Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya

Alicja Beksinska, Emily Nyariki, Rhoda Kabuti, Mary Kungu, Hellen Babu, Pooja Shah, The Maisha Fiti Study Champions, Chrispo Nyabuto, Monica Okumu, Anne Mahero, Pauline Ngurukiri, Zaina Jama, Erastus Irungu, Wendy Adhiambo, Peter Muthoga, Rupert Kaul, Janet Seeley, Helen A. Weiss, Joshua Kimani and Tara S. Beattie
Additional contact information
Alicja Beksinska: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
Emily Nyariki: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Rhoda Kabuti: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Mary Kungu: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Hellen Babu: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Pooja Shah: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
The Maisha Fiti Study Champions: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Chrispo Nyabuto: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Monica Okumu: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Anne Mahero: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Pauline Ngurukiri: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Zaina Jama: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Erastus Irungu: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Wendy Adhiambo: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Peter Muthoga: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Rupert Kaul: Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
Janet Seeley: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
Helen A. Weiss: MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Joshua Kimani: Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya
Tara S. Beattie: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK

IJERPH, 2022, vol. 19, issue 12, 1-19

Abstract: Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural–biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0–32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1–24.1%) and 16.9% harmful cannabis use (95%CI 14.7–19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours.

Keywords: female sex workers; alcohol; harmful alcohol use; drugs; harmful substance use; cannabis; amphetamines; Kenya; quantitative methods; qualitative methods (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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