Participant characteristics (Table 1)
The median age of participants was 20 years (inter-quartile range [IQR] 18 – 22); and 28.7% (N=117/408) were between the ages of 14 – 18 years (Table 1). Few (6.6%, N=27/408) were ever married. More than half (59.8%, N=244/408) reported having sex with a non-paying sexual partner in the past month, with a median of 2 (IQR 1 – 4) non-paying sexual partners in the past month. The median age of first sex was 15 years (IQR 14 – 17). The median age at which participants self-identified as a sex worker was 18 years (IQR 16 - 20), with a median duration in formal sex work of 2 years (IQR 1 – 3). Four out of five (80.4%, N=328/408) participants had at least one paying sexual clients in the past month. The median number of paying partners in the previous month was 7 (IQR 4 – 15). Over half of the participants (57.4%, N=234/408) had been pregnant at least once.
Table 1: Characteristics of women age 14-24 years who sell sex in Mombasa, Kenya (2015)
|
N=408
|
% (95% CI)
|
Current age (years)
|
|
|
Median age (IQR)
|
20 (18 – 22)
|
---
|
Age-group
|
|
|
14-18
|
117
|
28.7% (24.3 – 33.1)
|
19-24
|
291
|
71.3% (66.9 – 75.7)
|
Characteristics of sexual partnerships outside of sex work
|
Ever married
|
27
|
6.6% (4.2 – 9.0)
|
Had at least one non-paying sexual partner in past month
|
244
|
59.8% (55.0 – 64.6)
|
Median number of non-paying sexual partners in past month (IQR)a
|
2 (1 – 4)
|
---
|
Characteristics of sex work
|
Age of first sex, years
|
15 (14 – 17)
|
---
|
Age of first paid sexb, years
|
18 (16 – 20)
|
---
|
Duration in sex work, years
|
2 (1– 3)
|
---
|
Had at least one paying sexual clients in past month
|
328
|
80.4% (76.5 – 84.2)
|
Median number of paying sexual partners in past month (IQR)c
|
7 (4 – 15)
|
---
|
Reproductive History
|
Ever pregnant
|
234
|
57.4% (52.6 – 62.2)
|
CI (confidence interval)
IQR (inter-quartile range)
|
Program engagement by age (Figure 1)
One quarter of participants (25.7%, N=105/408) were aware of at least one program (Figure 1). Overall, 13.7% (N=56/408) were ever contacted by a program, 9.1% (N=37/408) were registered in a program, and 8.8% had ever used a program clinic (N=36/37; 97.3% of those who were registered). Only 1.2% (N=5/37; 13.5% of those registered) were peer workers. Program awareness (29.2% vs. 17.1%, p=0.01) and program contact (15.8% vs. 8.5%, p=0.06) were higher among participants aged 19 – 24 years compared to those aged 14 – 18. 3.4% (N=4/117) of participants aged 14 – 18 and 11.3% (N=33/291) of participants aged 19 – 24 were registered with a local program. With respect to later elements of program engagement, among YSW, 2.6% of those aged 14 – 18 years and 11.3% of those aged 19 – 24 years had ever used a program clinic (p=0.003).
Figure 1: Program engagement among women age 14-24 years who sell sex in Mombasa, Kenya (2015)
-Insert Figure 1 graphic file here -
Figure 1 Footnote
1Program defined as a non-governmental organization /community-based organization
2Peer worker of a non-governmental organization /community-based organization
Sexual vulnerabilities by age (Table 2)
Nearly half of the participants who had sex with any partner in the previous week (47.3%, N=160/338) reported inconsistent condom use. With respect to inconsistent condom use with at least one sexual encounter, 29.6% (N=86/291) and 55.8% (N=115/206) of participants reported this behaviour with any paying partner and with any non-paying partner respectively. The prevalence of inconsistent condom use was similar across the two age-groups, irrespective of partner type (Table 2).
Table 2: Vulnerabilities in sexual health (inconsistent condom use) amongst YSW in Mombasa, Kenya (2015)
|
Inconsistent condom use in previous week, by partner typea
|
|
Overall population
|
Age group
|
Program contactb
|
Sexual engagement in previous week, by partner type
|
|
|
Age 14-18 years
N=117
|
Age 19-24 years
N=291
|
|
No, N=352
|
Yes, N=56
|
|
|
|
% (95% CI)
|
% (95% CI)
|
% (95% CI)
|
p
|
% (95% CI)
|
% (95% CI)
|
p
|
With paying partner
(N=291)
|
86/291
|
29.6
|
32.5
|
28.4
|
0.56
|
29.8
|
28.3
|
0.97
|
(24.3 – 34.8)
|
(22.2 – 42.8)
|
(22.3 - 34.5)
|
(24.1-35.5)
|
(15.2-41.3)
|
With non- paying partner (N=206)
|
115/206
|
55.8
|
57.7
|
55.2
|
0.87
|
56.0
|
54.8
|
1.00
|
(49.0 – 62.6)
|
(44.3 - 71.1)
|
(47.3 - 63.0)
|
(48.6-63.4)
|
(37.3-72.4)
|
With any partnerc (N=338)
|
160/338
|
47.3
|
47.2
|
47.4
|
1.00
|
47.7
|
45.1
|
0.84
|
(42.0 – 52.7)
|
(36.8 - 57.6)
|
(41.2 - 53.6)
|
(42.0-53.5)
|
(31.4-58.8)
|
YSW (young women who sell sex, age 14-24 years)
aInconsistent condom use defined as at least one encounter (vaginal and/or anal sex) without a condom with any partner of a given type in the previous week
b Program contact defined as ever contacted by peers of a non-governmental organization /community-based organization
cDefined as inconsistent condom use during vaginal and/or anal sex with >=1 sexual partner in the previous week
|
Socioeconomic structural vulnerabilities by age (Table 3)
Most (83.6%, N=341/408) participants did not have a regular source of income; 82.4% (N=336/408) reported they could not independently cover their living expenses last month; although only 13.5% (N=55/408) reported they did not keep all their wages. Few participants (2.7% , N=11/408) could not read and/or write and 30.4% (N=124/408) had not completed primary school. There was little variability in socioeconomic vulnerabilities by age, although there was a trend towards lower educational attainment among younger participants (Table 3).
Violence-related structural vulnerabilities by age (Table 3)
Findings show that 29.9% (N=122/408), 29.2% (N=119/408), and 44.9% (N=183/408) of participants reported ever experiencing physical violence, sexual violence, and police harassment respectively (Table 3). Of those, 64.8% (N=79/408), 48.7% (N=58/408), and 76.0% (N=139/408) experienced physical violence, sexual violence, and police harassment, respectively in the previous year. The prevalence of physical or sexual violence did not vary by age: 29.1% (N=34/117) and 24.8% (N=29/117) of participants had experienced physical and sexual violence at least once by age 18. The prevalence of police harassment was higher among older participants (lifetime experience, 51.2% [N=149/291] vs. 29.1% [N=34/117], p<0.001).
Alcohol-related structural vulnerabilities by age (Table 3)
Most (79.4%, N=324/408) participants consumed alcohol in the past month (Table 3). Of those who consumed alcohol in the past month, 47.5% (N=154/408) were inebriated at least once in the past month; and 72.7% (N=112/154) reported they were inebriated at least once during sex in the past month. Most (69.4%, N=283/408) also reported that at least one partner was inebriated during sex in the past month. As with the other structural vulnerabilities, there was little variability by age.
Reproductive health vulnerabilities by age (Table 4)
Less than half (26.5%, N=108/408) of the participants reported a history of at least one pregnancy during their adolescence. There was a higher prevalence of adolescent pregnancy among younger participants (37.6% [N=44/117] vs. 22.0% [N=64/291], p=0.002). Among the 234 participants with a history of pregnancy, 23.9% (N=56) reported at least one induced abortion in their lifetime. There was little variability by age such that by the age of 18 years, nearly a quarter of participants with a history of pregnancy reported at least one induced abortion. Two-thirds (66.1%, N=37/56) of the most recent abortions were unsafe; with similar proportions across the age groups. Among those who were using contraception, 18.5% (N=62/336) used a non-reliable form; with little variability by age group.
Table 4: Vulnerabilities in reproductive health by age and program contact among YSW in Mombasa, Kenya (2015)
|
Overall population
|
Age group
|
Program contacta
|
|
N
|
% (95% CI)
|
14-18,
N=117
|
19-24,
N=291
|
p
|
No,
N=352
|
Yes,
N=56
|
p
|
Adolescent pregnancyb
|
108/408
|
26.5
|
37.6
|
22.0
|
0.002
|
25.3
|
33.9
|
0.19
|
(22.3-31.0)
|
(28.8-47.0)
|
(17.4-27.2)
|
(20.8-30.2)
|
(21.8-47.8)
|
Ever had abortionc
|
56/234
|
23.9
|
23.9
|
23.9
|
1.00
|
23.5
|
26.5
|
0.67
|
(18.6-29.9)
|
(12.6-38.8)
|
(18-30.7)
|
(17.8-30.0)
|
(12.9-44.4)
|
Most recent abortion was unsafe d, e
|
37/56
|
66.1
|
81.8
|
62.2
|
0.30
|
66.0
|
66.7
|
1.00
|
(52.2-78.2)
|
(48.2-97.7)
|
(46.5-76.2)
|
(50.7-79.1)
|
(29.9-92.5)
|
Currently using unreliable forms of contraceptionf, g
|
62/336
|
18.5
|
18.1
|
18.6
|
1.00
|
17.4
|
24.1
|
0.25
|
(14.4 – 23.0)
|
(10.9-27.4)
|
(13.9-24.1)
|
(13.1-22.3)
|
(13.5-37.6)
|
CI (confidence interval)
YSW (young women who sell sex, age 14-24 years)
a Program contact defined as ever contacted by peers of a non-governmental organization /community-based organization
bAdolescent pregnancy refers to the first pregnancy that occurred before age of 18
cAmong participants who had a history of pregnancy (N=234)
dAmong participants who had a history of abortion (N=56)
eUnsafe abortion defined as any abortion not performed in public/government/private/non-governmental organization /community-based organization/ faith-based organization facility
fAmong participants who are currently using any forms of contraception (N=336)
gUnreliable forms of contraception are defined as inconsistent and non-modern forms of contraception such as rhythm method, withdrawal, and emergency contraception
Vulnerabilities by program contact (Tables 2, 3 and 4)
There was little variability in the prevalence of sexual, structural and reproductive vulnerabilities by whether or not participants were contacted by local programs (Tables 2, 3, 4).