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Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study.

Publication ,  Journal Article
Lancaster, KE; MacLean, SA; Lungu, T; Mmodzi, P; Hosseinipour, MC; Hershow, RB; Powers, KA; Pence, BW; Hoffman, IF; Miller, WC; Go, VF
Published in: Subst Use Misuse
April 16, 2018

BACKGROUND: Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. OBJECTIVE: To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. METHODS: In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. RESULTS: Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. CONCLUSIONS: Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.

Duke Scholars

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Published In

Subst Use Misuse

DOI

EISSN

1532-2491

Publication Date

April 16, 2018

Volume

53

Issue

5

Start / End Page

782 / 791

Location

England

Related Subject Headings

  • Young Adult
  • Unsafe Sex
  • Substance Abuse
  • Sexual Behavior
  • Sex Workers
  • Risk-Taking
  • Malawi
  • Humans
  • Female
  • Cross-Sectional Studies
 

Citation

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MLA
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Lancaster, K. E., MacLean, S. A., Lungu, T., Mmodzi, P., Hosseinipour, M. C., Hershow, R. B., … Go, V. F. (2018). Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study. Subst Use Misuse, 53(5), 782–791. https://doi.org/10.1080/10826084.2017.1365088
Lancaster, Kathryn E., Sarah A. MacLean, Thandie Lungu, Pearson Mmodzi, Mina C. Hosseinipour, Rebecca B. Hershow, Kimberly A. Powers, et al. “Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study.Subst Use Misuse 53, no. 5 (April 16, 2018): 782–91. https://doi.org/10.1080/10826084.2017.1365088.
Lancaster KE, MacLean SA, Lungu T, Mmodzi P, Hosseinipour MC, Hershow RB, et al. Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study. Subst Use Misuse. 2018 Apr 16;53(5):782–91.
Lancaster, Kathryn E., et al. “Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study.Subst Use Misuse, vol. 53, no. 5, Apr. 2018, pp. 782–91. Pubmed, doi:10.1080/10826084.2017.1365088.
Lancaster KE, MacLean SA, Lungu T, Mmodzi P, Hosseinipour MC, Hershow RB, Powers KA, Pence BW, Hoffman IF, Miller WC, Go VF. Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe, Malawi: A Mixed Methods Study. Subst Use Misuse. 2018 Apr 16;53(5):782–791.

Published In

Subst Use Misuse

DOI

EISSN

1532-2491

Publication Date

April 16, 2018

Volume

53

Issue

5

Start / End Page

782 / 791

Location

England

Related Subject Headings

  • Young Adult
  • Unsafe Sex
  • Substance Abuse
  • Sexual Behavior
  • Sex Workers
  • Risk-Taking
  • Malawi
  • Humans
  • Female
  • Cross-Sectional Studies