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Panneh M, Ding Q, Kabuti R, Bradley J, Ngurukiri P, Kungu M, Abramsky T, Pollock J, Beksinska A, Shah P, Irungu E, Gafos M, Seeley J, Weiss HA, Elzagallaai AA, Rieder MJ, Kaul R, Kimani J, Beattie T. Associations of hair cortisol levels with violence, poor mental health, and harmful alcohol and other substance use among female sex workers in Nairobi, Kenya. DISCOVER MENTAL HEALTH 2024; 4:29. [PMID: 39198299 PMCID: PMC11358571 DOI: 10.1007/s44192-024-00086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
Violence, poor mental health, and harmful substance use are commonly experienced by female sex workers (FSWs) in sub-Saharan Africa, all of which are associated with increased HIV susceptibility. We aimed to investigate the associations between violence, poor mental health and harmful alcohol/substance use with hair cortisol concentration (HCC) levels as a potential biological pathway linking the experiences of these stressors and HIV vulnerability. We used the baseline data of the Maisha Fiti study of FSWs in Nairobi, Kenya. Participants reported recent violence, poor mental health, and harmful alcohol/substance use. Hair samples proximal to the scalp were collected to measure cortisol levels determined by ELISA. We analysed the data of 425 HIV-negative respondents who provided at least 2 cm of hair sample. The prevalence of recent violence was 89.3% (physical 54.6%; sexual 49.4%; emotional 77.0% and financial 66.5%), and 29.1% had been arrested due to sex work. 23.7% of participants reported moderate/severe depression, 11.6% moderate/severe anxiety, 13.5% PTSD and 10.8% recent suicidal thoughts and/or attempts. About half of the participants (48.8%) reported recent harmful alcohol and/or other substance use. In multivariable linear regression analyses, both physical and/or sexual violence (adjusted geometric mean ratio (aGMR) = 1.28; 95% CI 1.01-1.62) and harmful alcohol and/or other substance use (aGMR = 1.31; 95% CI 1.03-1.65) were positively and independently associated with increased HCC levels. Findings suggest a role of violence and substance use in elevated HCC levels, which could increase HIV risk due to cortisol-related T cell activation. However, longitudinal and mechanistic studies are needed to confirm this hypothesis.
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Affiliation(s)
- Mamtuti Panneh
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Qingming Ding
- Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Polly Ngurukiri
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tanya Abramsky
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Alicja Beksinska
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Pooja Shah
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mitzy Gafos
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janet Seeley
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Abdelbaset A Elzagallaai
- Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Michael J Rieder
- Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- Department for Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Beattie TS, Pollock J, Kabuti R, Abramsky T, Kung’u M, Babu H, Huibner S, Udayakumar S, Nyamweya C, Okumu M, Mahero A, Beksinska A, Panneh M, Ngurukiri P, Irungu E, Adhiambo W, Muthoga P, Seeley J, Weiss H, Kaul R, Kimani J. Are violence, harmful alcohol/substance use and poor mental health associated with increased genital inflammation?: A longitudinal cohort study with HIV-negative female sex workers in Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003592. [PMID: 39190654 PMCID: PMC11349110 DOI: 10.1371/journal.pgph.0003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024]
Abstract
Violence, alcohol use, substance use and poor mental health have been linked with increased HIV acquisition risk, and genital inflammation enhances HIV susceptibility. We examined whether past 6 month experience of these exposures was associated with increased genital inflammation, thereby providing a biological link between these exposures and HIV acquisition risk. The Maisha Fiti study was a longitudinal mixed-methods study of female sex workers in Nairobi, Kenya. Behavioural-biological surveys were conducted at baseline (June-December 2019) and endline (June 2020-March 2021). Analyses were restricted to HIV-negative women (n = 746). Women with raised levels of at least 5 of 9 genital inflammatory cytokines were defined as having genital inflammation. Multivariable logistic regression models were used to estimate (i) baseline associations between genital inflammation and violence, harmful alcohol/substance use, and poor mental health, and (ii) longitudinal associations between these exposures at different survey rounds, and genital inflammation at follow-up. Inflammation data was available for 711 of 746 (95.3%) women at baseline; 351 (50.1%) had genital inflammation, as did 247 (46.7%) at follow-up. At baseline, 67.8% of women had experienced physical and/or sexual violence in the past 6 months, 33.9% had harmful alcohol use, 26.4% had harmful substance use, 25.5% had moderate/severe depression/anxiety, and 13.9% had post-traumatic stress disorder. In adjusted analyses, there was no evidence that these exposures were associated cross-sectionally or longitudinally with genital inflammation. We report no associations between past 6 month experience of violence, harmful alcohol/substance use, or poor mental health, and immune parameters previously associated with HIV risk. This suggests that the well-described epidemiological associations between these exposures and HIV acquisition do not appear to be mediated by genital immune changes, or that any such changes are relatively short-lived. High prevalences of these exposures suggest an urgent need for sex-worker specific violence, alcohol/substance use and mental health interventions.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Suji Udayakumar
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mamtuti Panneh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Beattie TS, Adhiambo W, Kabuti R, Beksinska A, Ngurukiri P, Babu H, Kung’u M, Nyamweya C, Mahero A, Irungu E, Muthoga P, Seeley J, Kimani J, Weiss HA, Kaul R. The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001529. [PMID: 38190358 PMCID: PMC10773933 DOI: 10.1371/journal.pgph.0001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/26/2023] [Indexed: 01/10/2024]
Abstract
High HIV prevalence among female sex workers (FSWs) is heavily influenced by structural determinants (e.g. criminalisation of sex work; violence) and significant life events (e.g. orphanhood, teenage pregnancy). This study aims to understand the epidemiology of HIV among FSWs in Nairobi, Kenya using a structural determinants and life-course perspective. Baseline cross-sectional survey data were collected June-December 2019 for the Maisha Fiti study with 1003 FSWs (aged 18-45 years). Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression with a hierarchical modelling approach. HIV prevalence was 28.0%, and increased with age (<25 years 5.7%, 25-34 years 19.0%, ≥35 years 40.6%). In adjusted analyses, HIV seroprevalence was associated with childhood and adolescence including violence from militia or soldiers (AOR = 1.60; 95%CI:1.00-2.53), young age at sexual debut (≤15 years old vs. ≥18 years AOR = 0.57; 95%CI:0.39-0.84) and teenage pregnancy (AOR = 1.37; 95%CI:1.00-1.88). For adulthood the factors included lower SES score (lowest vs. highest tertile AOR = 0.63; 95%CI:0.40-0.98); reduced housing insecurity (AOR = 0.52; 95%CI:0.54-0.79); lower alcohol/drug use score (AOR = 0.44; 95%CI:0.31-0.61); and a longer duration of selling sex (0-5 years vs. ≥11 years AOR = 2.35; 95%CI:1.44-3.82). Among HIV-negative FSWs, prevalence of HIV risk factors was high (recent hunger 32.3%; internalised 67.7% and experienced 66.0% sex work stigma; recent police arrest 30.1%; recent physical or sexual violence 65.6%, condomless last sex intimate partner 71.1%; harmful alcohol or substance use 49.1%). Only 24.6% of HIV-negative FSWs reported taking PrEP. Taken together, adverse events in childhood and adolescence were associated with increased odds of living with HIV, and were more strongly associated with HIV serostatus than adulthood structural or behavioural risk factors. HIV-negative FSWs remain at high risk of HIV acquisition. This study highlights the importance of addressing adverse events throughout the life course to reduce HIV risk, and the need to continue multi-level HIV prevention and treatment efforts.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- UNITID, University of Nairobi, Nairobi, Kenya
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology and International Health, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rupert Kaul
- Department of Immunology, University of Toronto, Ontario, Canada
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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Kaggwa MM, Akatussasira R, Al-Mamun F, Prat S, Mamun MA, Combey I, Bongomin F, Harms S, Chaimowitz G, Griffiths MD, Olagunju AT. The global burden of suicidal behavior among people experiencing food insecurity: A systematic review and meta-analysis. J Affect Disord 2023; 342:91-120. [PMID: 37704054 DOI: 10.1016/j.jad.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association. METHODS Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858). RESULTS A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity. LIMITATIONS There was significant heterogeneity among the included studies. CONCLUSION There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
| | - Rita Akatussasira
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Firoj Al-Mamun
- CHINTA Research Bangladesh, Savar, Dhaka 1342, Bangladesh; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Department of Public Health, University of South Asia, Dhaka, Bangladesh
| | - Sébastien Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mohammed A Mamun
- CHINTA Research Bangladesh, Savar, Dhaka 1342, Bangladesh; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Department of Public Health, University of South Asia, Dhaka, Bangladesh
| | - Isabelle Combey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Québec, Canada
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu 166, Uganda
| | - Sheila Harms
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Gary Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham NG1 4FQ, United Kingdom
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, Ontario, Canada; Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5005, SA, Australia
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Mannarino JA, Carrico AW, Ean N, Bruce S, Vandermause R, Kryah R, Stein E, Bertram J, Shom V, Paul RH. Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN). Contemp Clin Trials 2023; 131:107257. [PMID: 37271413 PMCID: PMC10526682 DOI: 10.1016/j.cct.2023.107257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Low- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults. METHODS A stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization. PLANNED ANALYSES The percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes. DISCUSSION Findings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings.
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Affiliation(s)
- Julie A Mannarino
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America.
| | - Adam W Carrico
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States of America
| | - Nil Ean
- The Center for Trauma Care and Research Organization, Phnom Penh, Cambodia; Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Steven Bruce
- Center for Trauma Recovery, University of Missouri - St. Louis, St. Louis, MO, United States of America; Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Roxanne Vandermause
- College of Nursing, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Rachel Kryah
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Ellen Stein
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Julie Bertram
- College of Nursing, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Vireak Shom
- The Center for Trauma Care and Research Organization, Phnom Penh, Cambodia
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America; Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States of America
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Beksinska A, Karlsen O, Gafos M, Beattie TS. Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001216. [PMID: 37310993 DOI: 10.1371/journal.pgph.0001216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/08/2022] [Indexed: 06/15/2023]
Abstract
Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case-control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31-51%), and of daily alcohol use was 26% (95% CI: 17-36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01-2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15-1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24-4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oda Karlsen
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Beattie TS, Kabuti R, Beksinska A, Babu H, Kung’u M, Shah P, Nyariki E, Nyamweya C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J. Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6046. [PMID: 37297650 PMCID: PMC10253020 DOI: 10.3390/ijerph20116046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | | | - Pooja Shah
- 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, Nairobi P.O. Box 3737-00506, Kenya
| | - Chrispo Nyamweya
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, 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 and 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, Nairobi P.O. Box 3737-00506, Kenya
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Shah P, Beattie TS, Kabuti R, Liku J, Kung'u M, Babu H, Jama Z, Kaul R, Weiss HA, Kyegombe N, Medley GF, Devries K, Gafos M, Nyariki E, Kimani J, Seeley J. Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya. BMJ Open 2023; 13:e068886. [PMID: 37045579 PMCID: PMC10106030 DOI: 10.1136/bmjopen-2022-068886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya. DESIGN Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural-biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management. RESULTS 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency. CONCLUSIONS This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Jennifer Liku
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Mary Kung'u
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Anne Weiss
- MRC International and Statistics Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham F Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Panneh M, Gafos M, Nyariki E, Liku J, Shah P, Wanjiru R, Wanjiru M, Beksinska A, Pollock J, Jama Z, Babu H, Kaul R, Seeley J, Bradley J, Kimani J, Beattie T. Mental health challenges and perceived risks among female sex Workers in Nairobi, Kenya. BMC Public Health 2022; 22:2158. [PMID: 36418973 PMCID: PMC9685887 DOI: 10.1186/s12889-022-14527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) in Kenya are at an increased risk of violence, poverty, police arrest, and problematic alcohol and other substance use, all of which are linked to poor mental health and suicidal ideation. Despite the psychological stressors experienced by FSWs, there is no published qualitative methods research investigating their mental health experiences in Kenya. In this paper, we draw on data from in-depth interviews to examine FSWs' lifetime mental health experiences and perceived risk factors. METHODS We used baseline in-depth interviews of the Maisha Fiti longitudinal study of FSWs in Nairobi. We randomly selected 40 FSWs from 1003 FSWs who attended a baseline behavioural-biological interview as part of the Maisha Fiti study. The interview guide was semi-structured, and participants were asked to detail their life stories, including narrating specific events such as entry into sex work, experiences of violence, mental health experiences, and use of alcohol and other substances. Interviews were recorded in Kiswahili/ English and transcribed in English. Data were coded and thematically analysed in Nvivo (v.12). RESULTS Results indicated that the majority of participants understood 'mental health' as 'insanity', 'stress', 'depression', and 'suicide'; nevertheless, a number described mental health symptomatically, while a few believed that mental health problems were caused by witchcraft. Interestingly, poverty, low levels of education, poor job opportunities, a lack of family support, harmful gender norms, intimate partner violence and subsequent relationship breakdowns, and family bereavement all contributed to poor mental health and subsequent entry into sex work. In addition, the consequences of sex work such as sexual risks, and ongoing violence from police and clients, further exacerbated poor mental health. CONCLUSIONS There is a need for both micro- and macro interventions to address poverty and violence against FSWs in Kenya, thereby reducing mental health problems. Addressing violence against women and girls may also reduce entry into sex work. Improving mental health literacy and providing mental health intervention services for 'at-risk' populations such as FSWs should enhance coping strategies and help-seeking efficacy.
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Affiliation(s)
- Mamtuti Panneh
- LSHTM, Department for Global Health and Development, London, UK.
| | - Mitzy Gafos
- LSHTM, Department for Global Health and Development, London, UK
| | - Emily Nyariki
- LSHTM, Department for Global Health and Development, London, UK
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Pooja Shah
- LSHTM, Department for Global Health and Development, London, UK
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- LSHTM, Department for Global Health and Development, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Janet Seeley
- LSHTM, Department for Global Health and Development, London, UK
| | - John Bradley
- MRC International Statistics and Epidemiology Group, Department for Infectious Disease Epidemiology, LSHTM, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tara Beattie
- LSHTM, Department for Global Health and Development, London, UK
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Beksinska A, Nyariki E, Kabuti R, Kungu M, Babu H, Shah P, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J, Beattie TS. Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7294. [PMID: 35742558 PMCID: PMC9223659 DOI: 10.3390/ijerph19127294] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - 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; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Chrispo Nyabuto
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Monica Okumu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Anne Mahero
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Erastus Irungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Wendy Adhiambo
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Peter Muthoga
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - 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; (P.S.); (J.S.); (T.S.B.)
| | - 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; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
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Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya. Glob Ment Health (Camb) 2022; 9:401-415. [PMID: 36618737 PMCID: PMC9806968 DOI: 10.1017/gmh.2022.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at high risk of mental health problems and suicide risk. Few longitudinal studies have examined risk factors for poor mental health among FSWs. METHODS Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme clinics across Nairobi. Behavioural-biological survey data were collected at baseline (n = 1003, June-December 2019), midline (n = 366) (Jan-March 2020) and endline (n = 877) (June 2020-Jan 2021). Women reporting mental health problems were offered counselling services. Multivariable mixed logistic regression models were used to examine factors associated with mental health problems and suicidal behaviours. RESULTS There was a decline in the proportion of women reporting any mental health problem (depression and/or anxiety and/or PTSD) (baseline: 29.9%, midline: 13.3%, endline: 11.8%). There was strong evidence that any mental health problem was associated with recent hunger (aOR 1.99; 95% CI 1.37-2.88) and recent violence from non-intimate partners (2.23; 95% CI 1.55-3.19). Recent suicidal behaviour prevalence was similar across survey rounds (baseline: 10.2%; midline: 10.2%; endline: 10.4%), and was associated with recent violence from non-intimate partners (aOR 1.96; 95% CI 1.31-2.95), recent hunger (aOR 1.69; 95% CI 1.15-2.47) and having an additional employment to sex work (aOR 1.50; 95% CI 1.00-2.23). CONCLUSIONS Our study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.
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