Addressing alcohol use can improve structural factors in the lives of sex workers

The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial.

Parcesepe AM, KL LE, Martin SL, Green S, Sinkele W, Suchindran C, Speizer IS, Mwarogo P, Kingola N. Drug Alcohol Depend. 2016 Apr 1;161:21-8. doi: 10.1016/j.drugalcdep.2015.12.037. Epub 2016 Jan 22.

Aims: To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya.

Design: Randomized controlled trial.

Setting: HIV prevention drop-in centers in Mombasa, Kenya.

Participants: 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively).

Intervention: 6 session alcohol harm reduction intervention.

Comparator: 6 session non-alcohol related nutrition intervention.

Measurements: In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days.

Findings: The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention.

Conclusions: The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya.

Abstract access   [1]

Editor’s notes: Modifying structural drivers, such as alcohol, violence, or socio-economic status is a challenging but necessary component of developing sustainable, effective solutions to the HIV epidemic. This study presents findings from an individually randomised trial, where female sex workers were randomised to receive an individual-level programme focused on alcohol and substance use, and to assess non-alcohol associated outcomes of violence, and indirectly economic vulnerability. While the programme did not produce persistent effects at six months for all components, it very usefully demonstrated how addressing alcohol use, a structural factor central to sex workers’ lives, can potentially also improve non-alcohol associated outcomes. These included experiences of violence, economic status, and even ability to reduce time spent in sex work. Alcohol harm reduction programming should be integrated into HIV prevention programming with female sex workers, regardless of HIV status.

Africa [4]
Kenya [5]
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