Patterns of inconsistent condom use and risky sexual behaviors among female sex workers in Mozambique

• Published in: BMC public health Vol. 24; no. 1; pp. 2711 - 12
• Main Authors: Muleia, Rachid, Banze, Auria Ribeiro, Damião, Shelsea Luís, Baltazar, Cynthia Semá
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.10.2024; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age; Aggression; AIDS; Binge drinking; Condoms; Condoms - statistics & numerical data; Criminalization; Cross-Sectional Studies; Disease transmission; Drinking behavior; Education; Empowerment; Female; Female sex workers; Females; Gender equity; Geographical locations; Health aspects; Health behavior; Health risks; Health services; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Inconsistent condom use; Infections; Intervention; Mozambique; Mozambique - epidemiology; Population; Prevention; Prostitutes; Prostitution; Questionnaires; Regression analysis; Regression models; Risk taking; Risk-taking (Psychology); Risky sexual behaviors; Sex industry; Sex Workers - psychology; Sex Workers - statistics & numerical data; Sexual behavior; Sexual Behavior - statistics & numerical data; Sexual health; Sexually transmitted diseases; Statistical analysis; STD; Surveys; Urban areas; Violence; Workers; Young Adult; Mozambique; Female sex workers; Mozambique; Inconsistent condom use; Risky sexual behaviors
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-20236-y

Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions. This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI). Among the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15-24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work < 18 years (31.0%), binge drinking (23.7%), and experiencing physical violence (29.0%) were significantly associated with this behavior. Among the 2,564 FSWs reporting risky sexual behaviors, a higher prevalence was observed in FSWs aged 15-24 (75.6%), those with secondary or higher education (75.8%), nationals (74.4%), and those residing in Quelimane (87.3%). Early sexual debut (< 15 years, 79.3%), initiating sex work before 18 years of age (77.7%), and illicit drug use (82.2%) were all associated with increased risky sexual practices. Inconsistent condom use among FSWs was significantly associated with residing in Tete (aRR = 2.4, 95% CI: 1.77-3.25), not being aware of female condom (aRR = 1.22, 95% CI: 1.03-1.45) and having experienced sexual a physical violence. Moreover, being married was significantly linked to risky sexual behavior among female sex workers (aRR = 1.27, 95% CI: 1.19-1.37), along with initiating sexual activity before age 15, having at least five years of sex work experience, engaging in binge drinking, and experiencing sexual and physical violence. The study highlights the complex set of factors as age, education, geographic location, years of sex work services, early sexual debut, and illicit drug use that influence sexual risks behavior among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and illicit drug use is imperative for mitigating these risks.