Parcesepe, A.M., L'Engle, K.L., Martin, S.L., et al. Sexually Transmitted Infections (May 2016), pii: sextrans-2016-052549, doi: 10.1136/sextrans-2016-052549.
Between March and September 2011, the authors investigated whether early initiation of sex work was associated with consistent condom use and self-efficacy in condom negotiation among alcohol-using female sex workers (FSWs) in Mombasa, Kenya. At three drop-in HIV service centers, they interviewed 818 FSWs aged 18 or older who screened positive for hazardous or harmful drinking. Participants were asked about the age at which they first received money for sex, and the frequency of their condom use in the past 30 days. Nearly one-fifth (19.9%) reported early initiation of sex work (defined as initiation at age 17 or younger). These FSWs were less likely to report consistent condom use with paying partners compared with FSWs who began sex work when older. Early initiators reported feeling significantly less self-efficacy to refuse sex with a paying partner if a condom was not available compared with those who began sex work later. However, there was no significant difference between groups in consistent condom use with non-paying partners. The authors concluded that interventions for adolescent and adult FSWs who initiated sex work early should focus in particular on risk reduction with paying partners, and should incorporate strategies that do not require partner consent, such as pre-exposure prophylaxis, where available.