1. Six-Month Follow Up Data from RCT Testing Brief Alcohol Reduction Intervention with Female Sex Workers in Mombasa, Kenya Presenter: Peter Mwarogo FHI 360 IAS 2013 Kuala Lumpur Malaysia July, 2013

2. Study Objective To investigate whether FSWs at drop-in centers in Mombasa, Kenya, who report harmful or hazardous alcohol intake and participate in a brief alcohol intervention, will reduce their alcohol use and incidence of STIs, HIV, and sexual violence, as well as increase their condom use.

3. Study Design Recruited FSWs through APHIA Plus, Mombasa 818 participants enrolled March-October 2011 Participants randomized to 6-month alcohol intervention, or 6-month nutrition intervention Alcohol intervention based on an adaptation of WHO brief intervention Data collection at baseline, 6 month, and 12 month follow-up – Clinical testing for HIV, trichomoniasis, gonorrhea, chlamydia – Behavioral survey on alcohol, condom use, physical and sexual violence 6-month follow-up rate: 86% (n=701)

4. Study Sample Characteristics at Baseline Intervention N(%) 411 (50.2) Control N(%) 407 (49.8) TOTAL N(%) 818 Age (years) 18-24 25-29 30-34 35-54 163 (39.7) 124 (30.2) 65 (15.8) 59 (14.4) 153 (37.6) 131 (32.2) 65 (16.0) 58 (14.3) 316 (38.6) 255 (31.2) 130 (15.9) 117 (14.3) Education Never attended school Primary school, any Secondary school, any Post-secondary school, any 12 (2.9) 212 (51.6) 149 (36.3) 38 (9.2) 21 (5.2) 204 (50.1) 146 (35.9) 36 (8.8) 33 (4.0) 416 (50.9) 295 (36.1) 74 (9.0) Religion Christian Muslim None 296 (72.0) 115 (28.0) 0 (0.0) 296 (72.7) 109 (26.8) 2 (0.5) 592 (72.4) 224 (27.4) 2 (0.2) Marital status Never married Currently married Separated, divorced, widowed 187 (46.1) 14 (3.4) 205 (49.5) 190 (47.1) 14 (3.5) 199 (49.4) 377 (46.6) 28 (3.5) 404 (49.9) HIV Positive83 (20.2)83 (20.4)166 (20.3)

5. Alcohol Use at 6 Months Intervention N(%) 347 (49.5) Control N(%) 354 (50.5) TOTAL N(%) 701 Alcohol use in last 30 days Every day At least once per week Less than once per week Never 12 (3.5) 124 (35.7) 25 (7.2) 186 (53.6) 34 (9.6) 207 (58.5) 20 (5.6) 93 (26.3) 46 (6.6) 331 (47.2) 45 (6.4) 279 (39.8) Sex while feeling drunk in last 30 days Most of the time Sometimes Rarely Never 10 (3.8) 48 (18.3) 38 (14.5) 166 (63.4) 33 (10.6) 99 (31.8) 67 (21.5) 112 (36.0) 43 (7.5) 147 (25.7) 105 (18.3) 278 (48.5) Binge drinking (3+ drinks on one occasion) Most of the time Sometimes Rarely Never 25 (7.2) 34 (9.8) 33 (9.5) 255 (73.5) 142 (40.1) 60 (16.9) 34 (9.6) 118 (33.3) 167 (23.8) 94 (13.4) 67 (9.6) 373 (53.2) Any binge drinking (5+ drinks) before sex with client 1 21 (8.1)76 (24.7)97 (17.1) Any binge drinking (5+ drinks) before sex with nonpaying partner 2 9 (4.2)36 (14.7)45 (9.8) 1 For women who reported sex with client in last 30 days 2 For women with non-paying partners 1 Women who had sex with client in last 30 days 2 Women with non-paying partner

6. Sexual and Physical Violence at 6 Months Intervention N(%) 347 (49.5) Control N(%) 354 (50.5) TOTAL N(%) 701 Forced sex by client in last 30 days one or more times 45 (17.4)65 (21.1)110 (19.4) Forced sex by nonpaying partner in last 30 days one or more times 72 (26.5)75 (27.5)147 (27.0) Beaten/physically abused by client in last 30 days one or more times 16 (4.6)16 (4.5)32 (4.6) Threatened/verbally abused by client in last 30 days one or more times 72 (20.7)107 (30.3)179 (25.6) Robbed/not paid by client in last 30 days one or more times 59 (17.0)82 (23.2)141 (20.1) Beaten/physically abused by non-paying partner in last 30 days one or more times 40 (14.7)57 (20.9)97 (17.8)

7. Key Observations Participants are young, have little education, are predominantly Christian, and many are separated/divorced – Intervention and control groups have similar demographic characteristics Alcohol use at 6 months was reported be lower in intervention than control group, regarding: – Alcohol use in past 30 days – Sex while feeling drunk in past 30 days – Binge drinking 3+ drinks; Binge drinking 5+ drinks before sex Low rates of incident STIs and HIV seroconversion from baseline to 6 month follow-up Condom use is high with paying clients and lower with non-paying partners Physical and sexual violence by clients and partners is common