Unprotected sex, sexually transmitted infections and problem drinking among female sex workers in Ethiopia

Background: A description of the pattern of use of alcohol and other substances among female sex workers (FSWs) is particularly important because of the high prevalence of HIV in this particular group and their potential for transmitting HIV infection to other groups. However, there is currently lack of systematic studies from developing countries like Ethiopia regarding alcohol use visa vis unprotected sex and STIs. Objective: To describe the association of risky sexual behaviour with alcohol use and problem drinking among female sex workers in Ethiopia. Methods: A total of 2,487 female sex workers aged between of 15 and 49 years were randomly sampled from seven urban centres in Ethiopia and interviewed regarding their sexual behavior and substance use. Results: About 12% of FSWs included in this study reported having unprotected sex during the 12 months prior to the interview. A history of vaginal ulcer or discharge experienced by the FSWs was reported by 5% of the study subjects. Those who reported occasional use of alcohol were found to have a two-fold increase in the odds of havingunprotected sex compared to non-users: adjusted OR (95% CI) = 2.06 (1.28, 3.33). Those who responded positively to at least one question from the four - item questionnaire known as CAGE, and which is used as an indicator for problem drinking, had a 50% increased odds of unprotected sex compared with zero scorers: adj. OR (95% CI) = 1.48 (1.07, 2.05). Those who reported alcohol use on a daily basis were found to have a two-fold increased odds of having sexually transmitted infections (STIs) compared to the non-users of alcohol: adj. OR (95% CI) = 2.50 (1.35, 4.64). Compared to those who were not literate, educational attainment was associated with a lower odds of reporting vaginal discharge or ulcers in those that have attended elementary education: adj. Or (95% CI) = 0.56 (0.35, 0.89.), and secondary education: adj. OR (95% CI) = 0.59 (0.37, 0.93). Conclusion: Unprotected sex and symptoms of STIs were associated with alcohol use, problem drinking and lower educational attainment. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 93-98