{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:43:39Z","timestamp":1780667019002,"version":"3.54.1"},"reference-count":47,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>UNAIDS has identified female sex workers (FSW) as a key HIV at\u2010risk population. FSW disproportionately experience gender\u2010based violence, which compounds their risk of HIV acquisition and may contribute to adverse mental health outcomes. Pre\u2010exposure prophylaxis (PrEP) is a powerful but underused HIV prevention tool for these women. This study explored the associations between intimate partner violence (IPV) and client\u2010perpetrated violence against FSW, mental health outcomes and PrEP use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019, where PrEP was available free of charge. A modified version of the WHO Violence Against Women Instrument assessed IPV and client\u2010perpetrated violence, and the Patient Health Questionnaire\u20109 (PHQ\u20109) and Generalized Anxiety Disorder\u20107 (GAD\u20107) assessed depressive and anxiety symptoms respectively. Multivariable logistic regressions evaluated predictors of depression, generalized anxiety and PrEP use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the total 220 women (median [IQR] age 32 [27\u201039]), 56.8% (125\/220) reported depression (PHQ\u20109\u00a0\u2265\u00a010) and 39.1% (86\/220) reported anxiety (GAD\u20107\u00a0\u2265\u00a010). Only 41.4% (91\/220) reported optimal use of PrEP (taken correctly six to seven days\/week) despite the cohort pursuing sex work for a median of 7 (4 to 12) years. Most women reported experiencing any violence in the past 12\u00a0months (90%, 198\/220). Any recent IPV was frequent (78.7%, 129\/164), particularly emotional IPV (66.5%, 109\/164), as was any client\u2010perpetrated violence in the past 12\u00a0months (80.9%, 178\/220). Regression analyses found that violence was independently associated with depression (adjusted OR [aOR] 9.39, 95% CI 2.90 to 30.42, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.0002) and generalized anxiety (aOR 3.47, 95% CI 1.10 to 10.88, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03), with the strongest associations between emotional IPV and both depression and anxiety. Recent client\u2010perpetrated emotional violence (aOR 0.23, 95% CI 0.07 to 0.71, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.01) was associated with decreased PrEP use, whereas client\u2010perpetrated physical violence was associated with increased PrEP use (aOR 3.01, 95% CI 1.16 to 7.81, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was a high prevalence of recent violence by different perpetrators as well as depression and anxiety among FSW from Nairobi. PrEP use was relatively infrequent, and recent client\u2010perpetrated emotional violence was associated with PrEP non\u2010use. Interventions to reduce gender\u2010based violence may independently enhance HIV prevention and reduce the mental health burden in this community.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25711","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T07:03:12Z","timestamp":1624518192000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Intimate partner and client\u2010perpetrated violence are associated with reduced HIV pre\u2010exposure prophylaxis (PrEP) uptake, depression and generalized anxiety in a cross\u2010sectional study of female sex workers from Nairobi, Kenya"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7152-3704","authenticated-orcid":false,"given":"Maria","family":"Leis","sequence":"first","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda","family":"McDermott","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Koziarz","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Szadkowski","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"Kariri","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology University of Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara S","family":"Beattie","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1586-4093","authenticated-orcid":false,"given":"Rupert","family":"Kaul","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Kimani","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology University of Nairobi  Nairobi Kenya"},{"name":"Department of Medical Microbiology University of Manitoba  Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Global HIV & AIDS statistics \u2014 2020 fact sheet[Internet].Geneva Switzerland:United Nations;2020[cited 2020 Sep 8]. 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