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Citation
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Beattie T, Kabuti R, Shah P, Beksinska A, Nyakiri E, Babu H, Kungu M, Champions TMFS, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Weiss H, Seeley J, Kimani J. J. Int. AIDS Soc. 2021; 24(S4): 54-55. |
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Abstract
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Oral abstracts of the 11th IAS Conference on HIV Science, 18-21 July 2021 OAD0302
Background: Violence against women and girls is associated with an increased risk of HIV acquisition, with effects both direct (e.g. rape) and indirect (e.g. from child maltreatment). We examined violence experiences among female sex workers (FSWs) and how this relates to HIV risk using a syndemics and life-course perspective, in order to identify opportunities for interventions.
Methods: Maisha Fiti is a mixed-methods longitudinal study with FSWs aged 18 to 45 years randomly selected from across Nairobi. Baseline behavioural-biological surveys (n = 1003) were conducted June-December 2019. Violence was assessed using the WHO Adverse Childhood Experiences (ACE) and Violence Against Women questionnaires. Harmful alcohol and substance use were assessed using the WHO ASSIST Tool. Descriptive statistics and multivariable logistic regression models were used to examine violence across the life-course, and correlates of recent (past six months) sexual or physical violence experience.
Results: 1003 FSWs participated; HIV prevalence was 28.0%. Reports of adverse experiences in childhood were high: 41.4% were orphaned, 12.0% lived on the streets and 79.3% experienced physical or sexual violence. We found substantial overlap between violence in childhood, and subsequent partner and non-partner violence in adulthood, with 72.2% reporting multiple types of violence. We also found high levels of recent violence (past six months), with 64.9% reporting physical or sexual violence, 30.7% police arrest, 2.4% gang rape and 2.8% rape in the past seven days. In adjusted analyses, recent sexual or physical violence (by any perpetrator) was associated with a high ACE score (AOR 5.3 (95% CI 3.3 to 8.7)), forced sexual debut (AOR 1.4 (1.0 to 2.0)) ever being married/co-habiting (AOR 1.5 (1.0 to 2.1)), recent hunger (AOR 1.3 (1.0 to 1.8)), recent police arrest (AOR 2.3 (1.6, 3.2)), current harmful alcohol or substance use (AOR 1.6 (1.2 to 2.2)) and condomless last sex (AOR 1.4 (1.0 to 1.9)).
Conclusions: We report strong evidence of concurrent and sequential violence victimization across the life-course by different perpetrators, and syndemics with harmful alcohol and substance use and HIV risk. Large-scale holistic violence interventions are needed to reduce violence against women and girls in this setting. Interventions which focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including HIV risk.
Language: en |