Background: Female sex workers (FSW) are at high risk of contracting and transmitting HIV. The prevalence of HIV among FSW in Kazakhstan is rising, and has been shown to be higher among FSW who use drugs. However, little is known about the sex work environment in Kazakhstan or in Central Asia. We utilize baseline data from an HIV prevention study among 399 FSW who use drugs in two cities in Kazakhstan to address this gap.
Methods: Women were recruited through sex work venues and peer networks. Participants completed a computerized baseline survey including sociodemographic characteristics and risk behavior assessments. This paper provides an overview of participant''s sex work environment: history, employment structure, frequency and venue, and goods exchanged. It also examines sexual risk behaviors in commercial interactions, including number of partners and encounters and condom use. We use descriptive statistics and ordinary least squares (OLS) regression to examine the association between sex work environment and sexual risk behaviors.
Results: Participants averaged 34.6 years old (8.4 SD). The average age of initiation of sex work was 20.9 years (5.51 SD). Few participants (n=41, 10.3%) worked for a boss or pimp, and they worked an average of 8.9 months (4.18 SD) per year. Women exchanged sex for money (n=351, 87.9%), drugs (n=126, 31.6%), and basic needs such as food (n=97, 24.3%) and clothing (n=73, 18.3%). Participants averaged 6.78 (18.6 SD) commercial partners, and 28.9 (52.9 SD) vaginal sexual encounters with these partners in the prior 90 days. Only 13% (n=51) reported consistent condom use with these recent partners. Having a boss/pimp, working more months per year, and exchanging sex for basic needs were associated both with a higher number of paying clients and a greater number of sexual encounters. Few factors were significantly associated with condom use.
Conclusions: Our findings highlight the risks for FSW who use drugs in Kazakhstan and the need for HIV prevention efforts to increase safe sex practices. Moreover, prevention must address the structural characteristics faced by this population, such as their socioeconomic status and employment.