Unsafe Sexual Practice among Cross-Border Commercial Sex Workers in Mettema Yohannis, Northwest Ethiopia

Abstract

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Background: Commercial sex work is an occupation that makes its workers highly vulnerable to sexually transmitted infections (STIs), including HIV especially, in border areas. Currently, there is lack of information on unsafe sexual practice among cross-border commercial sex workers (CSWs). 

Objective: to assess unsafe sexual practices and associated factors among cross-border CSWs in Mettema Yohannis, northwest Ethiopia.

Method: A cross-sectional study triangulated with qualitative design was used. For the quantitative study, data were collected from a systematically selected sample of 474 CSWs. Data were analyzed using the global (sexual experiences in the last twelve months) and situational analyses (based on last sex). The SPSS version 16.0 statistical software with multiple logistic regression was used for analyses. For the qualitative component, seventeen in-depth interviews and four focus group discussions were carried out.

Result: The prevalence of unsafe sex during the last sexual intercourse, last seven days and last twelve months, were 21.5%, 31.1%, 63.9%, respectively. Sex workers were more likely to practice unsafe sex with Sudanese clients (OR=6.4, 95% CI: 3.20, 12.78) and truck drivers (OR = 4.89, 95%CI: 1.26, 18.90). Familiarization with sexual clients was the strongest and consistently associated factor for unsafe sex both in global and situational analyses: OR=16.76, 95%CI 8.24, 34.08 and OR=19.49, 95%CI 6.44, 58.98, respectively. Mobile CSWs (OR =6.12 95%CI: 1.11, 33.64), working in rental houses (OR = 3.72 95% CI 1.25, 11.02), duration of exposure to sex work, educational level, monthly income and problem drinking were also significantly associated with unsafe sex.

Conclusion: There was a high prevalence of unsafe sexual practice among cross border CSWs. It is recommend that the Government of Ethiopia in collaboration with other organizations develop and launch mobility friendly STI/HIV intervention programs to alleviate the vulnerability of CSWs in cross-border areas.