Police Discrimination, Misconduct, and Stigmatization of Female Sex Workers in Kenya: Associations with Delayed and Avoided Health Care Utilization and Lower Consistent Condom Use.
David Kuria Mbote, Laura Nyblade, Caroline Kemunto, Kayla Giger, Joshua Kimani, Pia Mingkwan, Stella Njuguna, Emmanuel Oga, John D Kraemer
Author Information
David Kuria Mbote: Independent researcher and Director at the Kuria Foundation for Social Enterprise, Nairobi, Kenya.
Laura Nyblade: Fellow and Senior Technical Advisor, Stigma and Discrimination, RTI International, Washington, DC, USA.
Caroline Kemunto: Programs Manager for Survivors Organisation, Busia, Kenya.
Kayla Giger: Public Health Analyst at RTI International, Washington, DC, USA.
Joshua Kimani: Clinical Director at Partners for Health and Development in Africa and Lecturer at the Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
Pia Mingkwan: Research Associate at RTI International, Washington, DC, USA.
Stella Njuguna: Research Officer at the Kenya Medical Research Institute, Nairobi, Kenya.
Emmanuel Oga: Senior Epidemiologist at RTI International, Rockville, MD, USA.
John D Kraemer: Associate Professor in the Department of Health Systems Administration at Georgetown University and Visiting Scholar at RTI International, Washington, DC, USA.
Discrimination and violence against sex workers by police are common in many populations and are associated with negative health outcomes, as well as being per se violations of human rights laws and norms. There is a close and mutually reinforcing nexus between legally actionable rights violations and stigma, and reducing human rights violations against sex workers likely requires both legal and societal interventions that address both. In this paper, we first aim to estimate levels of discrimination, violence, and stigma against women sex workers by police in Kenya. Second, we aim to estimate the association between manifestations of discrimination and stigma, on the one hand, and general health care utilization and consistent condom use, on the other. Using data from a survey of Kenyan sex workers, we document widespread discrimination and stigma. Through regression analyses, participants with the highest levels of all three categories of manifestations of discrimination and stigma reported significant lower consistent condom use. Those with the highest levels of witnessed/heard manifestations were significantly more likely to delay or avoid needed health care, and the highest level of experienced manifestations were associated with a marginally significant increase in delay or avoidance. Our findings document a plethora of violations of human rights obligations under Kenyan and international law.
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