Alcohol Use and Associated Risk Factors Among Female Sex Workers in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Aims Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. Methods The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Inclusion criteria: Any measure of prevalence or incidence of alcohol use among FSWs aged 18 years or older. Countries defined as LMIC in accordance with the World Bank income groups 2019. Study designs: cross-sectional survey, case–control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Pooled prevalence estimates were calculated for: Any hazardous/harmful/dependent alcohol use Harmful/dependent alcohol use only, both overall and by region Daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. Results In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31–51%), and of daily alcohol use was 26% (95% CI: 17–36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01–2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15–1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24–4.80), but not with HIV, violence or mental health problems. Conclusion We found a high burden of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with HIV risk factors such as inconsistent condom use, STIs and other drug use. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment


Sex Differences, and Resulting Treatment Differences, in a Cohort of Harmful Gamblers
Dr Rosalind Baker-Frampton* Gordon Moody, Dudley, United Kingdom *Corresponding author. doi: 10.1192/bjo.2023.178 Aims. Gordon Moody offers Tier 4 treatment for harmful gambling. This poster will look at the differences between male and female harmful gamblers who apply for treatment with Gordon Moody between 2015 and 2022, and consider how treatment should reflect these differences.
Methods. An opportunity sample (n = 3,241) are analysed and discussed. Data are anonymised and men and women will be compared for: mental health diagnosis; years spent gambling; methods of gambling; average monthly amount spent gambling; and job/relationship loss due to gambling. Statistical tests are run to ascertain whether any differences are significant. Results. Initial analysis found that on average females applying for treatment (n = 769) start gambling at 25.2 years old, and began gambling in a problematic way at 31.8 years old. In contrast, men (n = 2,472) began gambling on average at 17.5 years old, and began gambling in a harmful way at 22.7 years old. Younger women were more likely to gamble online (i.e. online casinos; online games), whilst older women preferred gaming machines in bingo halls, bookmakers, casinos or adult entertainment centres. Men were most likely to gamble at bookmakers, which does not differ with age. On average, men estimated that they spend nearly £2,000 a month before applying for treatment (£1,980), whilst women estimated that they spend 15% less (£1,680). 14.8% of women and 58.5% of men had lost a job due to harmful gambling. 49.2% of women and 69.1% of men had lost relationships due to harmful gambling. These data will be further analysed in SPSS to ascertain any significant differences. Conclusion. Men and women tend to gamble in different ways, and therefore treatment may need to be tailored for each sex. The poster will discuss differences implemented by Gordon Moody to account for sex differences. Whilst women tend to begin gambling at an older age, it still takes a similar length of time for at-risk people to develop harmful gambling practices. Women are less likely to lose jobs and/or relationships due to harmful gambling practices before they seek treatment. Key limitations of the study include the opportunistic nature of the sample, the different sample sizes, and the fact that there are insufficient applicants who identify as transgender/non-binary/ other to include in analysis.
Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication. Aims. Due to its widespread use in the sex work industry, female sex workers (FSWs) in low-and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. This systematic review and metaanalysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. Methods. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021.

Alcohol Use and Associated Risk Factors Among Female Sex Workers in Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis
Inclusion criteria: • Any measure of prevalence or incidence of alcohol use among FSWs aged 18 years or older. Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication. Results. A total of 515 articles were identified, out of which 8 apps were deemed eligible as per our inclusion criteria. 4 apps were based on dementia, 3 for depression, out of which 1 was for antenatal depression and 1 for anxiety. It was then analysed whether some apps investigated assessment, treatment or both. 5 apps were used for the treatment of mental health disorders including 1 for both assessment and treatment and 2 focused on the research, still including assessment of mental health disorders.

Mental Health Apps (Applications): A Review of Studies Conducted in the UK
Conclusion. This review only looked into apps that are currently available to download in the UK and some apps studied are currently in use in NHS mental health trusts. In general, digital apps could offer the ability to respond quickly and efficiently and can reach people over great distances with minimal mobility requirements, thus, guided by a rigorous evidence-based approach, apps could be the solution to combat large waiting lists in the NHS.
Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication. Aims. We report electroencephalography (EEG) results from a non-patient pilot study conducted whilst developing a neuromodulation approach for improving visual spatial working memory (vSWM) in people with schizophrenia. Working memory impairments are common in people with schizophrenia yet respond poorly to current drug treatments. Transcranial magnetic stimulation (TMS), a minimally-invasive, well-tolerated, brain stimulation technique that is performed whilst a person is awake and alert, may improve working memory performance. However, results have been inconsistent, possibly because TMS was delivered during the heterogenous "resting-state". We delivered TMS to left dorsolateral prefrontal cortex time-locked to specific events in a vSWM task, aiming to modulate functional networks involved in encoding spatial data into working memory. Methods. Each trial in the vSWM task started with a 2-secondlong sample display containing either three or four coloured circles positioned at random locations. This was followed by a 2-second delay period. At the end of the delay period, a visual cue appeared, indicating the target colour. Participants moved a crosshair to the screen location where the target had appeared. We recorded 64-channel EEG throughout. In Experiment 1, twelve participants completed three-and four-item task versions. In Experiment 2, eighteen participants completed the four-item task in three separate blocks within a single session. Between blocks, they completed a short task version alongside TMS. TMS (intermittent theta burst stimulation, 600 pulses, 3.3 minutes) was delivered over the F3 electrode position. Each stimulation on-phase was synchronised to coincide with the onset of sample display. In a random order, one TMS block was active, and one was sham (90°coil rotation). Results. In Experiment 1, EEG showed decreases ("desynchronisation") in beta (13-30 Hz) power during sample display and increases ("synchronisation") during the delay period. Both effects were greater in the four-item condition, and in posterior electrodes. In Experiment 2, posterior beta desynchronisation during