‘once they see blood then the mood for sex is spoiled’ A qualitative exploration of female sex worker’s male client views of menstruation, sex during menses and the menstrual disc

To continue working during menses, female sex workers (FSW) may use unhygienic absorbents to hide their menstrual status. The menstrual disc may provide a solution. Little is known about men’s knowledge and views, specifically around sex during menstruation with FSW, a population who are particularly vulnerable to violence which may be heightened during menses. To identify constructs for successful and safe menstrual disc implementation we sought to identify knowledge and attitudes towards menstruation among male clients of FSW, including views on FSW menstrual disc use during intercourse. We conducted six focus group discussions comprising a total of 51 male clients of FSW, in Kisumu, Kenya, exploring their perceptions of menses and sex during menses. In preparation for future implementation of a menstrual disc intervention, we introduced the disc to participants with an information session, answering their questions and gathering their opinions on it. Thematic analysis found most clients had limited or inaccurate knowledge about menstruation, viewing blood and the menstruator, as dirty or unclean. Sources of knowledge included school, female relatives/partners, community or church. Those reporting formal education described the biological processes more accurately, while church education lent towards stigmatized perceptions. Most participants expressed negative views towards sex during menses (i.e., unpleasurable, forbidden or risky), usually stemming from misconceptions, and reported seeking FSW services because their wife / girlfriend was menstruating. Many felt deceived if a FSW was menstruating, were often aware of materials placed vaginally to absorb blood, but generally continued with the service. No clients had prior knowledge of the menstrual disc but accepted it as a safe, hygienic, and cost-effective alternative, with some voicing interest to purchase for their wife / girlfriend. We conclude there is a need to provide accurate information on menstruation to boys and men including in school curricula and faith teaching to address lack of knowledge and negativity. These findings suggest potential for adoption of menstrual discs by FSW with minimal adverse client reaction, and highlight possible partner support for women considering adopting a menstrual disc

Water, sanitation and hygiene at sex work venues to support menstrual needs

Introduction: Adequate menstrual health and hygiene (MHH) is necessary for women’s health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods: Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor’s consent. WASH scores ranging 0 – 3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results: Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine, and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion: WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed

A Cross-Sectional Study of the Use of Antigen Rapid Diagnostic Tests for Community Identification of Severe Acute Respiratory Syndrome Coronavirus-2 in Kenya

Mass testing with antigen-detecting rapid diagnostic tests (Ag-RDT), including testing of asymptomatic individuals, is expected to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Mass testing was offered at large gatherings to determine the SARS-CoV-2 case detection rate and the acceptance and cost of implementing this community testing strategy. In 49 high-attendance venues in Kiambu County, Kenya, from June to September 2022, individuals 2 years and older were offered coronavirus disease 2019 (COVID-19) testing, vaccination, and participation in a survey. Polymerase chain reaction (PCR) testing and genome sequencing were conducted for those testing positive by Ag-RDT and those testing negative but with COVID-19 symptoms. Costs were collected from financial records, budgets, and invoices and estimated from a health systems perspective using a micro-costing method. A total of 4,062 individuals were offered testing. The testing acceptance was 3,174/4,062 (78.1%). The case detection rate was 34/3,174 (1.07%; 95% CI: 0.7-1.4%), and 11/34 (32%) of the positives were asymptomatic. The PCR results were available for 27 Ag-RDT‒positive participants and 14 Ag-RDT‒negative participants with SARS-CoV-2 symptoms and were positive in 24/27 (88.9%) and 4/14 (28.6%), respectively. Circulating variants were identified in 11 participants. Community mobilization was the major cost driver (26%) followed by purchase of SARS-CoV-2 Ag-RDTs (20.5%). The cost per individual tested was USD $15.89, and the cost per individual tested positive for SARS-CoV-2 was USD$1,484. The study demonstrates that SARS-CoV-2 Ag-RDTs could be used for identification of SARS-CoV-2 infections in both symptomatic and asymptomatic individuals at mass gatherings

Data_Sheet_1_Water, sanitation and hygiene at sex work venues to support menstrual needs.PDF

IntroductionAdequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya.MethodsStakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April–May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor's consent. WASH scores ranging 0–3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0–4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests.ResultsFull WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine; and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities.DiscussionWASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed.Trial registrationClinicaltrial.gov NCT0566678.</p