Adhiambo, Wendy, Muthoga, Peter, Kaul, Rupert, Seeley, Janet, Weiss, Helen A, Kimani, Joshua
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 03.06.2023; MDPI
• Subjects: Abused women; Adolescence; Adolescents; Adverse childhood experiences; Aggression; Analysis; Arrests; Breastfeeding & lactation; Childhood factors; Children; Clinics; Domestic violence; Ethics; Families & family life; Family violence; Females; Gender-based violence; Health risks; HIV; Human immunodeficiency virus; Hunger; Imprisonment; Inflammation; Intimate partner violence; Mental health; Police; Pregnancy; Questionnaires; Rape; Regression analysis; Reproductive health; Sex crimes; Sex industry; Sex oriented businesses; Sex workers; Sexual assault; Sexually transmitted diseases; Sociodemographics; Statistical analysis; STD; Surveys; Vagina; Variables; Violence; Womens health; Working women; Kenya; India; Nairobi Kenya; adverse childhood experiences (ACEs); HIV; Kenya; female sex workers; violence
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph20116046

We examined violence experiences among Female Sex Workers (FSWs) in Nairobi, Kenya, and how these relate to HIV risk using a life course perspective. Baseline behavioural-biological surveys were conducted with 1003 FSWs June-December 2019. Multivariable logistic regression models were used to estimate the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for associations of life course factors with reported experience of physical or sexual violence in the past 6 months. We found substantial overlap between violence in childhood, and recent intimate and non-intimate partner violence in adulthood, with 86.9% reporting one or more types of violence and 18.7% reporting all three. Recent physical or sexual violence (64.9%) was independently associated with life course factors, including a high WHO Adverse Childhood Experiences (ACE) score (AOR = 7.92; 95% CI:4.93-12.74) and forced sexual debut (AOR = 1.97; 95% CI:1.18-3.29), as well as having an intimate partner (AOR = 1.67; 95% CI:1.25-2.23), not having an additional income to sex work (AOR = 1.54; 95% CI:1.15-2.05), having four or more dependents (AOR = 1.52; 95% CI:0.98-2.34), recent hunger (AOR = 1.39; 95% CI:1.01-1.92), police arrest in the past 6 months (AOR = 2.40; 95% CI:1.71-3.39), condomless last sex (AOR = 1.46; 95% CI:1.02-2.09), and harmful alcohol use (AOR = 3.34; 95% CI:1.74-6.42). Interventions that focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including violence experience and HIV acquisition.