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Elmi N, Marquez NG, Rucinski K, Lyons C, Turpin G, Ba I, Turpin N, Gouane E, Obodou E, Diouf D, Baral S. Meeting the reproductive health needs of female sex workers in Côte d'Ivoire: protecting the human right to dignified health. Reprod Health 2023; 20:133. [PMID: 37670305 PMCID: PMC10481554 DOI: 10.1186/s12978-023-01659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023] Open
Abstract
The sexual and reproductive health needs of female sex workers (FSW) are often understudied and underserved in the context of HIV-related research in countries across Sub-Saharan Africa and West Africa. We assessed the lived experiences of FSW across Côte d'Ivoire to characterize unmet reproductive health needs and opportunities to address them. From February-August, 2020, ENDA Santé, Côte d'Ivoire conducted 75 in-depth interviews and 15 focus group discussions with FSW and community informants in five cities in Côte d'Ivoire. Themes that emerged included the inconsistent use of contraception services, a history of unintended pregnancies, and experiences of stigma at public healthcare facilities. Opportunities to increase the impact of both SRH and HIV services included strengthening existing HIV and family planning service integration for FSW. Taken together, the results highlight the importance of addressing the unmet reproductive health needs of FSW to both optimize the HIV response and increase the delivery of human-rights affirming sexual and reproductive health services for sex workers.
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Affiliation(s)
- Nika Elmi
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Nuria Gallego Marquez
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Katherine Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Gnilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | | | | | - Emile Gouane
- ENDA Santé Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | | | | | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
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2
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Franz R, Hahn A, Hagen RM, Rohde H, Eberhardt KA, Ehrhardt S, Baum J, Claussen L, Feldt T, Hinz R, Barthel D, Bindt C, Tagbor H, Nguah SB, Koffi M, Köller T, Warnke P, Pankok F, Taudien S, Frickmann H, Schoppen S. Screening for Resistant Bacteria, Antimicrobial Resistance Genes, Sexually Transmitted Infections and Schistosoma spp. in Tissue Samples from Predominantly Vaginally Delivered Placentae in Ivory Coast and Ghana. Pathogens 2023; 12:999. [PMID: 37623959 PMCID: PMC10459482 DOI: 10.3390/pathogens12080999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Medical complications during pregnancy have been frequently reported from Western Africa with a particular importance of infectious complications. Placental tissue can either become the target of infectious agents itself, such as, e.g., in the case of urogenital schistosomiasis, or be subjected to contamination with colonizing or infection-associated microorganisms of the cervix or the vagina during vaginal delivery. In the retrospective cross-sectional assessment presented here, the quantitative dimension of infection or colonization with selected resistant or pathogenic bacteria and parasites was regionally assessed. To do so, 274 collected placental tissues from Ivory Coastal and Ghanaian women were subjected to selective growth of resistant bacteria, as well as to molecular screening for beta-lactamase genes, Schistosoma spp. and selected bacterial causative agents of sexually transmitted infections (STI). Panton-Valentine-negative methicillin-resistant Staphylococcus aureus (MRSA) was grown from 1.8% of the tissue samples, comprising the spa types t008 and t688, as well as the newly detected ones, t12101 (n = 2) and t12102. While the culture-based recovery of resistant Enterobacterales and nonfermentative rod-shaped Gram-negative bacteria failed, molecular assessments confirmed beta-lactamase genes in 31.0% of the samples with multiple detections of up to four resistance genes per sample and blaCTX-M, blaIMP, blaGES, blaVIM, blaOXA-58-like, blaNDM, blaOXA-23-like, blaOXA-48-like and blaKPC occurring in descending order of frequency. The beta-lactamase genes blaOXA-40/24-like, blaNMC_A/IMI, blaBIC, blaSME, blaGIM and blaDIM were not detected. DNA of the urogenital schistosomiasis-associated Schistosoma haematobium complex was recorded in 18.6% of the samples, but only a single positive signal for S. mansoni with a high cycle-threshold value in real-time PCR was found. Of note, higher rates of schistosomiasis were observed in Ghana (54.9% vs. 10.3% in Ivory Coast) and Cesarean section was much more frequent in schistosomiasis patients (61.9% vs. 14.8% in women without Schistosoma spp. DNA in the placenta). Nucleic acid sequences of nonlymphogranuloma-venereum-associated Chlamydia trachomatis and of Neisseria gonorrhoeae were recorded in 1.1% and 1.9% of the samples, respectively, while molecular attempts to diagnose Treponema pallidum and Mycoplasma genitalium did not lead to positive results. Molecular detection of Schistosoma spp. or STI-associated pathogens was only exceptionally associated with multiple resistance gene detections in the same sample, suggesting epidemiological distinctness. In conclusion, the assessment confirmed considerable prevalence of urogenital schistosomiasis and resistant bacterial colonization, as well as a regionally expected abundance of STI-associated pathogens. Continuous screening offers seem advisable to minimize the risks for the pregnant women and their newborns.
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Affiliation(s)
- Roman Franz
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Berlin, 10115 Berlin, Germany
| | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (T.K.); (P.W.)
| | - Ralf Matthias Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany;
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany;
| | - Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center, 20359 Hamburg, Germany;
- Division of Hygiene and Infectious Diseases, Institute of Hygiene and Environment, 20539 Hamburg, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA 21205, USA;
| | - Jana Baum
- Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany;
| | - Lisa Claussen
- Department of Anaesthesiology and Intensive Care, Asklepios Klinik Altona, 22763 Hamburg, Germany;
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Rebecca Hinz
- Department of Clinical Microbiology, Synlab MVZ Hamburg GmbH, 22083 Hamburg, Germany;
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, 20251 Hamburg, Germany; (D.B.); (C.B.)
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, 20251 Hamburg, Germany; (D.B.); (C.B.)
| | - Harry Tagbor
- School of Medicine, Department of Community Health, University of Health and Allied Sciences, Ho PMB 31, Ghana;
| | - Samuel Blay Nguah
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi AK-385-1973, Ghana;
| | - Mathurin Koffi
- Université Jean Lorougnon GUEDE, UFR Environnement-Santé, Laboratoire des Interactions Hôte-Microorganismes-Environnement et Evolution (LIHME), Daloa BP 150, Côte d’Ivoire;
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (T.K.); (P.W.)
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (T.K.); (P.W.)
| | - Frederik Pankok
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.P.); (S.T.)
| | - Stefan Taudien
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.P.); (S.T.)
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (T.K.); (P.W.)
| | - Stefanie Schoppen
- Department of Health and Social Science, Hochschule Fresenius, 20148 Hamburg, Germany
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Ogale YP, Kennedy CE, Nalugoda F, Mpagazi J, Jackson JC, Galiwango R, Ssekubugu R, Kigozi G, Denison JA, Gaydos CA, Kagaayi J, Grabowski MK. Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001626. [PMID: 37126490 PMCID: PMC10150988 DOI: 10.1371/journal.pgph.0001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18-49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36-2.21; females = PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.
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Affiliation(s)
- Yasmin P. Ogale
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Jade C. Jackson
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Julie A. Denison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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4
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Ochonye B, Abiodun P, Sanni F, Tewobola O, Alamu T, Ogbonna N. Grassroots sexual and reproductive rights interventions on sexual risk behavior among female sex workers in Nigeria. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rinaldi G, Kiadaliri AA, Haghparast-Bidgoli H. Cost effectiveness of HIV and sexual reproductive health interventions targeting sex workers: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:63. [PMID: 30524207 PMCID: PMC6278021 DOI: 10.1186/s12962-018-0165-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/22/2018] [Indexed: 01/10/2023] Open
Abstract
Background Sex workers have high incidences of HIV and other sexually transmitted diseases. Although, interventions targeting sex workers have shown to be effective, evidence on which strategies are most cost-effective is limited. This study aims to systematically review evidence on the cost-effectiveness of sexual health interventions for sex workers on a global level. It also evaluates the quality of available evidence and summarizes the drivers of cost effectiveness. Methods A search of published articles until May 2018 was conducted. A search strategy consisted of key words, MeSH terms and other free text terms related to economic evaluation, sex workers and sexual and reproductive health (SRH) was developed to conduct literature search on Medline, Web of Science, Econlit and the NHS Economic Evaluation Database. The quality of reporting the evidence was evaluated using the CHEERS checklist and drivers of cost-effectiveness were reported. Results Overall, 19 studies met the inclusion criteria. The majority of the studies were based in middle-income countries and only three in low-income settings. Most of the studies were conducted in Asia and only a handful in Sub-Saharan Africa and Latin America. The reviewed studies mainly evaluated the integrated interventions, i.e. interventions consisted a combination of biomedical, structural or behavioural components. All interventions, except for one, were highly cost-effective. The reporting quality of the evidence was relatively good. The strongest drivers of cost-effectiveness, reported in the studies, were HIV prevalence, number of partners per sex worker and commodity costs. Furthermore, interventions integrated into existing health programs were shown to be most cost-effective. Conclusion This review found that there is limited economic evidence on HIV and SRH interventions targeting sex workers. The available evidence indicates that the majority of the HIV and SRH interventions targeting sex workers are highly cost-effective, however, more effort should be devoted to improving the quality of conducting and reporting cost-effectiveness evidence for these interventions to make them usable in policy making. This review identified potential factors that affect the cost-effectiveness and can provide useful information for policy makers when designing and implementing such interventions. Electronic supplementary material The online version of this article (10.1186/s12962-018-0165-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Aliasghar A Kiadaliri
- 2Clinical Epidemiology Unit, Department of Clinical Sciences, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
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6
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Lafort Y, Greener L, Lessitala F, Chabeda S, Greener R, Beksinska M, Gichangi P, Griffin S, Smit JA, Chersich M, Delva W. Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities. Trop Med Int Health 2018; 23:774-784. [PMID: 29752836 DOI: 10.1111/tmi.13072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To enhance uptake of sexual and reproductive health (SRH) services by female sex workers (FSWs), we conducted an implementation study in which we piloted and tested context-specific 'diagonal' interventions, combining vertical, targeted interventions with horizontally improved access to the general health services, in three cities in sub-Saharan Africa. METHODS We collected indicators of SRH service uptake through face-to-face interviews with approximately 400 FSWs, pre- and post-intervention, in Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, recruited by respondent-driven sampling. Changes in uptake were tested for their statistical significance using multivariate logistic regression models. RESULTS In all cities, overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete and 70.9% to 87.6% in Mombasa. In Tete and Mombasa, rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilisation of general health services. CONCLUSION SRH service utilisation improved in the short-term in three different sub-Saharan African contexts, primarily through vertical, targeted components. The long-term effectiveness of diagonal approaches, in particular on the use of general, horizontal health services, needs further investigation.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
| | - Letitia Greener
- Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | - Sophie Chabeda
- International Centre for Reproductive Health-Kenya, Mombasa, Kenya
| | - Ross Greener
- Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Peter Gichangi
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,International Centre for Reproductive Health-Kenya, Mombasa, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Sally Griffin
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | - Jenni A Smit
- Maternal, Adolescent and Child Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium
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Lafort Y, Lessitala F, Ismael de Melo MS, Griffin S, Chersich M, Delva W. Impact of a "Diagonal" Intervention on Uptake of Sexual and Reproductive Health Services by Female Sex Workers in Mozambique: A Mixed-Methods Implementation Study. Front Public Health 2018; 6:109. [PMID: 29721490 PMCID: PMC5915464 DOI: 10.3389/fpubh.2018.00109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/03/2018] [Indexed: 12/31/2022] Open
Abstract
Background Female sex workers (FSWs) have high risks for adverse sexual and reproductive health (SRH) outcomes, yet low access to services. Within an implementation research project enhancing uptake of SRH services by FSWs, we piloted a “diagonal” intervention, which combined strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal), and tested its effect. Methods The study applied a convergent parallel mixed-methods design to assess changes in access to SRH services. Results of structured interviews with FSWs pre-intervention (N = 311) and thereafter (N = 404) were compared with the findings of eight post-intervention focus group discussions (FGDs) with FSWs and two with FSW-peer educators (PEs). Results Marked and statistically significant rises occurred in consistent condom use with all partners (55.3–67.7%), ever use of female condoms (37.9–54.5%), being tested for HIV in the past 6 months (56.0–76.6%), using contraception (84.5–95.4%), ever screened for cervical cancer (0.0–16.9%) and having ≥10 contacts with a PE in the past year (0.5–24.45%). Increases mostly resulted from FSW-targeted outreach, with no rise detected in utilization of public health facilities. FGD participants reported that some facilities had become more FSW-friendly, but barriers such as stock-outs, being asked for bribes and disrespectful treatment persisted. Conclusion The combination of expanding FSW-targeted SRH services with improving access to the public health services resulted in an overall increased uptake of services, but almost exclusively because of the strengthened targeted (vertical) outreach services. Utilization of public SRH services had not yet increased and many barriers to access remained. Our diagonal approach was thus only successful in its vertical component. Improving access to the general health services remains nevertheless important and further research is needed how to reduce barriers. Ideally, the combination approach should be maintained and more successful approaches to increase utilization of public services should be explored.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | | | - Sally Griffin
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium.,Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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8
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Lafort Y, Greener R, Roy A, Greener L, Ombidi W, Lessitala F, Skordis-Worrall J, Beksinska M, Gichangi P, Reza-Paul S, Smit JA, Chersich M, Delva W. Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa. Reprod Health 2017; 14:13. [PMID: 28103896 PMCID: PMC5247811 DOI: 10.1186/s12978-017-0277-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, we identified gaps in service utilization in four different cities. METHODS A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 'seeds' identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. RDS-adjusted proportions and surrounding 95% confidence intervals were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests with Dunn-Šidák correction. RESULTS Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs' sociodemographic characteristics. CONCLUSION The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particular gaps in each city.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
| | - Ross Greener
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | | | - Letitia Greener
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Wilkister Ombidi
- International Centre for Reproductive Health-Kenya, Mombasa, Kenya
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | | | - Mags Beksinska
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Peter Gichangi
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,International Centre for Reproductive Health-Kenya, Mombasa, Kenya.,University of Nairobi, Nairobi, Kenya
| | | | - Jenni A Smit
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium
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Karamouzian M, Mirzazadeh A, Shokoohi M, Khajehkazemi R, Sedaghat A, Haghdoost AA, Sharifi H. Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010. PLoS One 2016; 11:e0166042. [PMID: 27861487 PMCID: PMC5115696 DOI: 10.1371/journal.pone.0166042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/22/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Unintended pregnancies and abortion may be considered as occupational hazards for female sex workers (FSWs). As our understanding of contraceptive and abortion practices of Iranian FSWs is very limited, this study tries to assess the dynamics of contraception and abortion among this sub-population. Methods This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 14 cities in Iran. Data were collected through face-to-face interviews using a pilot-tested standardized risk assessment questionnaire. We applied the logistic regression model to investigate the correlates of induced abortion among FSWs. Results Of the 863 participants with valid responses to the abortion variable, 35.3% (95% CI: 32.1–38.6) acknowledged ever induced abortion and the annual rate of abortion was estimated at 20.7 per 1000 women. Around 31.2% of FSWs reported no usual contraceptive use, 32.6% barrier method, 23.6% non-barrier modern contraception methods, and 12.5% dual protection. In our multivariable model, older age (Adjusted Odds Ratio (AOR) = 1.74, 95% Confidence Interval (CI): 1.02, 2.96), group sex (AOR = 1.92, 95% CI: 1.10, 3.35), history of travel for sex work (AOR = 1.55, 95% CI: 1.09, 2.20), sexual violence (AOR = 1.77, 95% CI: 1.25, 2.50), STIs in last year (AOR = 1.53, 95% CI: 1.09, 2.14), and accessing family planning services (AOR = 1.76, 95% CI: 1.24, 2.49) were significant predictors of lifetime abortion. Conclusions The reproductive health needs of Iranian FSWs are unmet and around one-third of FSWs reported induced abortion. Scaling-up comprehensive family planning services and empowering FSWs to have safer sex practices may help them to prevent unintended pregnancies and further risk of HIV transmission.
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Affiliation(s)
- Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Razieh Khajehkazemi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sedaghat
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail:
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Lafort Y, Greener R, Roy A, Greener L, Ombidi W, Lessitala F, Haghparast-Bidgoli H, Beksinska M, Gichangi P, Reza-Paul S, Smit JA, Chersich M, Delva W. HIV prevention and care-seeking behaviour among female sex workers in four cities in India, Kenya, Mozambique and South Africa. Trop Med Int Health 2016; 21:1293-1303. [PMID: 27479236 DOI: 10.1111/tmi.12761] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To identify gaps in the use of HIV prevention and care services and commodities for female sex workers, we conducted a baseline cross-sectional survey in four cities, in the context of an implementation research project aiming to improve use of sexual and reproductive health services. METHODS Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison. RESULTS Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P < 0.05) after adjusting for differences in FSWs' socio-demographic characteristics. CONCLUSION The use of HIV prevention and care by FSWs is often insufficient and differed greatly between cities. Differences could not be explained by variations in socio-demographic sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.
| | - Ross Greener
- MatCH Research Unit, University of the Witwatersrand, Durban, South Africa
| | | | - Letitia Greener
- MatCH Research Unit, University of the Witwatersrand, Durban, South Africa
| | - Wilkister Ombidi
- International Centre for Reproductive Health-Kenya, Mombasa, Kenya
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | | | - Mags Beksinska
- MatCH Research Unit, University of the Witwatersrand, Durban, South Africa
| | - Peter Gichangi
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,International Centre for Reproductive Health-Kenya, Mombasa, Kenya.,University of Nairobi, Nairobi, Kenya
| | | | - Jenni A Smit
- MatCH Research Unit, University of the Witwatersrand, Durban, South Africa.,Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium
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11
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Lafort Y, Greener R, Roy A, Greener L, Ombidi W, Lessitala F, Haghparast-Bidgoli H, Beksinska M, Gichangi P, Reza-Paul S, Smit JA, Chersich M, Delva W. Where Do Female Sex Workers Seek HIV and Reproductive Health Care and What Motivates These Choices? A Survey in 4 Cities in India, Kenya, Mozambique and South Africa. PLoS One 2016; 11:e0160730. [PMID: 27494412 PMCID: PMC4975460 DOI: 10.1371/journal.pone.0160730] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background A baseline cross-sectional survey among female sex workers (FSWs) was conducted in four cities within the context of an implementation research project aiming to improve FSWs’ access to HIV, and sexual and reproductive health (SRH) services. The survey measured where FSWs seek HIV/SRH care and what motivates their choice. Methods Using respondent-driven sampling (RDS), FWSs were recruited in Durban, South Africa (n = 400), Tete, Mozambique (n = 308), Mombasa, Kenya (n = 400) and Mysore, India (n = 458) and interviewed. RDS-adjusted proportions were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests. Results Across cities, FSWs most commonly sought care for the majority of HIV/SRH services at public health facilities, most especially in Durban (ranging from 65% for condoms to 97% for HIV care). Services specifically targeting FSWs only had a high coverage in Mysore for STI care (89%) and HIV testing (79%). Private-for-profit clinics were important providers in Mombasa (ranging from 17% for STI care and HIV testing to 43% for HIV care), but not in the other cities. The most important reason for the choice of care provider in Durban and Mombasa was proximity, in Tete ‘where they always go’, and in Mysore cost of care. Where available, clinics specifically targeting FSWs were more often chosen because of shorter waiting times, perceived higher quality of care, more privacy and friendlier personnel. Conclusion The place where care is sought for HIV/SRH services differs substantially between cities. Targeted services have limited coverage in the African cities compared to Mysore. Convenience appears more important for choosing the place of care than aspects of quality of care. The best model to improve access, linking targeted interventions with general health services, will need to be tailored to the specific context of each city.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
- * E-mail:
| | - Ross Greener
- MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa
| | | | - Letitia Greener
- MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa
| | - Wilkister Ombidi
- International Centre for Reproductive Health-Kenya, Mombasa, Kenya
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | | | - Mags Beksinska
- MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa
| | - Peter Gichangi
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
- International Centre for Reproductive Health-Kenya, Mombasa, Kenya
- University of Nairobi, Nairobi, Kenya
| | - Sushena Reza-Paul
- Ashodaya Samithi, Mysore, India
- University of Manitoba, Winnipeg, Canada
| | - Jenni A. Smit
- MatCH Research (Maternal, Adolescent and Child Health Research) Unit, University of the Witwatersrand, Durban, South Africa
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Gent, Belgium
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
- Center for Statistics, Hasselt University, Diepenbeek, Belgium
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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12
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Lafort Y, Lessitala F, Candrinho B, Greener L, Greener R, Beksinska M, Smit JA, Chersich M, Delva W. Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions. BMC Public Health 2016; 16:608. [PMID: 27440108 PMCID: PMC4955167 DOI: 10.1186/s12889-016-3305-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background In the context of an operational research project in Tete, Mozambique, use of, and barriers to, HIV and sexual and reproductive health (HIV/SRH) commodities and services for female sex workers (FSWs) were assessed as part of a baseline situational analysis. Methods In a cross-sectional survey 311 FSWs were recruited using respondent driven sampling and interviewed face-to-face, and three focus group discussions were held with respectively 6 full-time Mozambican, 7 occasional Mozambican and 9 full-time Zimbabwean FSWs, to investigate use of, and barriers to, HIV/SRH care. Results The cross-sectional survey showed that 71 % of FSWs used non-barrier contraception, 78 % sought care for their last sexually transmitted infection episode, 51 % of HIV-negative FSWs was tested for HIV in the last 6 months, 83 % of HIV-positive FSWs were in HIV care, 55 % sought help at a health facility for their last unwanted pregnancy and 48 % after sexual assault, and none was ever screened for cervical cancer. Local public health facilities were by far the most common place where care was sought, followed by an NGO-operated clinic targeting FSWs, and places outside the Tete area. In the focus group discussions, FSWs expressed dissatisfaction with the public health services, as a result of being asked for bribes, being badly attended by some care providers, stigmatisation and breaches of confidentiality. The service most lacking was said to be termination of unwanted pregnancies. Conclusions The use of most HIV and SRH services is insufficient in this FSW population. The public health sector is the main provider, but access is hampered by several barriers. The reach of a FSW-specific NGO clinic is limited. Access to, and use of, HIV and SRH services should be improved by reducing barriers at public health facilities, broadening the range of services and expanding the reach of the targeted NGO clinic.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.
| | - Faustino Lessitala
- International Centre for Reproductive Health-Mozambique, Maputo, Mozambique
| | | | - Letitia Greener
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ross Greener
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Mags Beksinska
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Jenni A Smit
- MatCH Research Unit (Maternal, Adolescent and Child Health Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.,Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Chersich
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- International Centre for Reproductive Health, Ghent University, Gent, Belgium.,The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa.,Center for Statistics, Hasselt University, Diepenbeek, Belgium
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Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, Lafort Y, Scorgie F. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Global Health 2014; 10:47. [PMID: 24916108 PMCID: PMC4074148 DOI: 10.1186/1744-8603-10-47] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. Methods In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Results Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Conclusions Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.
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Affiliation(s)
- Lizzie Moore
- MatCH (Maternal, Adolescent and Child Health), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.
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14
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Ghimire L, Smith WCS, van Teijlingen ER. Utilisation of sexual health services by female sex workers in Nepal. BMC Health Serv Res 2011; 11:79. [PMID: 21501473 PMCID: PMC3107775 DOI: 10.1186/1472-6963-11-79] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 04/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. Methods This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. Results The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. Conclusion FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The 'education' to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary.
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Affiliation(s)
- Laxmi Ghimire
- Department of Public Health, School of Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, UK.
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15
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Falling through the cracks: contraceptive needs of female sex workers in Cambodia and Laos. Contraception 2011; 84:194-8. [PMID: 21757062 DOI: 10.1016/j.contraception.2010.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 11/02/2010] [Accepted: 11/03/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Condom is the only method promoted for dual protection among female sex workers (FSWs) in most Asian countries, which may be insufficient to prevent pregnancies given FSWs' high frequency of sexual intercourse. STUDY DESIGN Data were obtained from independent cross-sectional surveillance surveys conducted in Cambodia and Laos. Random samples of FSWs provided behavioral information. RESULTS Respondents numbered 592 in Cambodia and 1421 in Laos. In Cambodia, 28.2% had abortions in the past year despite reporting 99.0% condom use at last commercial sex. Abortion increased with the number of clients, inconsistent condom use, recent condom breakage and recent forced unprotected sex with clients. In Laos, 26.0% of all FSWs had ever aborted as had 89.4% of those who had been pregnant in the past 6 months. CONCLUSIONS FSWs experience higher frequency of abortion than women from the general population. FSWs' reportedly high rate of condom use is insufficient to prevent pregnancies.
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16
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Lafort Y, Geelhoed D, Cumba L, Lázaro CDDM, Delva W, Luchters S, Temmerman M. Reproductive health services for populations at high risk of HIV: Performance of a night clinic in Tete province, Mozambique. BMC Health Serv Res 2010; 10:144. [PMID: 20507644 PMCID: PMC2890643 DOI: 10.1186/1472-6963-10-144] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 05/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability. METHODS In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held with FSW from Mozambique and Zimbabwe, and LDD from Mozambique and Malawi. Clinic outputs and costs were analysed. RESULTS An estimated 4,415 FSW work in the area, or 9% of women aged 15-49, and on average 66 trucks stay overnight near the clinic. Currently on average, 475 clients/month visit the clinic (43% for contraception, 24% for counselling and testing and 23% for STI care). The average clinic running cost is US$ 1408/month, mostly for human resources. All informants endorsed this clinic concept and the need to expand the services. FGD participants reported high satisfaction with the services and mentioned good reception by the health staff, short waiting times, proximity and free services as most important. Participants were in favour of expanding the range of services, the geographical coverage and the opening times. CONCLUSIONS Size of the target population, satisfaction of clients and endorsement by health policy makers justify maintaining a separate clinic for MARP. Cost-effectiveness may be enhanced by broadening the range of SRHR-HIV/AIDS services, adapting opening times, expanding geographical coverage and targeting additional MARP. Long-term sustainability remains challenging and requires private-public partnerships or continued project-based funding.
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Affiliation(s)
- Yves Lafort
- International Centre for Reproductive Health, University Ghent, Ghent, Belgium.
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Church K, Mayhew SH. Integration of STI and HIV prevention, care, and treatment into family planning services: a review of the literature. Stud Fam Plann 2009; 40:171-86. [PMID: 19852408 DOI: 10.1111/j.1728-4465.2009.00201.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last comprehensive literature review to examine the effectiveness of family planning (FP) services in delivering STI and HIV prevention and care was published in 2000. This review updates that report by examining evidence of the impact of integrating any component of STI or HIV prevention, care, and treatment into a family planning setting in developing countries. Forty-four reports were identified from a comprehensive search of published databases and "grey literature". The weight of evidence demonstrates that integrated services can have a positive impact on client satisfaction, improve access to component services, and reduce clinic-based HIV-related stigma, and that they are cost-effective. Evidence of FP services reaching men and adolescents and of their impact on health outcomes is inconclusive. Several studies found that providers frequently miss opportunities to integrate care and that the capacity to maintain the quality of care is also influenced by many programmatic challenges. The range of experiences indicates that managers need to determine appropriate health-care service-delivery models based on a consideration of epidemiological, structural, and health-systems factors.
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Affiliation(s)
- Kathryn Church
- Centre for Population Studies, London School of Hygiene & Tropical Medicine, 50 Bedford Square, London, WC1B 3DP.
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Self-Medication Prevalence for Sexually Transmitted Diseases: Meta-Analysis and Meta-Regression of Population Level Determinants. Sex Transm Dis 2009; 36:112-9. [DOI: 10.1097/olq.0b013e31818b2116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nuwaha F, Muganzi E. Predictors of Use of Traditional Medicine by Patients with Sexually Transmitted Infections in Southwest Uganda. J Altern Complement Med 2008; 14:733-9. [DOI: 10.1089/acm.2007.7160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University Institute of Public Health, Kampala, Uganda
| | - Elly Muganzi
- Integrated Community Based Initiatives, Kabwohe, Bushenyi, Uganda
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Nguyen MN, Venne T, Rodrigues I, Jacques J. Why and According to What Consultation Profiles Do Female Sex Workers Consult Health Care Professionals? A Study Conducted in Laval, Québec. Health Care Women Int 2008; 29:165-82. [DOI: 10.1080/07399330701738226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Delvaux T, Nöstlinger C. Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility. REPRODUCTIVE HEALTH MATTERS 2007; 15:46-66. [PMID: 17531748 DOI: 10.1016/s0968-8080(07)29031-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
From a policy and programmatic point of view, this paper reviews the literature on the fertility-related needs of women and men living with HIV and how the entry points represented by family planning, sexually transmitted infection and HIV-related services can ensure access to contraception, abortion and fertility services for women and men living with HIV. Most contraceptive methods are safe and effective for HIV positive women and men. The existing range of contraceptive options should be available to people living with HIV, along with more information about and access to emergency contraception. Potential drug interaction must be considered between hormonal contraception and treatment for tuberculosis and certain antiretroviral drugs. Couples living with HIV who wish to use a permanent contraceptive method should have access to female sterilisation and vasectomy in an informed manner, free of coercion. How to promote condoms and dual protection and how to make them acceptable in long term-relationships remains a challenge. Both surgical and medical abortion are safe for women living with HIV. To reduce risk of vertical transmission of HIV and in cases of infertility, people with HIV should have access to sperm washing and other assisted conception methods, if these are available. Simple and cost-effective procedures to reduce risk of vertical transmission should be part of counselling for women and men living with HIV who intend to have children. Support for the reproductive rights of people with HIV is a priority. More operations research on best practices is needed.
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Affiliation(s)
- Thérèse Delvaux
- STD/HIV Research and Intervention Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
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22
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Nuwaha F. Determinants of Choosing Public or Private Health Care Among Patients With Sexually Transmitted Infections in Uganda. Sex Transm Dis 2006; 33:422-7. [PMID: 16531938 DOI: 10.1097/01.olq.0000204574.78135.9f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify variables that distinguish patients with sexually transmitted infections (STIs) who seek care in public or private health units. GOAL To recommend measures for improved care of patients with STIs. STUDY DESIGN Patients with STIs were interviewed at public (n = 101) or private health units (n = 124). Information was collected on attitudinal, normative, and self-efficacy beliefs; STI symptoms; health-seeking behavior; sociodemographic characteristics, and on partner referral. RESULTS Choosing private health units is favored by age >25 years, favorable beliefs towards private health units (e.g., they cure or prevent STIs and give adequate drug doses); unfavorable beliefs towards public health units (such as they make STIs chronic and have corrupt staff); not being influenced by sexual partner(s) in choice of treatment site, being likely to chose a treatment site if sexual partners were not treated free, and being likely to choose a treatment site if not recommend by a friend. This 9-variable model correctly classified 214 (95%) of the 225 patients (model chi squared = 192, 9 degrees of freedom, P <0.001). CONCLUSIONS Psychosocial variables markedly influence choice of health care provider. Improving quality of care will enhance STI management and help to modify the unfavorable psychosocial beliefs.
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Affiliation(s)
- Fred Nuwaha
- Makerere University Institute of Public Health, Kampala, Uganda.
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23
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Vuylsteke B, Traore M, Mah-Bi G, Konan Y, Ghys P, Diarra J, Laga M. Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire. Trop Med Int Health 2004; 9:638-43. [PMID: 15117310 DOI: 10.1111/j.1365-3156.2004.01235.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers. METHODS A cross-sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems. RESULTS Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less. Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider-client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them. CONCLUSIONS The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.
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Affiliation(s)
- B Vuylsteke
- Institute of Tropical Medicine, Antwerp, Belgium.
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24
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Askew I, Berer M. The contribution of sexual and reproductive health services to the fight against HIV/AIDS: a review. REPRODUCTIVE HEALTH MATTERS 2004; 11:51-73. [PMID: 14708398 DOI: 10.1016/s0968-8080(03)22101-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Approximately 80% of HIV cases are transmitted sexually and a further 10% perinatally or during breastfeeding. Hence, the health sector has looked to sexual and reproductive health programmes for leadership and guidance in providing information and counselling to prevent these forms of transmission, and more recently to undertake some aspects of treatment. This paper reviews and assesses the contributions made to date by sexual and reproductive health services to HIV/AIDS prevention and treatment, mainly by services for family planning, sexually transmitted infections and antenatal and delivery care. It also describes other sexual and reproductive health problems experienced by HIV-positive women, such as the need for abortion services, infertility services and cervical cancer screening and treatment. This paper shows that sexual and reproductive health programmes can make an important contribution to HIV prevention and treatment, and that STI control is important both for sexual and reproductive health and HIV/AIDS control. It concludes that more integrated programmes of sexual and reproductive health care and STI/HIV/AIDS control should be developed which jointly offer certain services, expand outreach to new population groups, and create well-functioning referral links to optimize the outreach and impact of what are to date essentially vertical programmes.
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25
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Delvaux T, Crabbé F, Seng S, Laga M. The need for family planning and safe abortion services among women sex workers seeking STI care in Cambodia. REPRODUCTIVE HEALTH MATTERS 2003; 11:88-95. [PMID: 12800706 DOI: 10.1016/s0968-8080(03)02163-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Cambodia, clinics established for the prevention and management of sexually transmitted infections (STIs) in women sex workers do not address other reproductive health services. The aim of this study was to assess the need for more comprehensive sexual and reproductive health services for women sex workers in Cambodia. In January 2000, relevant documents were reviewed, interviews with key informants carried out and group interviews with women sex workers conducted. Medical records from women sex workers were also reviewed and some data collected prospectively in one government STI clinic. Interviews with the women and data from the government clinic indicated that excluding condoms, a very low proportion of women sex workers were currently using a modern contraceptive method--5% of 38 women and 1.6% of 632 women, respectively. Induced abortion was widely used but was perceived to be risky and costly. Data from a mobile team intervention and the government clinic respectively showed that 25.5% (n = 1744) and 21.9% (n = 588) of women sex workers reported at least one previous induced abortion. These findings reveal the need for accessible contraception and safe abortion services among sex workers in Cambodia, and raise the issue of the reproductive rights and reproductive health needs of women sex workers in general.
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Affiliation(s)
- Thérèse Delvaux
- STD/HIV Research and Intervention Unit, Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
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