Factors Influencing Female sex workers return for services.
A case study of HOPE worldwide Kenya Jua Kali DISC
Authors: Catherine N. Mukundi- Julius Nguku – Presenter- Malinda wheeler- Jeff Otieno - Roselyn Nyakundi
Presentation outline
• Introduction• Methods• Results• Conclusion • Recommendation
Introduction
• HOPE worldwide Kenya implements a wide range of health related programs within Kenya and East Africa.
• Among them is a 5-year CDC-funded HIV prevention Program dubbed ‘Shujaa’ that serves Key Populations in former Rift Valley Province in Kenya (2010 – 2016)
Introduction
• The goal of the national Guidelines for HIV/STI Programs for sex workers in 2010 is to increase access to HIV/STI and reproductive health services for sex workers and their clients In Kenya
• HWWK operates 8 Drop-In Service Centres (DISCs) for Key Populations (KPs) in Rift Valley
• Sex workers and their clients contribute 14% of the new HIV infections in Kenya (Kenya Modes of Transmission Study, 2008)
• Jua Kali DISC is situated along the Eldoret – Malaba road, Uasin Gishu County. The DISC has enrolled and serves 1,200 Sex workers to date
Introduction
• Between December 2012 and May 2013, 1,043 female sex workers (FSWS) were taken through risk assessment and risk reduction counseling at the Jua-Kali DISC in Uasin Gishu County using the risk assessment form in the National Guidelines for HIV/STI programs for sex workers
• Sex workers are encouraged to make quarterly visits to the DISCs for medical, behavioral and structural interventions.
• Risk assessment and Risk reduction counseling is also done on a quarterly basis to all clients.
Method
1st
Assessment2nd
Assessment3rd
Assessment 4th
Assessment
Total No. of assessments 1043
198 49 24
Average age 28.8 27.9 29.6 29.4
Level of Education (%- above
secondary )310/1043
(30%) 23/198 (12%) 11/49(22%)
4/24 (17%)
Marital Status (% married )
119/1043 (11%)
3/198 (1.5%)
0/49(0%)
0/24 (0%)
Occupation (% other source of
income-employed, in business or
farming)
96/1043 (9.2%)
8/198 (12%)
9/49 (18%)
5/24(21%)
Results
Results
Return rate of SWs to Jua-kali DISC: December 2012 and May 2013
Total 1,043
Did not return845 (81%)
1st Return198 (19%)
2nd Return49 (25%)
Did not return149 (75%)
Did not return25 (50%)
3rd Return24 (50%)
Returned Did not return
Level OR (95% CI) p-value
1st 198 845 reverent -
2nd 49 149 1.4035 (0. 9812-2.008) P=0.0635
3rd 25 24 4.445 (2.486-7.949)P<0.0001
Level of Assessment
1st
2nd
3rd
0% 10% 20% 30% 40% 50% 60%
19%
25%
50%
Percentageof returning SWs
Average Age
Series10.0%
5.0%
10.0%
15.0%
20.0%
25.0%
9.2%
12.0%
18.0%
21.0%
Average age of the Sex Workers by level of assessment
Marital status
1st 2nd 3rd 4th0%
2%
4%
6%
8%
10%
12%
11.00%
1.50% 0.00% 0.00%
Percentage of married FSWs with level of assessment
Level of education
1st 2nd 3rd 4th0%
5%
10%
15%
20%
25%
30%
35%
30%
12%
22%17%
Percentage with secondary level education and above with level of assessment
Having another source of income
Series10.0%
5.0%
10.0%
15.0%
20.0%
25.0%
9.2% 12.0%18.0%
21.0%
Having another source of income by level of assessment
OR =2.41 , 95% C.I 1.93-2.97
p<0.001
OR =2.43 , 95% C.I 0.94-4.65
p=0.0041
OR =2.59 , 95% C.I 1.06-7.19
P=0.0045
Conclusions
The predictors of FSWs returning for services are: being older, single and having another source of income apart from sex work. Having a higher level of education seems to have no effect on FSWs returning for services.
Recommendation Programs working with sex workers should consider • providing targeted messaging for sex workers
who are younger, married and those who have no other source of income apart from sex work to enhance return rates for services
• find ways of facilitating alternative livelihood opportunities
Acknowledgements
1. Co Authors:2. HOPE worldwide Kenya3. CDC
Thank you !!