title: Time to unsafe sexual practice among cross-border female sex workers in Metemma Yohannes, North West Ethiopia.
abstract: BACKGROUND
  Because of the nature of their work, female sex workers are at risk of sexually transmitted diseases. Cross-border areas are places where this situation becomes worse. In Ethiopia, there has been a serious scarcity of studies on the time at which unsafe sexual practice starts and on factors which determine the practice among female sex workers there. Therefore, this study aimed to fill this identified gap.
  
  
  METHODS
  A total of 467 women who had been sex workers at least for three months prior to the resumption of the study were included. A structured and pre-tested questionnaire was used to collect data from July-August, 2010. Descriptive statistics was used to explore the data, and the Extended Cox-Regression model was employed to identify the predictors of time-to-unsafe sexual practice.
  
  
  RESULTS
  The study participants were followed for 6, 643 person-months. The overall incidence density of unsafe sexual practice was 44.71 persons per 1000 persons-months. The hazard of unsafe sexual practice increased by 3.0 % every month (p-value =0.040) due to problem-drinking. Those female sex workers with familiarized clients had a two-fold hazard of practicing unsafe sex compared to their counterparts (AHR = 1.94 95 % CI 1.49, 2.53). The predominant sexual client type and the work place of sex workers were the other significant predictors of unsafe sexual practice.
  
  
  CONCLUSIONS
  The incidence of unsafe sexual practice was found to be high among sex workers in the cross-border area. Time-to-unsafe sexual practice was significantly associated with female sex workers' status of familiarity with their clients, predominant sexual client type, their work place, and the interaction term of time and problem-drinking. Interventions need to be made on these controllable social and behavioral characteristics to help sex workers extend the duration of their safe sexual practice beyond the time they will quit sex work.
authors.affiliation: University of Gondar, P.o.box.196, Gondar, Ethiopia. lemmagezie@gmail.com.
authors.forename: Lemma Derseh
authors.initials: LD
authors.lastname: Gezie
authors.affiliation: Bahir Dar University, Bahir Dar, Ethiopia. bewassie@gmail.com.
authors.forename: Belaynew Wassie
authors.initials: BW
authors.lastname: Taye
authors.affiliation: University of Gondar, P.o.box.196, Gondar, Ethiopia. t_awoke@yahoo.com.
authors.forename: Tadesse Awoke
authors.initials: TA
authors.lastname: Ayele
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D060386:Sex Workers / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013995:Time; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult