title: Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis.
abstract: OBJECTIVE
  Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.
  
  
  METHODS
  In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.
  
  
  RESULTS
  FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.
  
  
  CONCLUSIONS
  Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.
authors.affiliation: Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.|HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Parcesepe
authors.affiliation: FHI 360, Durham, North Carolina, USA.|Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: L'Engle
authors.affiliation: Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Martin
authors.affiliation: Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Green
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
authors.forename: Chirayath
authors.initials: C
authors.lastname: Suchindran
authors.affiliation: FHI 360, Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwarogo
mesh_terms: D000428:Alcohol Drinking / Q000523:psychology; D017280:Condoms / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D017008:Negotiating; D015995:Prevalence; D060386:Sex Workers / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology*
keywords: AFRICA; HIV; PROSTITUTION; WOMEN