Prevalence of HIV and Associated Risks of Sex Work among Youth in the Slums of Kampala

Monica H Swahn, Rachel Culbreth, Laura F Salazar, Rogers Kasirye, Janet Seeley, Monica H Swahn, Rachel Culbreth, Laura F Salazar, Rogers Kasirye, Janet Seeley

Abstract

Purpose. The purpose of this study is to examine the prevalence of and risk factors for engaging in sex work among youth living in Kampala, Uganda. Methods. Analyses are based on a cross-sectional study (N = 1,134) of youth aged 12-18 years, living in the slums of Kampala, conducted in Spring of 2014. The analytic sample consisted of only sexually active youth (n = 590). Youth who reported engaging in sex work were compared to youth who did not report sex work. Multivariable analyses were conducted to examine factors associated with sex work. Results. Among the youth who had ever had sexual intercourse (n = 590), 13.7% (n = 81) reported engaging in sex work. Self-reported HIV prevalence was 13.9% among the total sample (n = 81) and 22.5% (n = 18) among youth engaged in sex work. Engaging in sex work was associated with being female (AOR 10.4; 95% CI: 3.9, 27.4), being an orphan (AOR 3.8; 95% CI: 1.7, 8.4), ever drinking alcohol (AOR 8.3; 95% CI 3.7, 19.0), and experiencing any rape (AOR 5.3; 95% CI: 2.9, 9.5). Discussion. The reported prevalence of sex work is high among youth in the slums of Kampala and is associated with high HIV prevalence, ever drinking alcohol, previously being raped, and being an orphan.

References

    1. USAid. Uganda AIDS Indicator Survey. .
    1. Swahn M. H., Palmier J. B., Kasirye R., Yao H. Correlates of suicide ideation and attempt among youth living in the slums of Kampala. International Journal of Environmental Research and Public Health. 2012;9(2):596–609. doi: 10.3390/ijerph9020596.
    1. Gysels M., Pool R., Nnalusiba B. Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk. Social Science & Medicine. 2002;54(2):179–192. doi: 10.1016/s0277-9536(01)00027-2.
    1. United Nations Population Fund. 17 Fact Sheets with Concise Information on Gender-Related Aspects of HIV/AIDS. 2006. .
    1. Dias S., Gama A., Fuertes R., Mendão L., Barros H. Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey. Sexually Transmitted Infections. 2015;91(5):346–352. doi: 10.1136/sextrans-2014-051697.
    1. Schwitters A., Swaminathan M., Serwadda D., et al. Prevalence of rape and client-initiated gender-based violence among female sex workers: Kampala, Uganda, 2012. AIDS and Behavior. 2015;19(supplement 1):S68–S76. doi: 10.1007/s10461-014-0957-y.
    1. Surratt H. Sex work in the Caribbean Basin: patterns of substance use and HIV risk among migrant sex workers in the US Virgin Islands. AIDS Care. 2007;19(10):1274–1282. doi: 10.1080/09540120701426490.
    1. Mbonye M., Rutakumwa R., Weiss H., Seeley J. Alcohol consumption and high risk sexual behaviour among female sex workers in Uganda. African Journal of AIDS Research. 2014;13(2):145–151. doi: 10.2989/16085906.2014.927779.
    1. Ross M. W., Crisp B. R., Månsson S.-A., Hawkes S. Occupational health and safety among commercial sex workers. Scandinavian Journal of Work, Environment & Health. 2012;38(2):105–119. doi: 10.5271/sjweh.3184.
    1. Lanius R., Vermetten E., Pain C. The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge, UK: Cambridge University Press; 2010.
    1. Mbonye M., Nalukenge W., Nakamanya S., et al. Gender inequity in the lives of women involved in sex work in Kampala, Uganda. Journal of the International AIDS Society. 2012;15(supplement 1):1–9. doi: 10.1186/1758-2652-15-1.
    1. Mangoma J. F., Chimbari M. J., Dhlomo E. An enumeration of orphans and analysis of the problems and wishes of orphans: the case of Kariba, Zimbabwe. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2008;5(3):120–128. doi: 10.1080/17290376.2008.9724910.
    1. Oyefara J. L. Food insecurity, HIV/AIDS pandemic and sexual behaviour of female commercial sex workers in Lagos metropolis, Nigeria. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2007;4(2):626–635.
    1. Brody C., Tuot S., Chhea C., Saphonn V., Yi S. Factors associated with sex work among at-risk female youth in Cambodia: a cross-sectional study. AIDS Care. 2016;28(3):339–346. doi: 10.1080/09540121.2015.1096893.
    1. UNAIDS. The Gap Report 2014: Sex Workers. UNAIDS; 2014. .
    1. Swahn M., Haberlen M., Palmier J. B. Alcohol and drug use and other high-risk behaviors among youth in the slums of Kampala, Uganda: perceptions and contexts obtained through focus groups. The International Journal of Alcohol and Drug Research. 2014;3(4):289–295. doi: 10.7895/ijadr.v3i4.171.
    1. Elmes J., Nhongo K., Ward H., et al. The price of sex: condom use and the determinants of the price of sex among female sex workers in eastern Zimbabwe. The Journal of Infectious Diseases. 2014;210(supplement 2):S569–S578. doi: 10.1093/infdis/jiu493.
    1. Lang D. L., Salazar L. F., Diclemente R. J., Markosyan K. Gender based violence as a risk factor for HIV-associated risk behaviors among female sex workers in Armenia. AIDS and Behavior. 2013;17(2):551–558. doi: 10.1007/s10461-012-0245-7.
    1. Muldoon K. A., Akello M., Muzaaya G., Simo A., Shoveller J., Shannon K. Policing the epidemic: high burden of workplace violence among female sex workers in conflict-affected northern Uganda. Global Public Health. doi: 10.1080/17441692.2015.1091489. In press.
    1. Okanlawon K., Adebowale A. S., Titilayo A. Sexual hazards, life experiences and social circumstances among male sex workers in Nigeria. Culture, Health & Sexuality. 2013;15(supplement 1):22–33. doi: 10.1080/13691058.2012.754053.
    1. Gilbert L., Raj A., Hien D., Stockman J., Terlikbayeva A., Wyatt G. Targeting the SAVA (substance abuse, violence, and AIDS) syndemic among women and girls: a global review of epidemiology and integrated interventions. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2015;69:S118–S127. doi: 10.1097/QAI.0000000000000626.
    1. Zablotska I. B., Gray R. H., Koenig M. A., et al. Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda. AIDS and Behavior. 2009;13(2):225–233. doi: 10.1007/s10461-007-9333-5.
    1. Devries K. M., Child J. C., Bacchus L. J., et al. Intimate partner violence victimization and alcohol consumption in women: a systematic review and meta-analysis. Addiction. 2014;109(3):379–391. doi: 10.1111/add.12393.
    1. Neal A. M., Edwards K. M. Perpetrators’ and victims’ attributions for IPV: a critical review of the literature. Trauma, Violence & Abuse. 2015 doi: 10.1177/1524838015603551.
    1. Reingle J. M., Jennings W. G., Connell N. M., Businelle M. S., Chartier K. On the pervasiveness of event-specific alcohol use, general substance use, and mental health problems as risk factors for intimate partner violence. Journal of Interpersonal Violence. 2014;29(16):2951–2970. doi: 10.1177/0886260514527172.
    1. Sherman S. S., Plitt S., ul Hassan S., Cheng Y., Zafar S. T. Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2005;82(supplement 4):iv113–iv124.
    1. Swahn M. H., Gressard L., Palmier J. B., Kasirye R., Lynch C., Yao H. Serious violence victimization and perpetration among youth living in the slums of Kampala, Uganda. Western Journal of Emergency Medicine. 2012;13(3):253–259. doi: 10.5811/westjem.2012.3.11772.
    1. Swahn M. H., Braunstein S., Kasirye R. Demographic and psychosocial characteristics of mobile phone ownership and usage among youth living in the slums of Kampala, Uganda. Western Journal of Emergency Medicine. 2014;15(5):600–603. doi: 10.5811/westjem.2014.4.20879.
    1. Swahn M. H., Dill L. J., Palmier J. B., Kasirye R. Girls and young women living in the slums of Kampala. SAGE Open. 2015;5(2):1–8. doi: 10.1177/2158244015580853.
    1. Kenyon Densley M., Joss D. M. Street children: causes, consequences, and innovative treatment approaches. Work. 2000;15(3):217–225.
    1. le Roux J., Smith C. S. Causes and characteristics of the street child phenomenon: a global perspective. Adolescence. 1998;33(131):683–688.
    1. Mufune P. Street youth in Southern Africa. International Social Science Journal. 2000;52(164):233–243. doi: 10.1111/1468-2451.00254.
    1. Uganda Youth Development Link. August 2015,
    1. CDC Global School-based Student Health Survey (GSHS), 2016,
    1. Conigrave K. M., Hall W. D., Saunders J. B. The AUDIT questionnaire: choosing a cut-off score. Alcohol use disorder identification test. Addiction. 1995;90(10):1349–1356. doi: 10.1111/j.1360-0443.1995.tb03552.x.
    1. National Institute on Alcohol Abuse and Alcoholism, & American Psychiatric Association, CAGE Questionnaire, 2002, .
    1. Hennessy M., Romer D., Valois R. F., et al. Safer sex media messages and adolescent sexual behavior: 3-year follow-up results from project iMPPACS. American Journal of Public Health. 2013;103(1):134–140. doi: 10.2105/AJPH.2012.300856.
    1. Uganda Bureau of Statistics & ICF International. Uganda Demographic Health Survey. Uganda Bureau of Statistics & ICF International; 2012.
    1. World Health Organization. Global Status Report on Alcohol and Health 2014. 2014,
    1. Baral S. D., Friedman M. R., Geibel S., et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. The Lancet. 2015;385(9964):260–273. doi: 10.1016/s0140-6736(14)60801-1.
    1. Marshall B. D. L., Shannon K., Kerr T., Zhang R., Wood E. Survival sex work and increased HIV risk among sexual minority street-involved youth. Journal of Acquired Immune Deficiency Syndromes. 2010;53(5):661–664. doi: 10.1097/QAI.0b013e3181c300d7.
    1. Haley N., Roy E., Leclerc P., Boudreau J.-F., Boivin J.-F. HIV risk profile of male street youth involved in survival sex. Sexually Transmitted Infections. 2004;80(6):526–530. doi: 10.1136/sti.2004.010728.
    1. U.S. Department of State. Trafficking in Persons Report, 2015,
    1. United States Department of Labor (Bureau of International Affairs) Child Labor & Forced Labor: Uganda. Washington, Wash, USA: Bureau of International Affairs; 2014. .

Source: PubMed

3
Subskrybuj