Stanley Luchters,# 1 , 2 , 3 , 4 , * Marlise L. Richter,# 2 , 5 Wilkister Bosire, 6 Gill Nelson, 3 Nzioki Kingola, 6 Xu-Dong Zhang, 2 Marleen Temmerman, 2 and Matthew F. Chersich 7
Marianna Mazza, Editor
Affiliations
1 Centre for International Health, Burnet Institute, Melbourne, Australia
2 International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
3 School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
4 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
5 African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
6 International Centre for Reproductive Health (ICRH), Mombasa, Kenya
7 Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Catholic University of Sacred Heart of Rome, Italy
#Contributed equally.
* E-mail: ua.ude.tenrub@srethculs
Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: SL. Performed the experiments: SL WB NK. Analyzed the data: SL MR GN MC. Contributed reagents/materials/analysis tools: SL MT MC. Wrote the paper: SL MR MC XDZ.
Received 2012 Oct 6; Accepted 2013 Jun 6.
Copyright © 2013 Luchters et al
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
Associated Data
Abstract
Objectives
To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.
Design
Cohort study with quarterly follow-up visit over 12-months.
Methods
Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.
Results
Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use.
Conclusions
High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs’ vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
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