Discussion Paper No. 009/2010 - Predictors of Behaviour Change among Female Sex Workers Participating in Amref’s Maanisha Programme, Kenya

Abstract

HIV prevention remains one of the most efficacious strategies for tackling the pandemic, especially owing to the fact that there is still no known cure for AIDS. Initiatives aimed at targeting most-at-risk populations (MARPS) such as commercial sex workers are key in arresting the transmission of HIV among the general population. The purpose of this paper was to understand the predictors of behaviour change among female sex workers participating in the Maanisha Programme through CSOs in Kenya. This was a cross-sectional study conducted between June and July 2010 in Western and Nyanza provinces. Snowball sampling was used to contact and interview 156 female sex workers. Additionally, six focus group discussions for FSWs were conducted. Binary logistic regression was used to analyse the quantitative data. Qualitative data was categorised and summarised thematically. Results revealed 59.1% of the FSWs had undergone behaviour change. The multivariate regression model found that good behaviour change was associated with the level of education (p=0.035, adj. OR 2.23, CI=1.06-4.69), religious affiliation (p=0.001, adj. OR=4.61, CI=1.95- 13.16), number of years involved in sex work (p=0.025, adj. OR 2.36, CI=1.12-5.00), and knowledge on prevention of HIV (p=0.020, adj. OR 4.37, CI=1.26-15.11). Engagement in alternative income generating activities (IGAs) was almost statistically significant (P=0.054, adj. OR=2.30, CI=0.98-5.38). Re-orientation of the peer education programme to focus on HIV preventive measures beyond use of condoms is recommended. The Maanisha Programme should initiate distribution of female condoms. This will enhance the female sex workers’ ability to ensure safer sex. Prevention of re-infection by integrating treatment and adherence into the programme will strengthen prevention among those already infected. A strengthened access to alternative sources of income is likely to result in positive behaviour change among FSWs in the Maanisha Programme.