The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective

Tara S Beattie; Wendy Adhiambo; Rhoda Kabuti; Alicja Beksinska; Pauline Ngurukiri; Hellen Babu; Mary Kung'u; Chrispo Nyamweya; Anne Mahero; Maisha Fiti Study -Champions; Erastus Irungu; Peter Muthoga; Janet Seeley; Joshua Kimani; Helen A Weiss; Rupert Kaul

doi:10.1371/journal.pgph.0001529

The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective

PLOS Glob Public Health. 2024 Jan 8;4(1):e0001529. doi: 10.1371/journal.pgph.0001529. eCollection 2024.

Authors

Tara S Beattie¹, Wendy Adhiambo², Rhoda Kabuti², Alicja Beksinska¹, Pauline Ngurukiri², Hellen Babu², Mary Kung'u², Chrispo Nyamweya², Anne Mahero²; Maisha Fiti Study -Champions; Erastus Irungu², Peter Muthoga², Janet Seeley^{1

3}, Joshua Kimani^{2

4}, Helen A Weiss⁵, Rupert Kaul⁶

Affiliations

¹ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
² Partners for Health and Development in Africa, Nairobi, Kenya.
³ Africa Health Research Institute, KwaZulu-Natal, South Africa.
⁴ UNITID, University of Nairobi, Nairobi, Kenya.
⁵ Department of Infectious Disease Epidemiology and International Health, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁶ Department of Immunology, University of Toronto, Ontario, Canada.

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.

Copyright: © 2024 Beattie 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 credited.

Grants and funding

Funding for this study was provided by the Medical Research Council and the UK Foreign, Commonwealth and Development Office (FCDO) (MR/R023182/1) under the MRC/FCDO Concordat agreement. TB was the principal investigator and the recipient of the funding. JK, JS, HAW, and RK were coinvestigators of the grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.