{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:41:15Z","timestamp":1777959675556,"version":"3.51.4"},"reference-count":71,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council and the UK Department of International Development (DFID)","doi-asserted-by":"publisher","award":["MR\/R023182\/1"],"award-info":[{"award-number":["MR\/R023182\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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\u2013biological 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: &gt;11 for alcohol; &gt;4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0\u201332.6%) reported harmful (moderate\/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1\u201324.1%) and 16.9% harmful cannabis use (95%CI 14.7\u201319.2%). 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.<\/jats:p>","DOI":"10.3390\/ijerph19127294","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T23:50:14Z","timestamp":1655250614000},"page":"7294","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-1780","authenticated-orcid":false,"given":"Alicja","family":"Beksinska","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5737-5960","authenticated-orcid":false,"given":"Emily","family":"Nyariki","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9541-3742","authenticated-orcid":false,"given":"Rhoda","family":"Kabuti","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0331-3825","authenticated-orcid":false,"given":"Mary","family":"Kungu","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hellen","family":"Babu","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooja","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"The Maisha Fiti Study Champions","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chrispo","family":"Nyabuto","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Okumu","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Mahero","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pauline","family":"Ngurukiri","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaina","family":"Jama","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erastus","family":"Irungu","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Adhiambo","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Muthoga","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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, ON M5S 1A1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5272","authenticated-orcid":false,"given":"Janet","family":"Seeley","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-7936","authenticated-orcid":false,"given":"Helen A.","family":"Weiss","sequence":"additional","affiliation":[{"name":"MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Kimani","sequence":"additional","affiliation":[{"name":"Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9156-7341","authenticated-orcid":false,"given":"Tara S.","family":"Beattie","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"James","year":"2018","journal-title":"Lancet"},{"key":"ref_2","unstructured":"Global Burden of Disease Collaborative Network. 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