Mobility study of young women who exchange sex for money or commodities using Google Maps and qualitative methods in Kampala, Uganda

Sexual practices, their influencers, and utilization of HIV services among female sex workers in Mombasa County, Kenya

Introduction

female sex workers (FSWs) are vulnerable to acquiring HIV and other sexually transmitted infections due to unprotected sex. Understanding and addressing the gaps in safer sex among FSWs can help to reduce HIV acquisition and transmission. This study described sexual practices, their correlates and use of HIV services among FSWs in Mombasa County, Kenya.

Methods

participants were recruited for a baseline survey by a time-location cluster randomized design at predetermined intervals from five bars and five clubs in Mombasa County until a sample size of 160 was reached. Descriptive statistics and inferential analysis using R were conducted, and p<0.05 was regarded as statistically significant.

Results

nearly all (99%) of the participants were unmarried, and 11% had tertiary education. Ninety-eight percent (98%) reported vaginal intercourse, 51% reported using alcohol/drugs before sex, and 28% practiced unprotected intercourse. About 64% had tested for HIV within three months, 14% believed that it is safe to reuse condoms, and 10% that it is safe to engage in unprotected sex. In bi-variate analysis, FSWs were more likely to engage in unprotected intercourse if they reported more frequent sex, more frequent sex with regular clients, poor HIV knowledge, alcohol/drug use, and violence. In multivariate analysis, risky sexual practices were associated with frequency of sexual intercourse, alcohol/drug use, and poor HIV knowledge.

Conclusion

female sex workers engage in unprotected sex while under the influence of substances, belief in re-using condoms and have high frequency of sexual intercourse. Inadequate knowledge of HIV and substance use significantly correlated with unprotected sex. Interventions to address these modifiable factors are needed to mitigate the risk of HIV among FSWs.

A Comparison of Self-reported Condomless Sex and Yc-DNA Biomarker Data from Young Women Engaged in High Risk Sexual Activity in Kampala, Uganda

Reporting of condom-use can limit researchers' understanding of high-risk sexual behaviours. We compared self-reported condom-use with the Yc-DNA biomarker data and investigated potential factors influencing participation in, and reporting of, sexual behaviours. Self-reported data were collected using Audio Computer Assisted Self Interviews (ACASI) and samples for Yc-DNA biomarker were collected using self-administered and health worker-collected vaginal swabs from 644 women (aged 15-24 years) who were not living with HIV. Yc-DNA results and interview data were compared using McNemar-Bowker Analysis and Cohen's Kappa. Test statistics for Yc-DNA biomarker were calculated. Log Binomial models for Yc-DNA and self-reported results were conducted to assess for association. We found strong evidence (p < 0.001) for a difference between Yc-DNA and self-reported results. 13.7% of participants reported consistent condom-use with all partners, regardless of HIV status. Self-reported condom-use was discordant in 50.0% (n = 206) of cases, when compared to Yc-DNA results. Positive Yc-DNA results were found to be associated with older age (RR 1.36; 95%CI 1.04, 1.76 p = 0.023). Self-reported condom-use with partners with unknown HIV status was associated with higher education (RR 0.76; 95%CI 0.58,0.99 p = 0.043). Sensitivity analysis did not determine difference between methods for controlling for missing data. We found significant under-reporting of condomless sex in the self-reported data when compared to Yc-DNA results.

Geographical, social, and political contexts of tuberculosis control and intervention, as reported by mid-level health managers in Uganda: 'The activity around town'

Training district-level health officers and other mid-level health system managers revealed multiple contextual factors across political, administrative, and social axes affecting tuberculosis (TB) and TB control in Uganda. Individual relationships between local health, political, and media leaders affect efforts to inform the public and provide services, yet greater administrative coordination between national-level logistics, implementing partner funding, and local needs is required. Social challenges to TB control include high population mobility, local industries, poverty with high-density living and social venues, and misinformation about TB. Capitalizing on implementation knowledge and sharing data can overcome social geographic challenges to TB-prevention planning through strategic healthcare capacity-building at the district level.

Predictors of mobility among women engaged in commercial sex work in Uganda using generalized estimating equations model

BACKGROUND

Women engaged in commercial sex work (WESW) are at a higher risk of acquiring and transmitting HIV. WESW are highly mobile, and their mobility may increase their economic status, and increased access to healthcare and other social services. However, it may also facilitate the spread of HIV infection from higher to lower prevalence regions. This study examined the predictors of mobility among WESW in Uganda using a generalized estimating equations model.

METHODS

We defined and measured mobility as the change in residence by WESW between baseline, 6 months, and 12 months follow-up. Participants who changed places were considered mobile, and those who never changed were non-mobile. We used data from a longitudinal study, which recruited 542 WESW from Southern Uganda aged 18-55 years and constructed a Generalized Estimating Equations Model.

RESULTS

Findings show that 19.6% of WESW changed residence between baseline and 6 months of follow-up and 26.2% (cumulative) between baseline and 12 months of follow-up. Older women (OR = 0.966, 95% CI = 0.935, 0.997) were associated with decreased odds of mobility, whereas WESW who were HIV positive (OR = 1.475, 95% CI = 1.078, 2.018) and those from large households (OR = 1.066, 95% CI = 1.001, 1.134) were associated with increased odds of mobility. WESW residing in rural areas (OR = 0.535, 95% CI = 0.351, 0.817) were associated with decreased odds of mobility compared to those from fishing sites.

CONCLUSION

The results indicate risk factors for mobility, further research is needed to determine the directionality of these factors in order to design interventions addressing mobility among WESW.

Conducting high-frequency data collection in low-resource settings: Lessons from a financial diary study among women engaged in sex work in Uganda

Poverty and economic insecurity are driving forces in entering sex work among women in low resource areas. This increases their risk for HIV by influencing the decision-making process for high-risk behaviors. Few studies examine financial behaviors and capacities of women engaged in sex work (WESW). This paper describes the methodology used in a financial diary study aimed at characterizing women's spending patterns within a larger prevention intervention trial among WESW in Uganda. From June 2019 to March 2020, a subsample of 150 women randomized to the combination HIV prevention and economic empowerment treatment were asked to complete financial diaries to monitor daily expenditures in real time. Two hundred forty financial diaries were distributed to study participants during the financial literacy sessions at 8 sites. A total of 26,919 expense entries were recorded over 6 months. Sex work related expenses comprised approximately 20.01% of the total. The process of obtaining quality and consistent data was challenging due to the transient and stigmatized nature of sex work coupled with women's varying levels of education. Frequent check-ins, using peer support, code word or visuals, and a shorter timeframe would allow for a more accurate collection of high frequency data. Moreover, the ability of women to complete the financial diaries despite numerous challenges speaks to their potential value as a data collection tool, and also as an organizing tool for finances.

Young migrant men managing risk and seeking protection in a small town in Southern Uganda

Young migrants in resource-constrained settings face multiple challenges when they move away from home for work and try to make their way in a new place. In Uganda, with a growing youthful population increasing numbers of young people are leaving home to look for opportunities in urban areas, often facing a precarious existence as they try to make money. Using data from in-depth interviews we investigate the lived experience of precarity of 20 young men who had recently migrated to a small town in south-west Uganda. We adopt a case study approach to look in-depth at the experience of three of the young men, showing how they engage in a continual evaluation of risk in their day to day lives, as they face multiple challenges related to their insecure employment and poor access to health services. We found that the risks that the young men are willing to take to maximise their limited opportunities changed over time. Our findings provide valuable insights into the gendered risks faced by young male migrants and illustrate the ways in which young migrants, many of whom may only have travelled a relatively short distance from home, face risks and challenges to their health and wellbeing, and need to be recognised as a population in need of attention and support.

"Right now we are scared of each other, we fear everyone, the whole world has COVID": The impact of COVID-19 on young female sex workers in Kampala, Uganda, during national lockdowns in 2020-2021

In 2020-2021 the COVID-19 pandemic led to multiple and diverse global public health response strategies globally and in Uganda to slow the spread of the virus by promoting wearing face coverings in public, frequent hand washing, physical distancing, restricting travel, and imposing home lockdowns. We conducted 146 interviews over four rounds of phone-follow up calls over 15 months with 125 young female sex workers coinciding in time with four different government-imposed lockdown periods in Kampala, Uganda, to assess the impact of these measures on young sex workers, their families and their communities as well as to gauge their resilience. Our findings revealed how COVID-19 fears and public health restrictions over time pushed an already marginalized population to the brink and how that pressure drove some participants into a new way of life.

Oral pre-exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study

Introduction

Oral pre‐exposure prophylaxis (PrEP) has been scaled up; however, data from real‐world settings are limited. We studied oral PrEP preference, uptake, adherence and continuation among adolescent girls and young women (AGYW) vulnerable to HIV in sub‐Saharan Africa.

Methods

We conducted a prospective cohort study among 14‐ to 24‐year‐old AGYW without HIV who were followed for 12 months in Kampala, Uganda. Within at least 14 days of enrolment, they received two education sessions, including demonstrations on five biomedical interventions that are; available (oral PrEP), will be available soon (long‐acting injectable PrEP and anti‐retroviral vaginal ring) and in development (PrEP implant and HIV vaccine). Information included mode and frequency of delivery, potential side effects and method availability. Volunteers ranked interventions, 1 = most preferred to 5 = least preferred. Oral PrEP was “preferred” if ranked among the top two choices. All were offered oral PrEP, and determinants of uptake assessed using Poisson regression with robust error variance. Adherence was assessed using plasma tenofovir levels and self‐reports.

Results

Between January and October 2019, 532 volunteers were screened; 285 enrolled of whom 265 received two education sessions. Mean age was 20 years (SD±2.2), 92.8% reported paid sex, 20.4% reported ≥10 sexual partners in the past 3 months, 38.5% used hormonal contraceptives, 26.9% had chlamydia, gonorrhoea and/or active syphilis. Of 265 volunteers, 47.6% preferred oral PrEP. Willingness to take PrEP was 90.2%; however, uptake was 30.6% (n = 81). Following enrolment, 51.9% started PrEP on day 14 (same day PrEP offered), 20.9% within 30 days and 27.2% after 30 days. PrEP uptake was associated with more sexual partners in the past 3 months: 2–9 partners (aRR = 2.36, 95% CI: 1.20–4.63) and ≥10 partners (aRR 4.70, 95% CI 2.41–9.17); oral PrEP preference (aRR 1.53, 95% CI 1.08–2.19) and being separated (aRR 1.55, 95% CI 1.04–2.33). Of 100 samples from 49 volunteers during follow up, 19 had quantifiable tenofovir levels (>10 μg/L) of which only three were protective (>40 μg/L).

Conclusions

Half of AGYW preferred oral PrEP, uptake and adherence were low, uptake was associated with sexual behavioural risk and oral PrEP preference. Development of alternative biomedical products should be expedited to meet end‐user preferences and, community delivery promoted during restricted movement.