Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya.
Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya.
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DOI：
10.3390/ijerph19127294
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发表时间：
2022-06-14
影响因子：
--
通讯作者：
Beattie, Tara S.
中科院分区：
文献类型：
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作者：
Beksinska, Alicja;Nyariki, Emily;Kabuti, Rhoda;Kungu, Mary;Babu, Hellen;Shah, Pooja;Nyabuto, Chrispo;Okumu, Monica;Mahero, Anne;Ngurukiri, Pauline;Jama, Zaina;Irungu, Erastus;Adhiambo, Wendy;Muthoga, Peter;Kaul, Rupert;Seeley, Janet;Weiss, Helen A.;Kimani, Joshua;Beattie, Tara S.
关键词：
背景：女性性工作者(FSWs)是有害酒精和其他药物使用的高危人群。我们使用定量数据来描述酒精和其他药物使用的流行率，并确定相关的职业和社会经济风险因素，目的是通过从定性数据中获得的信息来阐明酒精和药物使用的模式。方法：Maisha Fiti是一项于2019年在肯尼亚内罗毕随机抽样的暗娼中进行的混合方法纵向研究。我们使用了行为生物学调查的基线数据，其中包括世界卫生组织酒精、吸烟和物质参与筛查测试，该测试衡量了过去三个月有害酒精和其他药物的使用情况(中等/高风险评分：酒精11分；其他药物4分)。对40名随机抽取的FSWs进行了深入访谈。结果：在1003名参与者中，29.9%(95%可信区间27.0-32.6%)报告了有害(中/高风险)酒精使用，21.5%有害安非他明(95%可信区间19.1-24.1%)和16.9%有害大麻使用(95%可信区间14.7%-19.2%)。定量分析发现，有害酒精、大麻和苯丙胺的使用与不同的风险因素有关，包括较高的不良童年经历(ACE)分数、街头无家可归、食物不安全(最近饥饿)、最近客户的暴力行为、避孕套使用减少、抑郁/焦虑和警察逮捕。定性访谈发现，童年时期的忽视和暴力是从事性工作和饮酒的驱动力，酒精和大麻有助于女性处理性工作。结论：需要针对性服务工作者量身定做的个人和结构层面的干预措施，以解决有害酒精和其他毒品使用以及相关的综合风险，包括A级、暴力和性危险行为。
Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural–biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0–32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1–24.1%) and 16.9% harmful cannabis use (95%CI 14.7–19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours.
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