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 !!