title: Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia.
abstract: BACKGROUND
  Although reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia.
  
  
  METHODS
  A cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15-35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers' total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier.
  
  
  RESULTS
  Respondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex.
  
  
  CONCLUSIONS
  Findings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to prevent violence against sex workers and reduce HIV transmission.
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA. ckennedy@jhsph.edu.
authors: Alyssa
authors: A
authors: Mooney
authors: Aklilu
authors: A
authors: Kidanu
authors: Heather M
authors: HM
authors: Bradley
authors: Evelyn Kuor
authors: EK
authors: Kumoji
authors: Caitlin E
authors: CE
authors: Kennedy
authors: Deanna
authors: D
authors: Kerrigan
mesh_terms: D000293:Adolescent; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015995:Prevalence; D060386:Sex Workers; D012747:Sexual Partners; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D064450:Workplace Violence / Q000706:statistics & numerical data; D055815:Young Adult
references: AIDS. 2003 Feb 14;17(3):415-23
references: 12556696
references: AIDS Educ Prev. 2004 Apr;16(2):137-49
references: 15134122
references: Reprod Health. 2012 Aug 20;9:14
references: 22906066
references: Sex Transm Dis. 2008 Feb;35(2):141-6
references: 17921913
references: AIDS Behav. 2008 May;12(3):441-51
references: 17710526
references: Cult Health Sex. 2007 Sep-Oct;9(5):489-503
references: 17687674
references: J Acquir Immune Defic Syndr. 2005 Mar 1;38(3):329-34
references: 15735453
references: Soc Sci Med. 2002 Oct;55(7):1231-44
references: 12365533
references: AIDS Care. 1995;7(1):35-47
references: 7748909
references: Trop Med Int Health. 2007 Feb;12(2):174-82
references: 17300623
references: AIDS Behav. 2013 Feb;17(2):551-8
references: 22760740
references: BMC Public Health. 2010 Aug 11;10:476
references: 20701791
references: AIDS Behav. 2012 May;16(4):1020-30
references: 21598033
references: Subst Use Misuse. 2006;41(10-12):1509-33
references: 17002991
references: Cult Health Sex. 1999 Jan-Mar;1(1):39-53
references: 12295114
references: AIDS Care. 1997 Oct;9(5):539-47
references: 9404396
references: ISRN Nurs. 2012;2012:307271
references: 22685673
references: Alcohol Alcohol. 2010 Mar-Apr;45(2):188-99
references: 20089544
references: Sex Transm Dis. 2013 Feb;40(2):168-74
references: 23441335
references: AIDS Behav. 2008 Mar;12(2):195-201
references: 17587171
references: AIDS Behav. 2007 May;11(3):463-70
references: 17096198
references: Health Care Women Int. 2002 Feb;23(2):163-72
references: 11868963
references: Int J Drug Policy. 2012 Nov;23(6):498-504
references: 22608567
references: Am J Drug Alcohol Abuse. 2007;33(5):687-98
references: 17891661
references: Am J Public Health. 2009 May;99(5):811-9
references: 19299685
references: Clin Invest Med. 2007;30(1):33-41
references: 17716538
references: J Prev Interv Community. 2010;38(2):89-103
references: 20391057
references: AIDS Patient Care STDS. 2001 Jan;15(1):41-51
references: 11177587
references: Harm Reduct J. 2011 Nov 20;8:30
references: 22099449
references: J Consult Clin Psychol. 1997 Oct;65(5):834-47
references: 9337502
references: BMC Public Health. 2011 Dec 29;11 Suppl 6:S11
references: 22376171
references: Soc Sci Med. 2001 Jul;53(1):99-121
references: 11380165
references: Am J Public Health. 1995 Nov;85(11):1521-5
references: 7485664
references: Int J STD AIDS. 2003 Mar;14(3):185-8
references: 12665441
references: AIDS. 2000 Nov 10;14(16):2523-34
references: 11101064
references: AIDS Care. 2007 Jan;19(1):79-86
references: 17129861
references: Acta Psychiatr Scand Suppl. 1999;397:30-4
references: 10470352
references: Sex Transm Infect. 2007 Dec;83(7):534-40
references: 17942575
references: Acta Psychiatr Scand Suppl. 1999;397:77-83
references: 10470359
references: AIDS Educ Prev. 2002 Apr;14(2):102-16
references: 12000229
references: Soc Sci Med. 2000 Feb;50(4):459-78
references: 10641800
references: J Womens Health (Larchmt). 2011 Jul;20(7):991-1006
references: 21668380
references: Afr J Reprod Health. 1997 Mar;1(1):74-88
references: 10214405
references: Soc Sci Med. 2004 Oct;59(8):1581-92
references: 15279917
references: BMJ. 2008 Jul 30;337:a811
references: 18667468
references: Int J STD AIDS. 2007 Nov;18(11):764-9
references: 18005511
references: Int J Drug Policy. 2008 Apr;19(2):106-12
references: 18187314
references: AIDS Care. 2001 Jun;13(3):351-65
references: 11397337
references: Women Health. 2002;35(4):27-42
references: 12216990
references: Addiction. 1994 Aug;89(8):961-70
references: 7950854
references: AIDS Care. 2005 Jun;17 Suppl 1:S55-64
references: 16096118