Exploring Factors Influencing to Early Initiation of Sex Work among Female Street Sex Workers in Jimma and Agaro Towns, Oromia Region, Southwest Ethiopia

Exploring Factors Influencing to Early Initiation of Sex Work among Female Street Sex Workers in Jimma and Agaro Towns, Oromia Region, Southwest Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Factors Influencing to Early Initiation of Sex Work among Female Street Sex Workers in Jimma and Agaro Towns, Oromia Region, Southwest Ethiopia dawit haile This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6388846/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study investigates the early beginning of street-based sex work among women, emphasizing on the factors Influencing these dangerous lifestyles, which accounts for 40% of all women in the sex industry globally. Objective To Assess factors contributing to early initiation of sex work among female street sex workers in Jimma and Agaro towns, Oromia, Southwest Ethiopia. Methods A cross-sectional study was conducted among 219 female street sex workers in five clinics from April 15 to September 15, 2024. Data was collected through face-to-face interviews and analyzed using SPSS version 25. Variables with a p-value of less than 0.05 were considered significant. Result From a total of 219 participants, with a 92.1% response rate,54.2% (95% CI: 47.1–61.2). had an early initiation of street sex work before the age of eighteen. Being illiterate (AOR: 2.66, 95% CI: 1.09–6.45) and having illiterate and primary-educated parents, (AOR: 3.29, 95% CI: 1.15–7.72) and (AOR: 2.94, 95% CI: 1.01–5.51), respectively, substance use (AOR: 3.56, 95% CI: 1.7–6.22) and migration (AOR: 2.88, 95% CI: 1.36–5.09); history of rural residence (AOR: 3.64; 95% CI: 1.69–5.84), were positively and significantly associated factors of early initiation of street sex work in this study Conclusion and Recommendations: This study revealed that more than half of teenage girls were engaged in early street sex work. Being Illiterate, having illiterate parents, migration, history of rural residence, and substance use, were factors significantly associated with early sex work initiation. Encourage and assist the less educated participants to finish their education, stop migrating by strongly penalize miss-brokers, and educate the young girls about the negative effects of various forms of substance usage. Sexual & Reproductive Medicine Early initiation Sex work teenagers Jimma Ethiopia INTRODUCTION Early initiation sex work is the beginning of exchanging sex for a living (such as cash, drugs, or housing) before the age of eighteen (1). These are common among female sex workers (FSWs) across global regions. Reports from both developed and developing countries indicate that female sex workers (FSWs) frequently begin their involvement in sex work at an early age; between twenty and forty percent of FSWs worldwide first engaged in sex work before reaching 18, with the average age being 16 or younger (1,2). Estimates of the prevalence of female sex among street youth range from 10% to 50% in the United States and from 12% to 32% in Canada (3). The fact that different investigators have different definitions of street sex work contributes to the vast range of these estimations. In this regard, some investigators defined street sex as simply engaging in sexual activity for payment. While others adopted a broader definition that also included trading sex for necessities like food, housing, and survival. The fundamental concept of exchanging sexual behaviors for money or other benefits is constant (4,5). Studies conducted in various countries such as India, Nepal, Thailand, and Canada have revealed some alarming facts about the risks associated with entry into sexual activities at an early age. Individuals who sell sex when they are still young are two to four times more likely to acquire sexually transmitted infections (STIs) and HIV/AIDS during their teenage years (6,7). A recent study has been conducted that has shed light on the complex issue of early sex work entry among females. The study revealed that childhood trauma, such as substance abuse, homelessness, and physical and sexual abuse, is a significant factor contributing to this problem (8). Data from Sub-Saharan Africa is scarce, but according to a study in South Africa and Uganda, teenagers who reported having sex at a young age were more likely to trade sex for material necessities (9). A significant number of sex workers reply that they engage in commercial sex for financial gain. In this early era of sexual engagement, the poorest and sex workers highly correlate (10). Young women, especially those engaged in informal sex work, face a greater risk of acquiring HIV and other sexually transmitted infections (STIs). Because of their early age beginning sex work, they are less inclined to use condoms and often engage in high-risk or multiple-partner relationships, leading to one in ten births, one in ten abortions, and two out of every seven new HIV infections (11–13). A study indicates that FSWs who worked on the streets while still minors were more likely to smoke cigarettes, use stimulants, drink alcohol, chew tobacco, watch pornographic films, or read pornographic magazines than other FSWs and adults in general (14). Additionally, it has been discovered that among Ethiopian female teenagers, early sexual initiation is linked to factors such as religion, money, region of residence, and educational attainment (15,16). These behaviors are linked, on their own, to a higher likelihood of engaging in risky sexual behaviors, such as having several sexual partners, particularly engaging with commercial sex workers also not using condoms (17,18). Even numerous studies were conducted in Ethiopia on early initiation of sex among adolescent females; however, it's mainly focused on institutional-based groups, such as university students, while investigating the factors that lead to the early onset of sex (14,16,19,20). There have been several notable correlations found between major life events and the early development of sex behaviors. The previous studies limited their attention to university and college students and institutional settings, while others focused on indoor female sex workers. As a result, those female sex workers who worked on the streets or outdoors have not gained the attention of researchers. Therefore, the purpose of this study is to assess the factors influencing the early onset of sexual activity among female street sex workers in Jimma and Agaro Towns, southwest Ethiopia. Early commencement of sex work is a global problem for reproductive health. Around the world, forty percent of women employed in the sex industry started their employment before turning 18 (21). These typical women who start working as street prostitutes before the age of eighteen are especially susceptible to adverse consequences concerning their sexual health in Middle Eastern nations (22). On the other hand, the study that is currently available indicates that early exposure to sex work, also known as distal exposure, increases the likelihood of negative health effects. Early sexual practice at a young age is a global public health concern that is more common in low- and middle-income nations (20). Those women faced great risks of blood-borne sexually transmitted infections and HIV/AIDS infections (23,24). Adolescent girls and young women account for 34% of new HIV infections globally, with 80% in sub-Saharan Africa (25). However, in Eastern and Southern Africa, new HIV infections among girls aged 10-19 decreased by 25% between 2010 and 2017, while there was no fall in West and Central Africa, according to UNAIDS (26). The other challenges faced relate to sexually transmitted infections (STIs), which disproportionately afflict street female sex workers (SFSWs) and teenage females under the age of 18, and are another issue associated with early-beginning sex workers on the street. Of the 385 participants in a Baltimore research study, 28% had an STI, with 15% having chlamydia and 18% having gonorrhea (21). and there was a significant prevalence of STIs among mostly street-based FSWs in two case studies of Mexico-US border cities: 6%, 13%, and 14% of the tested people had gonorrhea, chlamydia, and active syphilis, respectively (27). Early sex initiation in young women is substantially associated with maternal mortality; around 20 million unsafe abortions and 68,000 unsafe abortion-related fatalities take place every year worldwide. Of the 20 million unsafe abortions performed globally annually, adolescent girls account for 14% of the 68,000 deaths attributable to unsafe abortions (28). An estimated 252,000 unintended births occur each year as a result of sexual activity by 30% of youths under the age of 17. Girls who have unplanned first sexual experiences are at risk for HIV infection, sexually transmitted diseases, and unplanned pregnancy (29). Teenagers who date multiple partners too young and without protection are more likely to contract HIV and other sexually transmitted diseases, as well as become pregnant while still in their teens. Sexually transmitted diseases, fistulas, and premature or unsafe pregnancies are currently the main public health concerns (30). In low- and middle-income countries, early marriage, teenage pregnancy, and unplanned pregnancy are responsible for almost all maternal deaths (31). With SSA accounting for roughly 66% and Southern Asia accounting for 22% (28). Additionally, because of diminished bargaining power and self-efficacy with paying sex partners, early commencement of sex work may be linked to violence (32). With global lifetime prevalence estimates ranging from 45-75% in 2012 and 32-55% in 2013, early initiators are more likely to have recently experienced verbal abuse and physical and sexual violence from paying partners than from non-paying partners (33). A study in Moscow found that 37% of street-based FSWs experience violence, and a prospective cohort study in Canada found that out of 237 female sex workers, 57% experienced gender-based violence over an 18-month follow-up period (34,35). Research on street-based In India and Britain, sex workers are more likely to encounter client violence than those working in public spaces, brothels, or lodges; the odds are higher for outdoor work because of the varied risk behaviors and work environments (35–37). Studies on the violence of chilled sexual abuse (CSA) are in Thailand and Turkey, 34% and 84%, respectively, and in Zambia and South Africa, 66% and 48%, of CSA affected, respectively, among FSWs (18). Eighteen percent of 12–19-year-old girls in Burkina Faso who participated in nationally representative surveys on violence against teenage girls reported having their first sexual encounter through forced sex (38). However, 21.4–32% of Kenyan women are thought to have been sexually assaulted before turning 18 (39). Apart from facing violence during their adult lives, FSWs worldwide are more likely than women who do not work in the sex industry to have experienced childhood sexual abuse (CSA) (42). A cross-sectional survey on commercial sex workers in Northern Ethiopia found that 75.6% of CSWs had experienced sexual violence overall (43).Gender-based violence in CSWs increases infection risk, gynecologic dysfunction, and sexually transmitted infections, causing long-lasting mental and physical health effects (39). Young women who encounter violence are more susceptible to sexually transmitted diseases, blood-borne infections, and mental health conditions such as depression, anxiety, PTSD, and suicide (44,45). Despite the perils of HIV on an individual and systemic level, girls in this situation have limited access to sexual and reproductive health care. Nearly 60% of adolescent females aged 15 to 19 who are sexually active and unmarried in SSA, including Ethiopia, do not utilize a contemporary method of birth control (46). This study investigates factors driving street sex workers in Jimma and Agaro Towns to work on the streets, focusing on vulnerable victims of abuse, violence, and disease transmission. The purpose of this study is to close this gap by determining the factors that lead to female street sex workers in Jimma and Agaro Town initiating sex work early. Information about early sex work initiation and targeted public health programs to reduce the rate of HIV/AIDS and sexually transmitted diseases among these study groups is provided. Neighborhood-based initiatives that improve the resilience and well-being of individuals who are at risk can also benefit from the findings. The study's findings can help address the root causes of the early initiation of sex work and guide evidence-based policy, all while filling in the gaps in empirical research. Study setting, design and period . Jimma Town is located in the Jimma Zone of the Oromia Regional State. Located 352 km from Addis Ababa city. The Central Statistical Agency's 2024 population projections place Jimma Town's population account 500,000. A municipality includes three sub-cities, thirteen town kebeles, and four rural kebeles. 128 health facilities in the municipality offer medical services. Jimma City contains one referral and one general governmental hospital, five private hospitals, four public health centers, 55 private clinics, 25 pharmacies, 36 drug stores, and 5 drug distributors (47). Agaro, known in Oromo as Aggaaroo, is a prominent town that also functions as an independent woreda. It is 1,560 meters above sea level and is situated in the Oromia Region's Jimma Zone. 25,458 people were living in this woreda as of the 2007 national census, with 12,946 men and 12,512 women. The study was conducted in Jimma and Agaro Towns from April 15 up to September 15, 2024. An institution-based cross-sectional study design was employed. Study population, inclusion and exclusion criteria The study population consists of all female sexual workers in Jimma and Agaro towns, specifically focusing on active street female sex workers during the data collection period. To be included in the study, participants must be female street sex workers aged over 18 years. Excluded from the study are those who are ill and unable to respond to the questions, as well as individuals who have transitioned from street work to off-street venues. This approach ensures a clear focus on the target demographic while accounting for factors that could affect participation, including those who previously worked on the street but have since changed their working area to off-street locations. Sampling technique, Sampling procedures and data collection . procedure The Jimma City Health Office recently released data that sheds light on the number of women involved in sex work in Jimma. According to their findings, the total number of women engaged in sex work is 3,950. Furthermore, 300 of these women work on the streets, and the Agaro Town health office reported the number of active female street sex workers is one hundred. Those sex workers by peer educators invited to KPCs, after registering in the logbook, provide different types of provisions like STI screening and HIV testing roundly every three months. These data were checked from Key-Population (KP) Clinic registration books from five KP clinics, three health centers, and one general hospital in Jimma and one health center from Agaro, specifically Jimma Higher 1 and Jimma Higher 2, Jimma Mandira Qocii Health Center, and Jimma Shennan Gibe General Hospital, and Agaro Health Center KP Clinic. The data was collected after a thorough cross-check of registration books to ensure accuracy. To achieve the optimal sample size for this study, we employed a convenience sampling technique. This method is advantageous as it helps increase the sample size and minimizes errors. Before data collection, the health office of Jimma and Agaro Towns collaborated with the Social Affairs Office to identify areas where women work as street vendors. They also gathered statistical information from the selected Key-Population Clinics. (Study participants were appointed and interviewed face-to-face at the KP clinics). The data were collected using structured questionnaires developed after reviewing relevant literature on the early initiation of street female sex workers and pretested by in-person interviews. In Bacho Bore Health Centre (KP clinic), 20 females were street, which is 5% of the total 400 street sex workers, both in Jimma and Agaro Town street sex workers. The study a quantitative also structured questionnaire used. Experts in the languages translated it from English to Amharic and Afan-Oromo, then back to English to ensure uniformity. Five female BSc Nurse holders and experienced individuals served as data collectors, while two MSc Nurses served as supervisors. The investigator also provided two days of training for supervisors and data collectors. The questionnaire was pretested to detect clarity and cultural suitability and modified accordingly. The investigator and supervisors conducted routine oversight and counter-checked the daily completed questionnaire. Supervisors signed each completed questionnaire after ensuring it was complete. Confidentiality was considered when gathering the data. Study variables The study variables include one dependent variable, which is the initiation of early sex work. Several independent variables are categorized into three main areas. First, socio-demographic factors encompass age, marital status, educational status, parents' education levels, history of having children, migration patterns (from rural to urban or city to city), and income. Second, behavioral risk factors involve substance use, such as chewing khat, tobacco smoking, and hashish, as well as exposure to pornographic materials and the use of heavy drugs, including inhalants, tranquilizers, marijuana, cannabis, and cocaine. Lastly, family and social factors consider parental loss, parental divorce, history of rape, emotional abuse, childhood abuse, and peer influence. This comprehensive framework allows for an in-depth analysis of the various influences on the initiation of early sex work. Operational Definitions Sex work : The exchanging of sex for money/materials. Early initiation of sex work : has been defined as those who participated in sex work before the age of 18 (48). Heavy drug use - use any of this for non-medical purposes (cannabis, heroin, cocaine, and marijuana) alters mood or behavior. Substances use: When study subjects use alcohol, khat, or different types of tobacco. Age at sexual initiation: Age at first vaginal intercourse. Street female sex workers: Also known as prostitution, involves a sex worker soliciting customers in public areas such as streets, parks, and benches (49). Data Quality Assurance, Data management and analysis . Based on the pre-test results, the questionnaire was adjusted contextually and terminologically, and data were coded before it was filled by data collectors. The principal investigator and supervisors did spot checks and reviewed the completed questionnaires daily to ensure the completeness and consistency of the information collected. Moreover, all complete responses were coded before entry. Finally, data entry was made into EPI Data version 4.6. Statistical software by the principal investigator to keep the accuracy of the data. Cronbach’s alpha coefficient was calculated, and the result was 0.73. The data were entered into Epi-data version 4.6 after being double-checked for accuracy and were exported to SPSS version 25 for analysis. At each stage, the variables were appropriately coded and recoded as needed. A binary logistic regression analysis was done to sort variables that are candidates for multiple logistic regressions. Finally, those variables with a P-value ≤0.25 were fitted to the multivariate logistic regression model. A multivariate logistic regression analysis was conducted to identify factors strongly associated with the early initiation of sex work among street-based female sex workers. Finally, the association is to declare with a p-value less than 0.05 will be considered statically significant, and an adjusted odd ratio (AOR) at a 95% confidence interval measures the strength of the association. Hosmer and Lem show’s test was used to determine the model's fitness. Ethical consideration and consent participate The institutional review board at Jimma University's Institute of Health was provided ethical clearance by Ref No: JUIH/IRB/070/24 . Jimma and Agaro Town health offices provided official permission. Written consent was sought from participants. And the study subject was told about the goal and purpose of the investigation. The responders were made fully aware of what the data collectors needed from them. After gaining informed consent, information was gathered, and participants' involvement in the survey was entirely voluntary. If they chose not to answer any questions, the data collectors simply moved on to the next one, or they could end the interview at any moment. The data gathered from this study was kept private, and any personal information that would be gathered was saved in a file with a code number rather than your name. RESULTS Socio-demographic related factors This study achieved a 92.1% response rate, with 219 respondents in total. The respondents' average age was 19.8 (±SD 0.95). 135 (66.5%) were not married, and 49.2% had completed primary school. Forty-one percent (41%) migrated before entering this work (Table 1 ). Behavioral related factors Of the total participants, 98 (51.7%) had an experience of khat, alcohol, and different types of cigarettes smoking behaviors, 15.3% of participants reported a history of viewing pornographic images or films, while 10.8% participants using heavy drugs such as cocaine and tranquilizers (Table 2). Family and Social related factors . Of the 203 women who worked as street prostitutes, 77 (39.9%) had girlfriends who had previously engaged in street sex work. Of those who had been engaged in this work, 50 (24.6%) were vocationally trained, and 19.7% and 21.7%, respectively, had experienced parental divorce and parental loss (either mother/father or both). Intimate partner sex was imposed upon 23.6% of respondents against their will. Due to poor relationships, some of the sex workers did not openly discuss sexual behavioral risks with their parents (Table 3). Reasons for engaging in street sex work . The respondents were asked to give the main reasons for choosing street sex work. The reasons for entering this work were financial need and significantly associated with socio-demographic linked factors, behavioral factors, and family/social-related factors. Financial need for the matter of survival, the participants who entered into street sex work were 80.1%, and these were distantly followed by peer pressure, physical/sexual abuse, parent divorce, and parent loss. Before those participants entries into this work (Table 4). Prevalence and Factors associated with early initiations of female street sex work. The prevalence of early initiation into street sex work among two towns (Jimma and Agaro) was 54.2% (95% CI: 47.1-61.2). The mean age of entry into sex work was 19.8 (±SD 0.95); for 18 years it was 25.4 (±SD 0.9). In this study, around 72% of sex workers identified were aged between 15 and 24 years old. Using Bivariate analysis, variables such as respondents' educational background before engaging in sex work and the educational attainment of their parents before the females entering this work were found to be associated with early initiation, parent loss, parent divorce, watching pornographic films or videos, having poor relationships with parents, discussing the risk of early sex initiation with them, friends, using various substances, and migration, with a P-value ≤ 0.25. However, intimidation was more significant. This variable was found initial exposure to street sex work, the following independent variable was statistically significant among all components entered into multivariable logistic regressions (Table 5). Those who were illiterate were 2.66 times more likely to initiate street sex work than literate younger women (AOR: 2.6, 95% CI: 1.09-6.45). No formally educated and less educated parents of those who had early initiation street sex work were 3.29 and 2.94 times more likely to enter street sex work than those who had more educated parents (AOR: 3.29; 95% CI: 1.15-7.72) and (AOR: 2.94; 95% CI: 1.01-5.51), respectively. Those who didn’t have a history of parental loss and parental divorce entering street sex work were 67% and 62% less likely to enter street sex work early compared to their counterparts (AOR: 0.33, 95% CI: 0.12-0.61) and (AOR: 0.38; 95% CI: 0.16-0.87), respectively. Whereas those migrant women, before entering sex work, were 2.88 times more likely to have early initiation to street sex work than those who didn’t migrate (AOR: 2.88; 95% CI: 1.36-5.09) (Table 5). DISCUSSION According to this study, 110, representing more than half of SBFSW, entered into sex work before turning 18 years old (95% CI: 47.1-61.2). However, this result was higher than that of a study conducted in Addis Ababa regarding women's early engagement in sex work, which found that 48% of young women were initiated into commercial sex work at an early age (50).The variation between these studies may be because our study's primary focus is on those girls who begin street sex work before turning eighteen, but other studies excluded street-based sex workers and considered indoor types of female sex work. The difference may also be explained by the variations in the sociodemographic, behavioral risk-related, family, and societal-related factors. Our study also identified sociodemographic factors like financial problems, young women's education, parents' education, migration, substance use and addiction, losing parents, being from a divorced family, and having girlfriends with similar behavior before starting this job, which are all significantly associated with early initiation to street-based female sex work. According to the majority of research participants, they began engaging in sex work for financial gain. This study discovered an independent relationship between early street sex work entry and an economic issue. Respondents stated that their primary motivation for turning to street sex work as a source of income was hardship. regardless of the age of initiation into sex work, over 80.2% of 163 participants. But as regards age <18 years, from the total, 67.5% reported needing money for basic needs; these reasons for entering into sex work were similar to those found in previous studies(51,52). This study discovered a link between educational attainment and early involvement in the street sex trade. The study found that compared to those with secondary and higher education, those with no formal education were more likely to begin sex work early. Furthermore, individuals with secondary and higher-educated parents were less likely to engage in early street-based sex work than those with no and less-educated parents. Research from Canada, Thailand, Nepal, and India supported this finding (50).This might be due to parents with less education often overlooking their daughters' education due to societal beliefs about women's roles, leading to not sending their children to school. Other contributing factors to early involvement in street sex work include parental divorce and the loss of one or both parents. Previous evidence also confirmed that parent bereavement and parental divorce are important contributing variables(10,53,54). When parents’ divorce and drift away, children may lose control and live their lives on their own, meeting their requirements as well as the demands of the rest of the family. This is particularly true when both parents pass away, leading girls to drop out of school and look for high-risk and low-paying employment. The current study also illustrated that different types of substance users, including chewing khat, drinking alcohol, and smoking different cigarettes before starting sex, are more likely to early enter the sex-work trade, which is also under other previous studies (18,55). Also, this finding is supported by a study in the USA, stating drugs, including cocaine and other inhalants, were the primary reason for sex work (50). One possible explanation for this association may be that when respondents previously developed addictions to khat, cigars, alcohol, and different types of heavy drugs, they may have only chosen to take jobs in which they could easily generate income, which is supported by two other studies (14,20). Those participants who did not have children were more likely to be engaged in street sex work than those who had children in this study. This result is also in line with other previous studies, stating women with dependent children were more likely to engage in sex work at a later age (53). This result can also be a paradox from other study results showing those women having children are more likely to enter sex work to cover the basic needs of their children after they are separated or divorced from their husbands. According to this study, those who migrated had a 2.88-fold higher chance enter into street sex work early than those who did not migrate. This finding was corroborated by research conducted in two countries (56,57). In this study, more than half of the participants departed their homes to a city in pursuit of employment. Most young women move from one location to another in search of employment, which might be because of peer pressure, broker misguidance, and other factors. While those young women who did not have gainful employment when they came to the city will be forced to simply engage in street-based sex work as the last option. Moreover, this study highlighted that those participants who originated from rural areas were more likely to engage in early street sex work compared to urban residents. This may explain why those urban-dwelling women are more aware of the risks associated with sex work and the humiliation they could bring to their families and friends. Conclusion and Recommendation According to this study, we found a higher magnitude of early involvement in female street sex work than that of a study conducted in Addis Ababa on women's early engagement in sex work. Early initiation in street sex work was linked to Poverty, educational attainment, parental divorce, residence, parental loss, and migration. They also reported that used various forms of substances, having a poor bond with their parent, and having girlfriends before entry to This Work Were Significantly Associated with Early Sex Work Initiation. The study reveals various pathways for younger girls entering street sex work, highlighting the need for targeted interventions. Government officials should provide secure income opportunities, reduce divorce rates, invest in the education of daughters, foster healthy relationships, teach sustainable livelihoods, encourage sex workers to seek safe employment and prioritize larger sample sizes along with diverse methodologies for deeper insights. Strengths and Limitations of the Study This study employed a cross-sectional design, which was used to determine the prevalence and give initial data for further investigation. The associations between multiple exposures and outcomes. When compared to other study designs, cross-sectional studies are easier and less expensive to conduct. However, it has some limitations. Because it is unable to record longitudinal changes, it is not appropriate for researching behavior over lengthy periods. Additionally, it is unable to conclusively prove cause-and-effect linkages. Lastly, a study taken at a specific moment may not be an accurate representation of the whole population or typical behavior. Future studies should consider a longitudinal study design with a larger sample size to provide a representative sample. Abbreviations AIDs Acquired Immunity Deficiency Syndrome CSA Childhood Sexual Abuse CSW Commercial Sex Workers EDHS Ethiopian Demographic and Health Survey FSWs Females-sexually workers SFSWs Street Female Sex Workers SSA Sub-Saharan Africa STDs Sexually Transmitted Diseases STIs Sexually Transmitted Infections UNAIDS United Nations Program me on HIV/AIDS. USA United States of America. WHO World Health Organization. Declarations Ethics approval and consent to participate . The Jimma University Institute of Health's review board granted ethical approval under the reference JUIH/IRB/070/24. And official permission from Jimma and Agaro Town health offices. Consent was obtained in writing, and participants were informed of the study's objective and requirements. Data was collected, kept private, and personal information was saved in a coded file. Authors declare that there are no conflicts of interest related to this investigation and that no funding was received for this study. Data Availability Statement All relevant data are within the paper and its supporting information file. Acknowledgments The authors acknowledge Jimma University and the research participants. Funding Regarding funding, there was no funding agent for this research work. Author Contribution DHZ: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Supervision, Writing – original draft. TBT: Project administration, Supervision, Validation, Resources, Visualization, Writing – review & editing. BTG : Methodology, Formal analysis, Software, review and Writing – original draft. GYT : Data curation, Investigation, Project administration, Resources, Visualization, Writing – review & editing Conflict of interest There were no financial or commercial relationships that may be interpreted as creating a conflict of interest in the research. References Goldenberg SM, Chettiar J, Simo A, Silverman JG, Strathdee SA, Montaner JSG, et al. Early sex work initiation independently elevates odds of hiv infection and police arrest among adult sex workers in a canadian setting. J Acquir Immune Defic Syndr. 2014;65(1):122–8. Goldenberg SM, Rangel G, Vera A, Patterson TL, Abramovitz D, Silverman JG, et al. 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E PIDEMIOLOGY AND S OCIAL S CIENCE HIV Incidence Trends Among White and. 2006;43(3):351–5. Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014;104(5):42–54. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49. Shannon K, Kerr T, Strathdee SA, Shoveller J, Montaner JS, Tyndall MW. Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers. BMJ. 2009;339(7718):442–4. Blanchard JF, O’Neil J, Ramesh BM, Bhaitacharjee P, Orchard T, Moses S. Understanding the social and cultural contexts of female sex workers in Karnataka, India: Implications for prevention of HIV infection. J Infect Dis. 2005;191(SUPPL. 1):139–46. 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BMC Public Health. 2022;22(1):1–12. Alemayehu M, Yohannes G, Damte A, Fantahun A, Gebrekirstos K, Tsegay R, et al. Prevalence and predictors of sexual violence among commercial sex workers in Northern Ethiopia. Reprod Health. 2015;12(1):1–7. Nerøien AI, Schei B. Partner violence and health: Results from the first national study on violence against women in Norway. Scand J Public Health. 2008;36(2):161–8. Pico-Alfonso MA, Garcia-Linares MI, Celda-Navarro N, Blasco-Ros C, Echeburúa E, Martinez M. The Impact of Physical , Psychological , and Sexual. J Women’S Heal. 2006;15(5):599–611. Singh S, Darroch JE, Ashford LS. ADDING IT UP. Sexual and Reproductive Health. Guttmacher Inst. 2014; Lemu YK, Terfa YB, Inkosa LT, Mohammed AA, Yadeta GB, Tulu YT, et al. Women ’ s Experiences on Injectable Contraceptive Preference Among Jimma Town Public Health Facilities , Southwest Ethiopia 2023 . A Phenomenological Study Design. 2024;(February):1–12. Arefaynie M, Yalew M, Damtie Y, Kefale B. Determinants of early sexual initiation among female youth in Ethiopia: A multilevel analysis of 2016 Ethiopian Demographic and Health Survey. BMC Womens Health. 2020;20(1):4–11. Kakchapati S, Paudel T, Maharjan M, Lim A. Systematic Differences in HIV, Syphilis and Risk Behaviors among Street Based and Establishment Based Female Sex Workers in Kathmandu Valley of Nepal. Nepal J Epidemiol. 2017;6(4):620–30. Sciences H, To E, Work SEX, Factors A, Commercial A, Workers SEX, et al. Early engagement to sex work and associated factors among commercial sex workers in Addis ketema sub-city Addis. 2015; Saggurti N, Verma RK, Halli SS, Swain SN, Singh R, Modugu HR, et al. Motivations for entry into sex work and HIV risk among mobile female sex workers in India. J Biosoc Sci. 2011;43(5):535–54. Tilahun M, Ayele G. Factors associated with age at first sexual initiation among youths in Gamo Gofa , South West Ethiopia : a cross sectional study. 2013; Grosso A, Fielding-Miller R, Matse S, Sithole B, Baral S. The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini. Front Psychiatry. 2023;14(June):1–10. Silverman JG. Adolescent female sex workers: Invisibility, violence and HIV. Arch Dis Child. 2011;96(5):478–81. M. T, G. A. Factors associated with Khat use among youths visiting HIV testing and counseling centers in Gamo Gofa, Southern Ethiopia. BMC Public Health. 2013;13:1199. Zhang Y, Liang B, Liu D, Wei G, Mo S, Nong A, et al. file:///C:/Users/ju/Downloads/s12981-020-0260-0 (1).pdf cross-sectional study. AIDS Res Ther. 2020;17(1):1–11. Richter M, Chersich MF, Vearey J, Sartorius B, Temmerman M, Luchters S. Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities. J Immigr Minor Heal. 2014;16(1):7–17. Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6388846","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":439156869,"identity":"e0b8362c-f722-49b7-99d0-6f6db22d6166","order_by":0,"name":"dawit haile","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYDCCA1DEB2QbfKgAkszMDYS1HACSbEB24YwzIC2MhLUwwLR85mwDCRHQwnf8jOHhD3/uyLOxdyduZpxXG83fDtTyo2IbTi2SZ3IMDhxse2bYxnN2s3HhtuO5Mw4zNjD2nLmNU4vBgdwNBw42HGZsk8jdZjxz27FcILuBmbENj5bzbzccOPDnsD1Qy/bfvHOO5c4nqOUG0JYDbIcTgVo2GPM21ORuIKRF8sb7DwfOth1OBvplg+GMYwdyNwK1HMTnF77zackfKv4ctu1n791g8KGmLnfe+cMHH/yowK0FHRwGkweIVg8EdaQoHgWjYBSMghECALO5bnZlMY5EAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0006-4981-3370","institution":"jimma university","correspondingAuthor":true,"prefix":"","firstName":"dawit","middleName":"","lastName":"haile","suffix":""}],"badges":[],"createdAt":"2025-04-06 23:13:25","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6388846/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6388846/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80121345,"identity":"95570026-21fe-4670-b7c4-2205a5a84979","added_by":"auto","created_at":"2025-04-08 07:37:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":794173,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6388846/v1/3dfab4ec-12c7-416d-958d-2bebe8b294f4.pdf"},{"id":80120170,"identity":"d387cf3a-3b86-4ad9-89a9-de54eac514ee","added_by":"auto","created_at":"2025-04-08 07:21:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45669,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6388846/v1/ebcaa007604d3c775ccbe023.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eExploring Factors Influencing to Early Initiation of Sex Work among Female Street Sex Workers in Jimma and Agaro Towns, Oromia Region, Southwest Ethiopia\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEarly initiation sex work is the beginning of exchanging sex for a living (such as cash, drugs, or housing) before the age of eighteen\u0026nbsp;(1).\u0026nbsp;These are common among female sex workers (FSWs) across global regions. Reports from both developed and developing countries indicate that female sex workers (FSWs) frequently begin their involvement in sex work at an early age; between twenty and forty percent of FSWs worldwide first engaged in sex work before reaching 18, with the average age being 16 or younger\u0026nbsp;(1,2). Estimates of the prevalence of female sex among street youth range from 10% to 50% in the United States and from 12% to 32% in Canada\u0026nbsp;(3).\u0026nbsp;The fact that different investigators have different definitions of street sex work contributes to the vast range of these estimations. In this regard, some investigators defined street sex as simply engaging in sexual activity for payment. While others adopted a broader definition that also included trading sex for necessities like food, housing, and survival. The fundamental concept of exchanging sexual behaviors for money or other benefits is constant (4,5).\u0026nbsp;Studies conducted in various countries such as India, Nepal, Thailand, and Canada have revealed some alarming facts about the risks associated with entry into sexual activities at an early age. Individuals who sell sex when they are still young are two to four times more likely to acquire sexually transmitted infections (STIs) and HIV/AIDS during their teenage years\u0026nbsp;(6,7).\u0026nbsp;A recent study has been conducted that has shed light on the complex issue of early sex work entry among females. The study revealed that childhood trauma, such as substance abuse, homelessness, and physical and sexual abuse, is a significant factor contributing to this problem\u0026nbsp;(8).\u0026nbsp;Data from Sub-Saharan Africa is scarce, but according to a study in South Africa and Uganda, teenagers who reported having sex at a young age were more likely to trade sex for material necessities\u0026nbsp;(9).\u0026nbsp;A significant number of sex workers reply that they engage in commercial sex for financial gain. In this early era of sexual engagement, the poorest and sex workers highly correlate\u0026nbsp;(10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYoung women, especially those engaged in informal sex work, face a greater risk of acquiring HIV and other sexually transmitted infections (STIs). Because of their early age beginning sex work, they are less inclined to use condoms and often engage in high-risk or multiple-partner relationships, leading to one in ten births, one in ten abortions, and two out of every seven new HIV infections\u0026nbsp;(11\u0026ndash;13).\u0026nbsp;A study indicates that FSWs who worked on the streets while still minors were more likely to smoke cigarettes, use stimulants, drink alcohol, chew tobacco, watch pornographic films, or read pornographic magazines than other FSWs and adults in general\u0026nbsp;(14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, it has been discovered that among Ethiopian female teenagers, early sexual initiation is linked to factors such as religion, money, region of residence, and educational attainment\u0026nbsp;(15,16).\u0026nbsp;These behaviors are linked, on their own, to a higher likelihood of engaging in risky sexual behaviors, such as having several sexual partners, particularly engaging with commercial sex workers also not using condoms\u0026nbsp;(17,18).\u0026nbsp;Even numerous studies were conducted in Ethiopia on early initiation of sex among adolescent females; however, it\u0026apos;s mainly focused on institutional-based groups, such as university students, while investigating the factors that lead to the early onset of sex\u0026nbsp;(14,16,19,20).\u0026nbsp;There have been several notable correlations found between major life events and the early development of sex behaviors. The previous studies limited their attention to university and college students and institutional settings, while others focused on indoor female sex workers. As a result, those female sex workers who worked on the streets or outdoors have not gained the attention of researchers. Therefore, the purpose of this study is to assess the factors influencing the early onset of sexual activity among female street sex workers in Jimma and Agaro Towns, southwest Ethiopia.\u003c/p\u003e\n\u003cp id=\"_Toc175420377\"\u003eEarly commencement of sex work is a global problem for reproductive health. Around the world, forty percent of women employed in the sex industry started their employment before turning 18 (21). These typical women who start working as street prostitutes before the age of eighteen are especially susceptible to adverse consequences concerning their sexual health in Middle Eastern nations (22). On the other hand, the study that is currently available indicates that early exposure to sex work, also known as distal exposure, increases the likelihood of negative health effects. Early sexual practice at a young age is a global public health concern that is more common in low- and middle-income nations (20). Those women faced great risks of blood-borne sexually transmitted infections and HIV/AIDS infections (23,24). Adolescent girls and young women account for 34% of new HIV infections globally, with 80% in sub-Saharan Africa (25). However, in Eastern and Southern Africa, new HIV infections among girls aged 10-19 decreased by 25% between 2010 and 2017, while there was no fall in West and Central Africa, according to UNAIDS (26).\u0026nbsp;The other challenges faced relate to sexually transmitted infections (STIs), which disproportionately afflict street female sex workers (SFSWs) and teenage females under the age of 18, and are another issue associated with early-beginning sex workers on the street. Of the 385 participants in a Baltimore research study, 28% had an STI, with 15% having chlamydia and 18% having gonorrhea\u0026nbsp;(21).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eand there was a significant prevalence of STIs among mostly street-based FSWs in two case studies of Mexico-US border cities: 6%, 13%, and 14% of the tested people had gonorrhea, chlamydia, and active syphilis, respectively\u0026nbsp;(27).\u0026nbsp;Early sex initiation in young women is substantially associated with maternal mortality; around 20 million unsafe abortions and 68,000 unsafe abortion-related fatalities take place every year worldwide. Of the 20 million unsafe abortions performed globally annually, adolescent girls account for 14% of the 68,000 deaths attributable to unsafe abortions\u0026nbsp;(28).\u003c/p\u003e\n\u003cp\u003eAn estimated 252,000 unintended births occur each year as a result of sexual activity by 30% of youths under the age of 17. Girls who have unplanned first sexual experiences are at risk for HIV infection, sexually transmitted diseases, and unplanned pregnancy (29). Teenagers who date multiple partners too young and without protection are more likely to contract HIV and other sexually transmitted diseases, as well as become pregnant while still in their teens. Sexually transmitted diseases, fistulas, and premature or unsafe pregnancies are currently the main public health concerns (30). In low- and middle-income countries, early marriage, teenage pregnancy, and unplanned pregnancy are responsible for almost all maternal deaths (31). With SSA accounting for roughly 66% and Southern Asia accounting for 22% \u0026nbsp;(28). Additionally, because of diminished bargaining power and self-efficacy with paying sex partners, early commencement of sex work may be linked to violence (32). With global lifetime prevalence estimates ranging from 45-75% in 2012 and 32-55% in 2013, early initiators are more likely to have recently experienced verbal abuse and physical and sexual violence from paying partners than from non-paying partners (33). A study in Moscow found that 37% of street-based FSWs experience violence, and a prospective cohort study in Canada found that out of 237 female sex workers, 57% experienced gender-based violence over an 18-month follow-up period (34,35).\u003c/p\u003e\n\u003cp\u003eResearch on street-based In India and Britain, sex workers are more likely to encounter client violence than those working in public spaces, brothels, or lodges; the odds are higher for outdoor work because of the varied risk behaviors and work environments (35\u0026ndash;37). Studies on the violence of chilled sexual abuse (CSA) are in Thailand and Turkey, 34% and 84%, respectively, and in Zambia and South Africa, 66% and 48%, of CSA affected, respectively, among FSWs (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEighteen percent of 12\u0026ndash;19-year-old girls in Burkina Faso who participated in nationally representative surveys on violence against teenage girls reported having their first sexual encounter through forced sex (38). However, 21.4\u0026ndash;32% of Kenyan women are thought to have been sexually assaulted before turning 18 (39). Apart from facing violence during their adult lives, FSWs worldwide are more likely than women who do not work in the sex industry to have experienced childhood sexual abuse (CSA) (42).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey on commercial sex workers in Northern Ethiopia found that 75.6% of CSWs had experienced sexual violence overall\u0026nbsp;(43).Gender-based violence in CSWs increases infection risk, gynecologic dysfunction, and sexually transmitted infections, causing long-lasting mental and physical health effects\u0026nbsp;(39).\u0026nbsp;Young women who encounter violence are more susceptible to sexually transmitted diseases, blood-borne infections, and mental health conditions such as depression, anxiety, PTSD, and suicide\u0026nbsp;(44,45).\u0026nbsp;Despite the perils of HIV on an individual and systemic level, girls in this situation have limited access to sexual and reproductive health care. Nearly 60% of adolescent females aged 15 to 19 who are sexually active and unmarried in SSA, including Ethiopia, do not utilize a contemporary method of birth control\u0026nbsp;(46).\u0026nbsp;This study investigates factors driving street sex workers in Jimma and Agaro Towns to work on the streets, focusing on vulnerable victims of abuse, violence, and disease transmission. The purpose of this study is to close this gap by determining the factors that lead to female street sex workers in Jimma and Agaro Town initiating sex work early. Information about early sex work initiation and targeted public health programs to reduce the rate of HIV/AIDS and sexually transmitted diseases among these study groups is provided. Neighborhood-based initiatives that improve the resilience and well-being of individuals who are at risk can also benefit from the findings. The study\u0026apos;s findings can help address the root causes of the early initiation of sex work and guide evidence-based policy, all while filling in the gaps in empirical research.\u003c/p\u003e\n\u003ch2 id=\"_Toc194106069\"\u003e\u003cstrong\u003eStudy setting, design and period\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eJimma Town is located in the Jimma Zone of the Oromia Regional State. Located 352 km from Addis Ababa city. The Central Statistical Agency\u0026apos;s 2024 population projections place Jimma Town\u0026apos;s population account 500,000. A municipality includes three sub-cities, thirteen town kebeles, and four rural kebeles. 128 health facilities in the municipality offer medical services. Jimma City contains one referral and one general governmental hospital, five private hospitals, four public health centers, 55 private clinics, 25 pharmacies, 36 drug stores, and 5 drug distributors (47). Agaro, known in Oromo as Aggaaroo, is a prominent town that also functions as an independent woreda. It is 1,560 meters above sea level and is situated in the Oromia Region\u0026apos;s Jimma Zone. 25,458 people were living in this woreda as of the 2007 national census, with 12,946 men and 12,512 women. The study was conducted in Jimma and Agaro Towns from April 15 up to September 15, 2024. An institution-based cross-sectional study design was employed.\u003c/p\u003e\n\u003ch2 id=\"_Toc194106071\"\u003e\u003cstrong\u003eStudy population, inclusion and exclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc194106077\"\u003eThe study population consists of all female sexual workers in Jimma and Agaro towns, specifically focusing on active street female sex workers during the data collection period. To be included in the study, participants must be female street sex workers aged over 18 years. Excluded from the study are those who are ill and unable to respond to the questions, as well as individuals who have transitioned from street work to off-street venues. This approach ensures a clear focus on the target demographic while accounting for factors that could affect participation, including those who previously worked on the street but have since changed their working area to off-street locations.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eSampling technique, Sampling procedures\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and data collection\u003c/strong\u003e. procedure\u003c/h2\u003e\n\u003cp id=\"_Toc194106079\"\u003eThe Jimma City Health Office recently released data that sheds light on the number of women involved in sex work in Jimma. According to their findings, the total number of women engaged in sex work is 3,950. Furthermore, 300 of these women work on the streets, and the Agaro Town health office reported the number of active female street sex workers is one hundred. Those sex workers by peer educators invited to KPCs, after registering in the logbook, provide different types of provisions like STI screening and HIV testing roundly every three months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese data were checked from Key-Population (KP) Clinic registration books from five KP clinics, three health centers, and one general hospital in Jimma and one health center from Agaro, specifically Jimma Higher 1 and Jimma Higher 2, Jimma Mandira Qocii Health Center, and Jimma Shennan Gibe General Hospital, and Agaro Health Center KP Clinic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data was collected after a thorough cross-check of registration books to ensure accuracy. To achieve the optimal sample size for this study, we employed a convenience sampling technique. This method is advantageous as it helps increase the sample size and minimizes errors.\u0026nbsp;Before data collection, the health office of Jimma and Agaro Towns collaborated with the Social Affairs Office to identify areas where women work as street vendors. They also gathered statistical information from the selected Key-Population Clinics. (Study participants were appointed and interviewed face-to-face at the KP clinics).\u003c/p\u003e\n\u003cp\u003eThe data were collected using structured questionnaires developed after reviewing relevant literature on the early initiation of street female sex workers and pretested by in-person interviews. In Bacho Bore Health Centre (KP clinic), 20 females were street, which is 5% of the total 400 street sex workers, both in Jimma and Agaro Town street sex workers.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study a quantitative also structured questionnaire used. Experts in the languages translated it from English to Amharic and Afan-Oromo, then back to English to ensure uniformity. Five female BSc Nurse holders and experienced individuals served as data collectors, while two MSc Nurses served as supervisors. The investigator also provided two days of training for supervisors and data collectors. The questionnaire was pretested to detect clarity and cultural suitability and modified accordingly. The investigator and supervisors conducted routine oversight and counter-checked the daily completed questionnaire. Supervisors signed each completed questionnaire after ensuring it was complete. Confidentiality was considered when gathering the data.\u003c/p\u003e\n\u003ch2 id=\"_Toc194106083\"\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study variables include one dependent variable, which is the initiation of early sex work. Several independent variables are categorized into three main areas. First, socio-demographic factors encompass age, marital status, educational status, parents\u0026apos; education levels, history of having children, migration patterns (from rural to urban or city to city), and income. Second, behavioral risk factors involve substance use, such as chewing khat, tobacco smoking, and hashish, as well as exposure to pornographic materials and the use of heavy drugs, including inhalants, tranquilizers, marijuana, cannabis, and cocaine. Lastly, family and social factors consider parental loss, parental divorce, history of rape, emotional abuse, childhood abuse, and peer influence. This comprehensive framework allows for an in-depth analysis of the various influences on the initiation of early sex work.\u003c/p\u003e\n\u003ch2 id=\"_Toc194106086\"\u003e\u003cstrong\u003eOperational Definitions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSex work\u003c/strong\u003e: The exchanging of sex for money/materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly initiation of sex work\u003c/strong\u003e: has been defined as those who participated in sex work before the age of 18 (48).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHeavy drug\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003euse\u003c/strong\u003e- use any of this for non-medical purposes (cannabis, heroin, cocaine, and marijuana) alters mood or behavior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubstances use:\u003c/strong\u003e When study subjects use alcohol, khat, or different types of tobacco.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAge at sexual initiation:\u0026nbsp;\u003c/strong\u003eAge at first vaginal intercourse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStreet female sex workers:\u0026nbsp;\u003c/strong\u003eAlso known as prostitution, involves a sex worker soliciting customers in public areas such as streets, parks, and benches (49).\u003c/p\u003e\n\u003ch2 id=\"_Toc194106087\"\u003e\u003cstrong\u003eData Quality\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAssurance, Data management and analysis\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc194106088\"\u003eBased on the pre-test results, the questionnaire was adjusted contextually and terminologically, and data were coded before it was filled by data collectors. The principal investigator and supervisors did spot checks and reviewed the completed questionnaires daily to ensure the completeness and consistency of the information collected. Moreover, all complete responses were coded before entry. Finally, data entry was made into EPI Data version 4.6. Statistical software by the principal investigator to keep the accuracy of the data. Cronbach\u0026rsquo;s alpha coefficient was calculated, and the result was 0.73.\u003c/p\u003e\n\u003cp\u003eThe data were entered into Epi-data version 4.6 after being double-checked for accuracy\u0026nbsp;and were exported to SPSS version 25 for analysis.\u0026nbsp;At each stage, the variables were appropriately coded and recoded as needed. A binary logistic regression analysis was done to sort variables that are candidates for multiple logistic regressions. Finally, those variables with a P-value\u0026nbsp;\u0026le;0.25 were fitted to the multivariate logistic regression model.\u003c/p\u003e\n\u003cp\u003eA multivariate logistic regression analysis was conducted to identify factors strongly associated with the early initiation of sex work among street-based female sex workers. Finally, the association is to declare with a p-value less than 0.05 will be considered statically significant, and an adjusted odd ratio (AOR) at a 95% confidence interval measures the strength of the association. Hosmer and Lem show\u0026rsquo;s test was used to determine the model\u0026apos;s fitness.\u003c/p\u003e\n\u003ch2 id=\"_Toc194106090\"\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and consent participate\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe institutional review board at Jimma University\u0026apos;s Institute of Health was provided ethical clearance by Ref No:\u003cu\u003e\u0026nbsp;JUIH/IRB/070/24\u003c/u\u003e. Jimma and Agaro Town health offices provided official permission. Written consent was sought from participants. And the study subject was told about the goal and purpose of the investigation. The responders were made fully aware of what the data collectors needed from them. After gaining informed consent, information was gathered, and participants\u0026apos; involvement in the survey was entirely voluntary. If they chose not to answer any questions, the data collectors simply moved on to the next one, or they could end the interview at any moment. The data gathered from this study was kept private, and any personal information that would be gathered was saved in a file with a code number rather than your name.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003e\u003cstrong\u003eSocio-demographic related factors\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study achieved a 92.1% response rate, with 219 respondents in total. The respondents\u0026apos; average age was 19.8 (\u0026plusmn;SD 0.95). 135 (66.5%) were not married, and 49.2% had completed primary school. Forty-one percent (41%) migrated before entering this work (Table \u003cem\u003e1\u003c/em\u003e).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eBehavioral related factors\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc175420648\"\u003eOf the total participants, 98 (51.7%) had an experience of khat, alcohol, and different types of cigarettes smoking behaviors, 15.3% of participants reported a history of viewing pornographic images or films, while 10.8% participants using heavy drugs such as cocaine and tranquilizers (Table 2).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFamily and Social related factors\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc175420649\"\u003eOf the 203 women who worked as street prostitutes, 77 (39.9%) had girlfriends who had previously engaged in street sex work. Of those who had been engaged in this work, 50 (24.6%) were vocationally trained, and 19.7% and 21.7%, respectively, had experienced parental divorce and parental loss (either mother/father or both). Intimate partner sex was imposed upon 23.6% of respondents against their will. Due to poor relationships, some of the sex workers did not openly discuss sexual behavioral risks with their parents (Table 3).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eReasons for engaging in street sex work\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc175420650\"\u003eThe respondents were asked to give the main reasons for choosing street sex work. The reasons for entering this work were financial need and significantly associated with socio-demographic linked factors, behavioral factors, and family/social-related factors. Financial need for the matter of survival, the participants who entered into street sex work were 80.1%, and these were distantly followed by peer pressure, physical/sexual abuse, parent divorce, and parent loss. Before those participants entries into this work (Table 4).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003ePrevalence\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand Factors associated with early initiations of female street sex work.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp id=\"_Toc194106099\"\u003eThe prevalence of early initiation into street sex work among two towns (Jimma and Agaro) was 54.2% (95% CI: 47.1-61.2). The mean age of entry into sex work was 19.8 (\u0026plusmn;SD 0.95);\u003c/p\u003e\n\u003cp\u003efor \u0026lt;18years it was 15.6 (\u0026plusmn;SD 0.49), and for \u0026gt;18 years it was 25.4 (\u0026plusmn;SD 0.9). In this study, around 72% of sex workers identified were aged between 15 and 24 years old. Using Bivariate analysis, variables such as respondents\u0026apos; educational background before engaging in sex work and the educational attainment of their parents before the females entering this work were found to be associated with early initiation, parent loss, parent divorce, watching pornographic films or videos, having poor relationships with parents, discussing the risk of early sex initiation with them, friends, using various substances, and migration, with a P-value \u0026le; 0.25. However, intimidation was more significant. This variable was found initial exposure to street sex work, the following independent variable was statistically significant among all components entered into multivariable logistic regressions (Table 5).\u003c/p\u003e\n\u003cp\u003eThose who were illiterate were 2.66 times more likely to initiate street sex work than literate younger women (AOR: 2.6, 95% CI: 1.09-6.45). No formally educated and less educated parents of those who had early initiation street sex work were 3.29 and 2.94 times more likely to enter street sex work than those who had more educated parents (AOR: 3.29; 95% CI: 1.15-7.72) and (AOR: 2.94; 95% CI: 1.01-5.51), respectively. Those who didn\u0026rsquo;t have a history of parental loss and parental divorce entering street sex work were 67% and 62% less likely to enter street sex work early compared to their counterparts (AOR: 0.33, 95% CI: 0.12-0.61) and (AOR: 0.38; 95% CI: 0.16-0.87), respectively. Whereas those migrant women, before entering sex work, were 2.88 times more likely to have early initiation to street sex work than those who didn\u0026rsquo;t migrate (AOR: 2.88; 95% CI: 1.36-5.09)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Table 5).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAccording to this study, 110, representing more than half of SBFSW, entered into sex work before turning 18 years old (95% CI: 47.1-61.2). However, this result was higher than that of a study conducted in Addis Ababa regarding women\u0026apos;s early engagement in sex work, which found that 48% of young women were initiated into commercial sex work at an early age (50).The variation between these studies may be because our study\u0026apos;s primary focus is on those girls who begin street sex work before turning eighteen, but other studies excluded street-based sex workers and considered indoor types of female sex work. The difference may also be explained by the variations in the sociodemographic, behavioral risk-related, family, and societal-related factors.\u003c/p\u003e\n\u003cp\u003eOur study also identified sociodemographic factors like financial problems, young women\u0026apos;s education, parents\u0026apos; education, migration, substance use and addiction, losing parents, being from a divorced family, and having girlfriends with similar behavior before starting this job, which are all significantly associated with early initiation to street-based female sex work.\u003c/p\u003e\n\u003cp\u003eAccording to the majority of research participants, they began engaging in sex work for financial gain. This study discovered an independent relationship between early street sex work entry and an economic issue. Respondents stated that their primary motivation for turning to street sex work as a source of income was hardship. regardless of the age of initiation into sex work, over 80.2% of 163 participants. But as regards age \u0026lt;18 years, from the total, 67.5% reported needing money for basic needs; these reasons for entering into sex work were similar to those found in previous studies(51,52).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study discovered a link between educational attainment and early involvement in the street sex trade. The study found that compared to those with secondary and higher education, those with no formal education were more likely to begin sex work early. Furthermore, individuals with secondary and higher-educated parents were less likely to engage in early street-based sex work than those with no and less-educated parents. Research from Canada, Thailand, Nepal, and India supported this finding (50).This might be due to parents with less education often overlooking their daughters\u0026apos; education due to societal beliefs about women\u0026apos;s roles, leading to not sending their children to school.\u003c/p\u003e\n\u003cp\u003eOther contributing factors to early involvement in street sex work include parental divorce and the loss of one or both parents. Previous evidence also confirmed that parent bereavement and parental divorce are important contributing variables(10,53,54).\u0026nbsp;When parents\u0026rsquo; divorce and drift away, children may lose control and live their lives on their own, meeting their requirements as well as the demands of the rest of the family. This is particularly true when both parents pass away, leading girls to drop out of school and look for high-risk and low-paying employment.\u003c/p\u003e\n\u003cp\u003eThe current study also illustrated that different types of substance users, including chewing khat, drinking alcohol, and smoking different cigarettes before starting sex, are more likely to early enter the sex-work trade, which is also under other previous studies\u0026nbsp;(18,55).\u0026nbsp;Also, this finding is supported by a study in the USA, stating drugs, including cocaine and other inhalants, were the primary reason for sex work\u0026nbsp;(50).\u0026nbsp;One possible explanation for this association may be that when respondents previously developed addictions to khat, cigars, alcohol, and different types of heavy drugs, they may have only chosen to take jobs in which they could easily generate income, which is supported by two other studies\u0026nbsp;(14,20).\u003c/p\u003e\n\u003cp\u003eThose participants who did not have children were more likely to be engaged in street sex work than those who had children in this study. This result is also in line with other previous studies, stating women with dependent children were more likely to engage in sex work at a later age (53). This result can also be a paradox from other study results showing those women having children are more likely to enter sex work to cover the basic needs of their children after they are separated or divorced from their husbands.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to this study, those who migrated had a 2.88-fold higher chance enter into street sex work early than those who did not migrate. This finding was corroborated by research conducted in two countries (56,57). In this study, more than half of the participants departed their homes to a city in pursuit of employment. Most young women move from one location to another in search of employment, which might be because of peer pressure, broker misguidance, and other factors. While those young women who did not have gainful employment when they came to the city will be forced to simply engage in street-based sex work as the last option.\u003c/p\u003e\n\u003cp\u003eMoreover, this study highlighted that those participants who originated from rural areas were more likely to engage in early street sex work compared to urban residents. This may explain why those urban-dwelling women are more aware of the risks associated with sex work and the humiliation they could bring to their families and friends.\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eAccording to this study, we found a higher magnitude of early involvement in female street sex work than that of a study conducted in Addis Ababa on women\u0026apos;s early engagement in sex work. Early initiation in street sex work was linked to Poverty, educational attainment, parental divorce, residence, parental loss, and migration. They also reported that used various forms of substances, having a poor bond with their parent, and having girlfriends before entry to This Work Were Significantly Associated with Early Sex Work Initiation.\u003c/p\u003e\n\u003cp\u003eThe study reveals various pathways for younger girls entering street sex work, highlighting the need for targeted interventions. Government officials should provide secure income opportunities, reduce divorce rates, invest in the education of daughters, foster healthy relationships, teach sustainable livelihoods, encourage sex workers to seek safe employment and prioritize larger sample sizes along with diverse methodologies for deeper insights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a cross-sectional design, which was used to determine the prevalence and give initial data for further investigation. The associations between multiple exposures and outcomes. When compared to other study designs, cross-sectional studies are easier and less expensive to conduct. However, it has some limitations. Because it is unable to record longitudinal changes, it is not appropriate for researching behavior over lengthy periods. Additionally, it is unable to conclusively prove cause-and-effect linkages. Lastly, a study taken at a specific moment may not be an accurate representation of the whole population or typical behavior. Future studies should consider a longitudinal study design with a larger sample size to provide a representative sample.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDs\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Acquired Immunity Deficiency Syndrome\u003c/p\u003e\n\u003cp\u003eCSA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Childhood Sexual Abuse\u003c/p\u003e\n\u003cp\u003eCSW\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Commercial Sex Workers\u003c/p\u003e\n\u003cp\u003eEDHS \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ethiopian Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003eFSWs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Females-sexually workers\u003c/p\u003e\n\u003cp\u003eSFSWs\u0026nbsp;Street Female Sex Workers\u003c/p\u003e\n\u003cp\u003eSSA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003eSTDs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sexually Transmitted Diseases\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSTIs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sexually Transmitted Infections\u003c/p\u003e\n\u003cp\u003eUNAIDS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;United Nations Program me on HIV/AIDS.\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;United States of America.\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; World Health Organization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Jimma University Institute of Health\u0026apos;s review board granted ethical approval under the reference JUIH/IRB/070/24. And official permission from Jimma and Agaro Town health offices. Consent was obtained in writing, and participants were informed of the study\u0026apos;s objective and requirements. Data was collected, kept private, and personal information was saved in a coded file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e declare that there are no conflicts of interest related to this investigation and that no funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are within the paper and its supporting information file.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc194106115\"\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge Jimma University and the research participants.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc194106116\"\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding funding, there was no funding agent for this research work.\u003c/p\u003e\n\u003cp id=\"_Toc194106117\"\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDHZ:\u003c/strong\u003e Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Supervision, Writing \u0026ndash; original draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTBT:\u003c/strong\u003e Project administration, Supervision, Validation, Resources, Visualization, Writing \u0026ndash; review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBTG\u003c/strong\u003e: Methodology, Formal analysis, Software, review and Writing \u0026ndash; original draft. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGYT\u003c/strong\u003e: Data curation, Investigation, Project administration, Resources, Visualization, Writing \u0026ndash; review \u0026amp; editing\u003c/p\u003e\n\u003cp id=\"_Toc194106118\"\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were no financial or commercial relationships that may be interpreted as creating a conflict of interest in the research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGoldenberg SM, Chettiar J, Simo A, Silverman JG, Strathdee SA, Montaner JSG, et al. Early sex work initiation independently elevates odds of hiv infection and police arrest among adult sex workers in a canadian setting. J Acquir Immune Defic Syndr. 2014;65(1):122\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eGoldenberg SM, Rangel G, Vera A, Patterson TL, Abramovitz D, Silverman JG, et al. Exploring the impact of underage sex work among female sex workers in two Mexico-us border cities. AIDS Behav. 2012;16(4):969\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eWeber AE, Boivin JF, Blais L, Haley N, Roy \u0026Eacute;. Predictors of initiation into prostitution among female street youths. J Urban Heal. 2004;81(4):584\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eYates GL, MacKenzie R, Pennbridge J, Cohen E. A risk profile comparison of runaway and non-runaway youth. Am J Public Health. 1988;78(7):820\u0026ndash;1.\u003c/li\u003e\n \u003cli\u003eDematteo D, Major C, Block B, Coates R, Fearon M, Goldberg E, et al. 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Factors associated with Khat use among youths visiting HIV testing and counseling centers in Gamo Gofa, Southern Ethiopia. BMC Public Health. 2013;13:1199.\u003c/li\u003e\n \u003cli\u003eZhang Y, Liang B, Liu D, Wei G, Mo S, Nong A, et al. file:///C:/Users/ju/Downloads/s12981-020-0260-0 (1).pdf cross-sectional study. AIDS Res Ther. 2020;17(1):1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eRichter M, Chersich MF, Vearey J, Sartorius B, Temmerman M, Luchters S. Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities. J Immigr Minor Heal. 2014;16(1):7\u0026ndash;17.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Jimma University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early initiation, Sex work, teenagers, Jimma, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6388846/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6388846/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study investigates the early beginning of street-based sex work among women, emphasizing on the factors Influencing these dangerous lifestyles, which accounts for 40% of all women in the sex industry globally.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo Assess factors contributing to early initiation of sex work among female street sex workers in Jimma and Agaro towns, Oromia, Southwest Ethiopia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted among 219 female street sex workers in five clinics from April 15 to September 15, 2024. Data was collected through face-to-face interviews and analyzed using SPSS version 25. Variables with a p-value of less than 0.05 were considered significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFrom a total of 219 participants, with a 92.1% response rate,54.2% (95% CI: 47.1\u0026ndash;61.2). had an early initiation of street sex work before the age of eighteen. Being illiterate (AOR: 2.66, 95% CI: 1.09\u0026ndash;6.45) and having illiterate and primary-educated parents, (AOR: 3.29, 95% CI: 1.15\u0026ndash;7.72) and (AOR: 2.94, 95% CI: 1.01\u0026ndash;5.51), respectively, substance use (AOR: 3.56, 95% CI: 1.7\u0026ndash;6.22) and migration (AOR: 2.88, 95% CI: 1.36\u0026ndash;5.09); history of rural residence (AOR: 3.64; 95% CI: 1.69\u0026ndash;5.84), were positively and significantly associated factors of early initiation of street sex work in this study\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion and Recommendations:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study revealed that more than half of teenage girls were engaged in early street sex work. Being Illiterate, having illiterate parents, migration, history of rural residence, and substance use, were factors significantly associated with early sex work initiation. Encourage and assist the less educated participants to finish their education, stop migrating by strongly penalize miss-brokers, and educate the young girls about the negative effects of various forms of substance usage.\u003c/p\u003e","manuscriptTitle":"Exploring Factors Influencing to Early Initiation of Sex Work among Female Street Sex Workers in Jimma and Agaro Towns, Oromia Region, Southwest Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-08 07:21:25","doi":"10.21203/rs.3.rs-6388846/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac82dbf9-4abf-4794-9a20-602dbd5429a6","owner":[],"postedDate":"April 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46831396,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2025-04-08T07:21:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-08 07:21:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6388846","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6388846","identity":"rs-6388846","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}