The contribution of emotional partners to sexual risk taking and violence among female sex workers in Mombasa, Kenya: a cohort study.
OBJECTIVE
To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.


METHODS
Cohort study with quarterly follow-up visit over 12-months.


METHODS
Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.


RESULTS
Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5-6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of "trust" underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use.


CONCLUSIONS
High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
Centre for International Health, Burnet Institute, Melbourne, Australia. sluchters@burnet.edu.au
Stanley
S
Luchters
Marlise L
ML
Richter
Wilkister
W
Bosire
Gill
G
Nelson
Nzioki
N
Kingola
Xu-Dong
XD
Zhang
Marleen
M
Temmerman
Matthew F
MF
Chersich
D000328:Adult; D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007630:Kenya; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data; D012736:Sex Education / Q000379:methods; D060386:Sex Workers / Q000523:psychology / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D018454:Spouses; D013997:Time Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult