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Macleod CI, Reynolds JH, Delate R. Violence Against Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:691-703. [PMID: 36964683 PMCID: PMC10666481 DOI: 10.1177/15248380231160847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Women who sell sex (WSS) are vulnerable to violence. We present a scoping review of the last decade of research on the prevalence and incidence of, factors associated with, and services regarding violence against WSS in Eastern and Southern African (ESA). A systematic search of various databases resulted in 20 papers being reviewed. Inclusion criteria, applied by the first two authors, were as follows: empirical papers, key research problem is violence against WSS, and conducted in ESA countries. The lifetime prevalence of violence revealed in the studies ranged from 21% to 82%. A pattern of generalized violence against WSS from paying clients, male partners, strangers, family members, friends/acquaintances, and the authorities emerged. Factors associated with violence included the context within which the sex work occurs, alcohol use, type of sex exchange interactions, and personal factors (low education, low income, marriage, youth, high client volume, time in sex work, forced sexual debut, and internalized sex work stigma). WSS seldom access services after violence. Evaluations of two programs, a woman-focused HIV intervention, and the Diagonal Interventions to Fast-Forward Reproductive Health project, showed improvements in gender-based violence services. Findings suggest that targeted programmes should be paired with improving general health services and focus on promoting collective agency among WSS.
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Affiliation(s)
| | | | - Richard Delate
- United Nations Population Fund (UNFPA), Pretoria, South Africa
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Willis B, Church K, Perttu E, Thompson H, Weerasinghe S, Macias-Konstantopoulos W. The preventable burden of mortality from unsafe abortion among female sex workers: a Community Knowledge Approach survey among peer networks in eight countries. Sex Reprod Health Matters 2023; 31:2250618. [PMID: 37712508 PMCID: PMC10506426 DOI: 10.1080/26410397.2023.2250618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraption, safe abortion, and post-abortion care.
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Affiliation(s)
- Brian Willis
- Director, Global Health Promise, Portland, OR, USA
| | - Kathryn Church
- Independent Consultant, London, UK; Honorary Assistant Professor, Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Perttu
- Director of Data Analysis, Global Health Promise, Portland, OR, USA
| | - Heather Thompson
- Maternal Health Advisor, Global Health Promise, Portland, OR, USA; Adjunct Professor, Schulich School of Medicine, McMaster Faculty of Medicine; & Obstetrician/Gynecologist, Grey Bruce Health Services, Hamilton, Ontario, Canada
| | - Swarna Weerasinghe
- Biostatistician, Global Health Promise, Portland, OR, USA; Associate Professor, Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Wendy Macias-Konstantopoulos
- Global Policy Advisor, Global Health Promise, Portland, OR, USA; Director, Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Khezri M, Tavakoli F, Schwartz S, Karamouzian M, Sharifi H, McKnight CA, Jarlais DD, Baral S, Shokoohi M. Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression. Ann Epidemiol 2023; 85:13-37. [PMID: 37356778 DOI: 10.1016/j.annepidem.2023.06.022] [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: 10/07/2022] [Revised: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Despite the evidence of a high rate of unintended pregnancy, there remains limited information about the prevalence and experiences of abortion among female sex workers (FSWs). In response, we aimed to summarize the available evidence on abortion among FSWs. METHODS We searched Medline, Embase, PsycINFO, CINAHL, Scopus, and Web of Science from inception to January 29, 2023 . We pooled data from the included studies using random-effects meta-analyses. We also grouped countries for the legality of elective abortion stratified by the United Nations database on abortion laws and policies. RESULTS We identified 60 eligible studies from 2031 potentially eligible records. The pooled lifetime prevalence of at least one and multiple induced abortions was 37.7% (95% confidence interval, 31.8-43.7) and 21.7% (14.9-29.2), respectively. Among FSWs recruited in countries where elective abortion is illegal, at least one induced abortion prevalence was 35.1% (28.1-42.4), and multiple induced abortion prevalence was 23.1% (12.4-35.9). In countries where elective abortion is legal, at least one induced abortion prevalence was 44.6% (34.8-54.6), and multiple induced abortion prevalence was 19.9% (11.9-29.3). Among FSWs experiencing abortion, self-managed abortion prevalence was estimated at 32.8% (23.6-42.7) overall, 42.8% (37.2-48.5) for countries where elective abortion is illegal, and 15.6% (3.9-32.7) for countries that legally allow elective abortion. CONCLUSIONS Induced abortion is prevalent among FSWs, highlighting the need for interventions to increase access to effective contraception and safe abortion care. While induced abortion prevalence did not significantly differ across the legal grounds for abortion, self-managed abortion prevalence was higher in countries where elective abortion was illegal, highlighting the urgent need for accessible abortion services for FSWs in criminalized settings. Moving forward necessitates implementing and evaluating culturally acceptable models of safe abortion and post-abortion care for FSWs to increase access to the full spectrum of sexual and reproductive health services.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York; 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
| | - Fatemeh Tavakoli
- 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
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - 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
| | - Courtney A McKnight
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - 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; Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.
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Modisaotsile I, Stacey M, Odek W, Ogutu D, Kindyomunda R. Heightened risk of unintended pregnancy among sex workers and sex worker organizations' response during the stringent COVID-19 containment measures in East and Southern Africa. CHINA POPULATION AND DEVELOPMENT STUDIES 2023; 7:37-47. [PMID: 37193367 PMCID: PMC10072027 DOI: 10.1007/s42379-023-00128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
The UNFPA 2022 State of the World Population (SWOP) report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy, but did not adequately address the grave situation of female sex workers (FSWs), who experience the worst sexual and reproductive health outcomes, especially during humanitarian crises. This study assesses the risks of unintended pregnancy among FSWs and sex worker organizations? response during the stringent COVID-19 containment measures in East and Southern Africa (ESA). A mixed-methods approach consisting of a desk review, key informant interviews and an online survey was used for data collection. Key informants and survey respondents included representatives of sex worker-led organisations and networks, organisations providing services to sex workers, development partners, advocacy organisations and donors, with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic. In total, 21 key informants were interviewed and 69 respondents participated in the online survey, with representation from 14 out of 23 countries in the ESA region. The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers' access to contraception and risk of unintended pregnancy. Looking to the uncertain future of humanitarian crises, the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions, such as sex workers.
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Affiliation(s)
| | | | - Willis Odek
- UNFPA Regional Office for East and Southern Africa, Johannesburg, South Africa
| | - Daughtie Ogutu
- Africa Key Population Experts Group- AKPEG, Nairobi, Kenya
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Moore BE, Govaerts L, Kapadia F. Maternal health and maternal health service utilization among female sex workers: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231206303. [PMID: 37899632 PMCID: PMC10617279 DOI: 10.1177/17455057231206303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High proportions of female sex workers (FSWs) become pregnant and have children. Many FSWs are at increased risk of maternal health complications due to factors such as poverty, violence, and healthcare barriers. Despite this, FSWs' maternal health and use of maternal health services (MHS) receive limited attention. OBJECTIVES The objectives of this scoping review are to (1) synthesize existing data on FSWs' maternal health and MHS utilization and (2) assess the state of peer-reviewed literature on FSWs' maternal health in regard to methodological approaches and reported outcomes. ELIGIBILITY CRITERIA Included articles were peer-reviewed, published in English, and reported empirical data on FSWs for outcomes related to antenatal care, pregnancy, and labor complications, postnatal and delivery care, and/or barriers to MHS. SOURCES OF EVIDENCE Article searches were conducted in PubMed, Web of Science, Global Health, Sociological Abstracts, Sociological Index, PsychInfo, and CINAHL. CHARTING METHODS Information extracted from eligible articles included publication year, study design, location, sample size, outcome measures, and findings. The "Three Delays" model was used to synthesize findings on barriers to MHS as relevant to phase I, II, or III delays. RESULTS Eighteen publications met the eligibility criteria. Studies were conducted in 11 countries and primarily reported quantitative data from cross-sectional surveys. The most frequently reported outcome was antenatal care utilization (n = 14), whereas few studies reported findings related to postnatal care and breastfeeding counseling (n = 2). Across publications, there was a substantial range in the proportion of FSWs who reported accessing different types of MHS. CONCLUSION Literature on FSWs' maternal health is limited and heterogenous. More research is needed that specifically focuses on measuring outcomes related to FSWs' maternal health and examines associated factors. Such work can inform future research directions and public health interventions for FSWs-a population of marginalized women whose maternal health has been overlooked in existing efforts.
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Affiliation(s)
- Brandi E Moore
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Lauren Govaerts
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Farzana Kapadia
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
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Ngo A, Nguyen VT, Phan H, Pham V, Ngo C, Nguyen L, Ha T. Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam. Mhealth 2023; 9:3. [PMID: 36760784 PMCID: PMC9902234 DOI: 10.21037/mhealth-22-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. METHODS iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. RESULTS There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). CONCLUSIONS The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.
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Affiliation(s)
- Anh Ngo
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Thi Nguyen
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Ha Phan
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Pham
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Cuong Ngo
- US News and World Report, Washington, DC, USA
| | | | - Toan Ha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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Weikum D, Kelly-Hanku A, Neo-Boli R, Aeno H, Badman SG, Vallely LM, Willie B, Kupul M, Hou P, Amos A, Narokobi R, Pekon S, Coy K, Wapling J, Gare J, Kaldor JM, Vallely AJ, Hakim AJ. Sexual and reproductive health needs and practices of female sex workers in Papua New Guinea: findings from a biobehavioral survey Kauntim mi tu (‘Count me too’). Arch Public Health 2022; 80:202. [PMID: 36064615 PMCID: PMC9442976 DOI: 10.1186/s13690-022-00926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Little research has explored the sexual and reproductive health (SRH) experience of female sex workers (FSW), including girls aged < 18 years who are commercially sexually exploited (CSE), in Papua New Guinea (PNG). This paper describes the SRH history of FSW and CSE girls and factors associated with their use of moderately or highly effective contraceptive methods in three settings in PNG. Methods From 2016 to 2017, respondent-driven sampling (RDS) surveys were conducted among FSW and CSE girls in Port Moresby, Lae, and Mt. Hagen. FSW and CSE girls who were born female, aged ≥12 years, sold or exchanged vaginal sex in the past 6 months, spoke English or Tok Pisin, and had a valid RDS study coupon were eligible to participate. Interviews were conducted face-to-face and participants were offered rapid routine HIV and syphilis testing. Survey logistic regression procedures were used to identify factors associated with the use of moderately or highly effective contraceptive methods. Weighted data analysis was conducted. Results A total of 2901 FSW and CSE girls (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled. The proportion using moderately or highly effective contraceptive methods was 37.7% in Port Moresby, 30.9% in Lae, and 26.5% in Mt. Hagen. After adjusting for covariates, factors significantly associated with the use of moderately or highly effective contraceptive methods in Port Moresby were being age 20–24, being married, being divorced or separated, having one or more dependent children, being away from home for more than 1 month in the last 6 months, and having tested HIV negative. No factors were significantly associated in Lae or Mt. Hagen. ANC attendance amongst FSW and CSE girls who gave birth in last 3 years was highest in Port Moresby at 91.2%. HIV testing was inconsistently and inadequately offered at ANC across the three cities. Conclusions Kauntim mi tu provides much-needed insight into the SRH experiences of FSW and CSE girls in PNG, where their use of moderately or highly effective contraceptive methods is low. We hope to shed light on the complicated reality they face due to illegality of sex work and multitude of complex healthcare experiences.
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Moradi G, Gouya MM, Ezzati Amini E, Ghorbani SS, Akbarpour S, Zareie B, Izadi N, Kashefi F, Moradi Y. Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020. PLoS One 2022; 17:e0273732. [PMID: 36037196 PMCID: PMC9423624 DOI: 10.1371/journal.pone.0273732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.
Methods
This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.
Results
From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.
Conclusion
Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.
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Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Elnaz Ezzati Amini
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Izadi
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kashefi
- Reproductive health, Population, Family and School Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- * E-mail:
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, Hladik W. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda. BMC Pregnancy Childbirth 2022; 22:646. [PMID: 35978285 PMCID: PMC9382809 DOI: 10.1186/s12884-022-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - Reena H Doshi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
| | - Herbert Kiyingi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Jonathan Standish
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, USA
| | - Wolfgang Hladik
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
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Macleod CI, Reynolds JH, Delate R. Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion. Public Health Rev 2022; 43:1604376. [PMID: 35646420 PMCID: PMC9131513 DOI: 10.3389/phrs.2022.1604376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.
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Affiliation(s)
- Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | | | - Richard Delate
- 2gether 4 SRHR, United Nations Population Fund, Johannesburg, South Africa
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Global Health Facility-Based Interventions to Achieve UNAIDS 90-90-90: A Systematic Review and Narrative Analysis. AIDS Behav 2022; 26:1489-1503. [PMID: 34694526 DOI: 10.1007/s10461-021-03503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
To evaluate whether health facility-based HIV interventions align with UNAIDS 90-90-90 targets, we performed a systematic review through the lens of UNAIDS targets. We searched 11 databases, retrieving 5201 citations with 26 eligible studies classified by country income and UNAIDS target. We analyzed whether reporting of study outcome metrics was in line with UNAIDS targets using a standardized extraction form and results were summarized in a narrative synthesis given data heterogeneity. We also assessed the quality of randomized trials with the Cochrane Risk of Bias Tool and observational studies with the Newcastle-Ottawa Scale. Stratification of interventions by country income level revealed themes in successful interventions that provide insight for scale-up in similar resource contexts. Few studies reported outcomes using metrics according to UNAIDS targets. Standardization of reporting according to the UNAIDS framework could facilitate comparability of interventions and inform country-level progress on an international scale.
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Evolution of Condom Use Among a 5-Year Cohort of Female Sex Workers in Zambia. AIDS Behav 2022; 26:470-477. [PMID: 34333718 PMCID: PMC8801539 DOI: 10.1007/s10461-021-03403-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
Observing sexual behaviour change over time could help develop behavioural HIV prevention interventions for female sex workers in Zambia, where these interventions are lacking. We investigated the evolution of consistent condom use among female sex workers and their clients and steady partners. Participants were recruited into an HIV incidence cohort from 2012 to 2017. At each visit, women received HIV counselling and testing, screening for sexually transmitted infections (STIs) and free condoms. Our outcome was reported consistent (100%) condom use in the previous month with steady partners, repeat clients, and non-repeat clients. Consistent condom use at baseline was highest with non-repeat clients (36%) followed by repeat clients (27%) and steady partners (17%). Consistent condom use between baseline and Month 42 increased by 35% with steady partners, 39% with repeat clients and 41% with non-repeat clients. Access to condoms, HIV/STI counselling and testing promoted positive sexual behaviour change.
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Macleod CI, Reynolds JH. Human Papilloma Virus infection and cervical cancer among women who sell sex in Eastern and Southern Africa: A scoping review. WOMENS HEALTH 2021; 17:17455065211058349. [PMID: 34775848 PMCID: PMC8593294 DOI: 10.1177/17455065211058349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Women who sell sex have a high prevalence of human papilloma virus, which may cause cervical cancer. The objective of this review was to collate findings on prevalence, associated factors, screening, service provision and utilization of services in relation to human papilloma virus and cervical cancer among women who sell sex in Eastern and Southern Africa. METHODS A scoping review methodology was employed. Inclusion criteria were as follows: (1) empirical papers, (2) of studies conducted in Eastern and Southern Africa, (3) published in the last 10 years, and (4) addressing women who sell sex in relation to (5) human papilloma virus and cervical cancer. A thorough search of a range of databases surfaced 66 papers. Both authors applied inclusion and exclusion criteria, resulting in 14 papers being reviewed. RESULTS The reported prevalence of high-risk human papillomavirus virus varied between 23.6% and 70.5%. HIV sero-positivity, other sexually transmitted infections and Epstein-Barr virus were associated with human papilloma virus and high-grade cervical lesions. High-risk human papilloma virus was associated with women who reported younger age at first intercourse, non-barrier contraceptive use, and no history of condom use. For screening, there was overall agreement between physician- and self-collected samples. Contradictory results were found for visual inspection with acetic acid. Screening services utilization was associated with provider's recommendation, history of sexually transmitted infections, frequency of facility visit and history of vaginal examination. A diagonal programme led to an increase in screening, attributed to the targeted services. CONCLUSIONS Context is important in planning cervical cancer services. There is a need for enhanced sexually transmitted infections and viral management within cervical cancer prevention. Women who sell sex should be empowered in self-collection of stored-dry specimens, especially in resource-constrained regions. Cervical cancer screening services should be honed to the needs of women who sell sex.
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Affiliation(s)
- Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
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Sikhosana N, Mokgatle MM. A qualitative exploration on accounts of condom-use negotiation with clients: challenges and predicaments related to sex work among street-based female sex workers in Ekurhuleni District, South Africa. Pan Afr Med J 2021; 40:54. [PMID: 35059100 PMCID: PMC8724014 DOI: 10.11604/pamj.2021.40.54.29918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION female sex workers (FSWs) are the key vulnerable populations since they carry the high burden of HIV and sexually transmitted infections (STIs). However, the vulnerability of street-based FSWs to HIV/STIs is much higher than that of the establishment-based FSWs. The study aimed to explore street-based FSWs' condom negotiation skills, barriers to condom use as well as the challenges and predicaments they face on a daily basis. METHODS an exploratory qualitative approach using focus group discussions was conducted among FSWs working in a major provincial road in a district of Gauteng Province. Thematic content analysis using NVivo version 10 software was conducted. RESULTS the age range of the FSWs was 19 to 44 years. The themes that emerged from the data on challenges to negotiation and condom use among FSWs revealed the ways condoms are used in early sex work and over time, ways of enforcing condom used, preferred types of condoms and the predicaments to working in the sex trade. FSWs gained experience of negotiating condom use over time in their work. Both female and male condoms were available and accurate insertion of condoms was reported. Male condom was preferred. Condom use strategies included direct request; using health-information messages; charging more for condomless sex; and refusing condomless sex. The FSW reported the risks of violent attacks of unregulated street-based environment. CONCLUSION condom negotiation strategies illustrated that peer-education and sharing experiences among themselves were beneficial for protective sexual behaviours. Peer-education benefits and peer-interactions yielded assertive attitudes and behaviours of demanding and/or enforcing condom use.
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Affiliation(s)
- Nokuthula Sikhosana
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud
| | - Mathildah Mpata Mokgatle
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud,Corresponding author: Mathildah Mpata Mokgatle, Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud.
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Llangarí-Arizo LM, Sadiq ST, Márquez C, Cooper P, Furegato M, Zhou L, Aranha L, Mateo MM, Romero-Sandoval N. Sexually transmitted infections and factors associated with risky sexual practices among female sex workers: A cross sectional study in a large Andean city. PLoS One 2021; 16:e0250117. [PMID: 33956840 PMCID: PMC8101946 DOI: 10.1371/journal.pone.0250117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background There are limited published data on factors related to risky sexual practices (RSP) affecting sexually transmitted infections (STIs) among female sex workers (FSWs) in Ecuador. Methods Cross-sectional study of FSWs presenting for a consultation in a primary health care centre during 2017. A questionnaire was administered to collect information on RSP and potential risk factors including age, membership of an FSW association, self-report of previous STI diagnosis, previous treatment for suspected STI and temporary migration for sex work. Associations between RSP and potential risk factors were estimated by logistic regression. The proportion of STI was estimated from vaginal swabs by real-time PCR for four sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and Mycoplasma genitalium). Results Of 249 FSWs recruited, 22.5% had reported RSPs at least once during sex work. Among FSWs reporting unprotected vaginal sex in the previous three months, 25.5% had at least one other RSP type. 17.6% (95%CI 13.3–22.8) had at least one active STI. Prevalence of co-infections was 2.4% (95%CI 1.1–5.2). In multivariable analysis, RSP was associated with age (adjusted OR 1.06; 95%CI 1.02–1.10), membership of an FSWs association (aOR 3.51; 95%CI 1.60–7.72) and self-reported previous STI (aOR 3.43; 95%CI 1.28–9.17). Conclusions Among a population of female sex workers with high proportion of STIs, increasing age and belonging to an FSWs association was associated with a higher likelihood of engaging in RSP with clients. Engaging with FSWs organisations may reduce the burden of STI among sex workers.
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Affiliation(s)
- Luz Marina Llangarí-Arizo
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
- * E-mail:
| | - S. Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Cynthia Márquez
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
| | - Philip Cooper
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Martina Furegato
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
| | - Liqing Zhou
- Applied Diagnostic Research and Evaluation Unit, St George’s University of London, London, United Kingdom
- Institute for Infection & Immunity, St George’s University of London, London, United Kingdom
| | - Luisa Aranha
- Ministerio de Salud Pública de Ecuador, Quito, Ecuador
| | - Miguel Martín Mateo
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
| | - Natalia Romero-Sandoval
- School of Medicine, Universidad Internacional de Ecuador, Quito, Ecuador
- Red Internacional Grups de Recerca d’Amèrica i Àfrica Llatines – GRAAL, Barcelona, Spain
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Atuhaire L, Adetokunboh O, Shumba C, Nyasulu PS. Effect of community-based interventions targeting female sex workers along the HIV care cascade in sub-Saharan Africa: a systematic review and meta-analysis. Syst Rev 2021; 10:137. [PMID: 33952347 PMCID: PMC8101125 DOI: 10.1186/s13643-021-01688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa. METHODS We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely, HIV testing and diagnosis, linkage to care, receipt of ART, and achievement of viral suppression. We conducted a systematic search of randomized controlled trials, cohort, and cross-sectional studies done in sub-Saharan African countries and published from 2004 to 2020. The period was selected based on the time span within which ART was scaled up through widespread roll-out of comprehensive HIV programs in sub-Saharan Africa. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible, and for the rest of the studies, data were synthesized using summary statistics. RESULTS The significant impact of the community interventions was observed on HIV testing, HIV diagnosis, and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage. CONCLUSIONS The evidence brought forward from this review shows that the effect of community-based interventions varies across the different stages of HIV care cascade. A broad package of interventions including a combination of behavioral, biomedical, and structural, designed with specific strategies, unique to each cascade stage appears to be more effective, although information on long-term treatment outcomes and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence-based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020157623.
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Affiliation(s)
- Lydia Atuhaire
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olatunji Adetokunboh
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Wall KM, Nyombayire J, Parker R, Ingabire R, Bizimana J, Mukamuyango J, Mazzei A, Price MA, Unyuzimana MA, Tichacek A, Allen S, Karita E. Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services. PLoS One 2021; 16:e0250044. [PMID: 33878134 PMCID: PMC8057583 DOI: 10.1371/journal.pone.0250044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms. METHODS Radio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men. RESULTS Among 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts. CONCLUSIONS Syndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.
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Affiliation(s)
- Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Julien Nyombayire
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Rosine Ingabire
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Jean Bizimana
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | | | - Amelia Mazzei
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Matt A. Price
- IAVI, NY, NY, University of California San Francisco, San Francisco, CA, United States of America
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Etienne Karita
- Project San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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Brief Report: Incidence and Correlates of Pregnancy in HIV-Positive Kenyan Sex Workers. J Acquir Immune Defic Syndr 2021; 85:11-17. [PMID: 32427720 DOI: 10.1097/qai.0000000000002402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The incidence of pregnancy in female sex workers (FSWs) living with HIV is not well characterized. METHODS Current and former FSWs living with HIV and enrolled in a prospective cohort study in Mombasa, Kenya, were followed monthly to ascertain sexual behavior and underwent quarterly pregnancy testing. Pregnancies were considered planned, mistimed, or unwanted according to fertility desires and pregnancy intentions. Cox proportional hazards models were used to estimate hazard ratios (HRs) of the association between characteristics and incident pregnancy. RESULTS Two hundred seventy-nine FSWs were eligible (October 2012-April 2017). Most women had a nonpaying, regular partner (83.2%, 232/279), were not using modern nonbarrier contraception (69.5%, 194/279), and did not desire additional children (70.6%, 197/279). Of 34 first incident pregnancies [5.8/100 person-years (p-y); 95% confidence interval (CI): 4.1 to 8.0], 91.2% (n = 31) were unintended. The incidences of planned (5.7/100 p-y, n = 3), mistimed (10.4/100 p-y, n = 9), and unwanted pregnancies (4.9/100 p-y, n = 22) were similar (P = 0.15). In univariable analysis, oral contraceptive pill use (versus no contraception), having a nonpaying, regular partner, transactional sex, vaginal washing, condomless sex, and higher sex frequency were associated with an increased pregnancy risk. Older age was associated with a lower pregnancy risk. In multivariable analysis, having a nonpaying, regular partner (adjusted HR 4.0, 95% CI: 1.2 to 14.1) and age ≥40 years (aHR 0.2, 95% CI: 0.0 to 0.9) remained significantly associated with a higher and lower pregnancy risk, respectively. CONCLUSION In this cohort of HIV-positive FSWs, most pregnancies were unintended. Identifying FSWs' fertility desires and pregnancy intentions could facilitate efforts to increase contraceptive use and implement safer conception strategies.
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Twizelimana D, Muula AS. Unmet contraceptive needs among female sex workers (FSWs) in semi urban Blantyre, Malawi. Reprod Health 2021; 18:11. [PMID: 33468198 PMCID: PMC7814425 DOI: 10.1186/s12978-020-01064-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background Research has paid limited attention to understanding factors that are associated with unmet contraceptive needs among female sex workers. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined associated factors among FSWs in semi urban Blantyre, Malawi. Methods We used systematic sampling to recruit 290 female sex workers in semi urban Blantyre between February and March 2019. In this cross sectional study, we used questionnaire interviews to collect quantitative data. We calculated the mean and standard deviation for continuous variables and proportions for categorical variables to describe the data. Logistic regression analysis was used to investigate the association between unmet needs (the outcome variable) and explanatory variables such as: having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Results Out of the 290 study participants 102 (35.2%) reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: female sex workers’ history of physical and sexual violence by clients [OR 3.38, 95% CI (1.10, 10.43)], p < 0.03, participants with a steady partner [OR 3.28, 95% CI (1.89, 5.68)], p < 0.001, and participants who feared side effects of contraceptives [OR 2.99, 95% CI (1.73, 5.20)], p < 0.001. Conclusion Reproductive Health services should address barriers to contraceptives use for instance: violence by female sex workers’ clients, fear and misinformation on contraceptives. There is need to improve awareness of contraceptives. Specific health promotion interventions on female sex workers engaged in a steady partnership are recommended. It is important to enhance the knowledge, attitudes, and counseling skills of health care providers in order to address unmet contraceptive needs among female sex workers in semi-urban Blantyre. Plain English summary Unmet contraceptive needs are defined as lack of contraceptives use in heterosexually active women of childbearing age who do not wish to become pregnant. Unmet contraceptive needs are the main cause of short inter-pregnancy intervals, early childbearing, physical abuse, unintended pregnancy, poor maternal and child health outcomes. Several studies have documented low contraceptives use among female sex workers (FSWs), but research has paid limited attention to understanding factors associated with unmet contraceptive needs among this population in semi urban Blantyre Malawi. In order to fill this knowledge gap, we estimated the prevalence of unmet contraceptive needs and examined factors that were associated with unmet contraceptive needs among FSWs in semi urban Blantyre, Malawi. We recruited 290 FSWs and collected quantitative data. These data were analyzed to obtain descriptive statistics. Logistic regression analysis was used to investigate the association between unmet contraceptive needs (the outcome variable) and explanatory variables such as: FSWs with history of physical and sexual violence by clients, having a steady partner, fear of contraceptives’ side effects and having a history of sexually transmitted infections. Out of the 290 FSWs, 35% reported unmet contraceptive needs. The following factors were significantly associated with unmet contraceptive needs in multivariate analysis: FSWs’ history of physical and sexual violence by clients, participants with a steady partner and participants who feared contraceptive side effects. Sexual and Reproductive Health services should address barriers to contraceptives use, female sex workers exposure to violence, having a steady partners and concerns about side effects. There is also a need to improve the knowledge, attitudes, and counseling skills of health providers in order to address unmet contraceptive needs among FSWs.
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Affiliation(s)
- Donatien Twizelimana
- Ekwendeni Mission Hospital, P.O. Box: 19, Ekwendeni, Mzimba, Malawi. .,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi. .,The Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM) College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi.
| | - Adamson S Muula
- Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi.,The Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM) College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi
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Ampt FH, Lim MSC, Agius PA, L'Engle K, Manguro G, Gichuki C, Gichangi P, Chersich MF, Jaoko W, Temmerman M, Stoové M, Hellard M, Luchters S. Effect of a mobile phone intervention for female sex workers on unintended pregnancy in Kenya (WHISPER or SHOUT): a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2020; 8:e1534-e1545. [PMID: 33220217 DOI: 10.1016/s2214-109x(20)30389-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Female sex workers in low-income and middle-income countries face high risks of unintended pregnancy. We developed a 12-month, multifaceted short messaging service intervention (WHISPER) for female sex workers in Kenya who had the potential to become pregnant, to improve their contraceptive knowledge and behaviours. The aim of this study was to assess the effectiveness of the intervention to reduce the incidence of unintended pregnancy among sex workers in Kenya compared with an equal-attention control group receiving nutrition-focused messages (SHOUT). METHODS Our two-arm, cluster-randomised controlled trial was done in sex-work venues in two subcounties of Mombasa, Kenya (Kisauni and Changamwe). Participants, aged 16-34 years, not pregnant or planning pregnancy, able to read text messages in English, residing in the study area, and who had a personal mobile phone with one of two phone networks, were recruited from 93 randomly selected sex-work venues (clusters). Random cluster allocation (1:1) to the intervention or control group was concealed from participants and researchers until the intervention started. Both groups received text messages in English delivered two to three times per week for 12 months (137 messages in total), as well as additional on-demand messages. Message content in the intervention group focused on promotion of contraception, particularly long-acting reversible contraception and dual method contraceptive use; message content in the control group focused on promotion of nutritional knowledge and practices, including food safety, preparation, and purchasing. The primary endpoint, analysed in all participants who were randomly assigned and attended at least one follow-up visit, compared unintended pregnancy incidence between groups using discrete-time survival analysis at 6 and 12 months. This trial is registered with Australian New Zealand Clinical Trials Registry, ACTRN12616000852459, and is closed to new participants. FINDINGS Between Sept 14, 2016, and May 16, 2017, 1728 individuals were approached to take part in the study. Of these, 1155 were eligible for full screening, 1035 were screened, and 882 were eligible, enrolled, and randomly assigned (451 participants from 47 venues in the intervention group; 431 participants from 46 venues in the control group). 401 participants from the intervention group and 385 participants from the control group were included in the primary analysis. Incidence of unintended pregnancy was 15·5 per 100 person-years in the intervention group and 14·7 per 100 person-years in the control group (hazard ratio 0·98, 95% CI 0·69-1·39). INTERPRETATION The intervention had no measurable effect on unintended pregnancy incidence. Mobile health interventions, even when acceptable and rigorously designed, are unlikely to have a sufficient effect on behaviour among female sex workers to change pregnancy incidence when used in isolation. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kelly L'Engle
- Department of Health Professions, University of San Francisco, San Francisco, CA, USA
| | | | | | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya; Technical University of Mombasa, Mombasa, Kenya; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Matthew F Chersich
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Mark Stoové
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia
| | - Stanley Luchters
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium; Department of Population Health, Aga Khan University, Nairobi, Kenya.
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21
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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22
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Perrault Sullivan G, Guédou FA, Batona G, Kintin F, Béhanzin L, Avery L, Bédard E, Gagnon MP, Zannou DM, Kpatchavi A, Alary M. Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin. BMC WOMENS HEALTH 2020; 20:248. [PMID: 33167931 PMCID: PMC7650197 DOI: 10.1186/s12905-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. Methods Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. Results Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. Conclusion One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Fernand Aimé Guédou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Georges Batona
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Frédéric Kintin
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Luc Béhanzin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Lisa Avery
- Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emmanuelle Bédard
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Marie-Pierre Gagnon
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département des sciences infirmières, Université Laval, Québec, Canada
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre national hospitalier universitaire HMK de Cotonou, Cotonou, Bénin
| | - Adolphe Kpatchavi
- Département de Sociologie - Anthropologie, Faculté des Lettres, Arts et Sciences Humaines, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
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23
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Atuhaire L, Adetokunboh O, Shumba C, Nyasulu PS. Effect of female sex work-targeted community-based interventions along the HIV treatment cascade in sub-Saharan Africa: a systematic review protocol. BMJ Open 2020; 10:e039495. [PMID: 33109669 PMCID: PMC7592303 DOI: 10.1136/bmjopen-2020-039495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs' uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs' continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade. METHODS AND ANALYSIS We will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and the WHO websites, peer-reviewed conference papers and grey literature sources will be searched for additional reports of sex work programmes. We will include randomised controlled trials, cross-sectional surveys and cohort interventions where community-based HIV services were provided to FSWs and measure the performance of the HIV intervention on one or more cascade stages. We will conduct a systematic review of studies published from 2004 to present within the sub-Saharan Africa region. We will report quantitative study outcomes of HIV testing and diagnosis, linkage to care, initiation on antiretroviral therapy and viral suppression. We will analyse the data using the random-effects meta-analysis method, and funnel plots will be used to assess the publication bias. ETHICS AND DISSEMINATION This systematic review will not require ethical approval; we will publish data from manuscripts. The results of this study will be disseminated in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020157623.
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Affiliation(s)
- Lydia Atuhaire
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olatunji Adetokunboh
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape town, South Africa
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University East Africa, Nairobi, Kenya
- Department of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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24
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Khezri M, Shokoohi M, Karamouzian M, Mirzazadeh A, Ghalekhani N, Gholamypour Z, Valipour A, Haghdoost AA, Sharifi H. Induced abortion and associated factors among female sex workers in Iran. EUR J CONTRACEP REPR 2020; 25:434-438. [PMID: 32938240 DOI: 10.1080/13625187.2020.1815007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Induced abortion is an occupational hazard for female sex workers (FSWs). This study aimed to examine the prevalence and factors associated with induced abortion among FSWs in Iran. METHODS 1337 FSWs aged ≥18 years who reported selling sex to more than one male client in the past 12 months were recruited in 13 major cities in Iran between January and August 2015. Bivariable and multivariable modified Poisson regression models were constructed to examine the correlates of induced abortion. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported. RESULTS Lifetime induced abortion was reported by 621 of 1335 participants (46.5%; 95% CI 43.8, 49.2). Older age (APR for ≥ 35 vs. < 25 years, 1.46; 95% CI: 1.03, 2.07), having ever been married (APR 1.58; 95% CI 1.05, 2.39), having ever worked in a brothel (APR 1.19; 95% CI 1.02, 1.38) and a lifetime history of being raped (APR 1.19; 95% CI 1.03, 1.38) were significantly associated with lifetime induced abortion (all p < 0.05). CONCLUSION The high prevalence of induced abortion among FSWs in Iran is concerning. Evidence-informed programmes targeting FSWs in Iran would improve their knowledge and encourage contraceptive use as well as promote pregnancy prevention and post-abortion care.
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Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future 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 Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Gholamypour
- Centre for Disease Control and Prevention, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Valipour
- Centre for Communicable Diseases, Ministry of Health, 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 Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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25
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Reproductive Healthcare Needs of Sex Workers in Rural South Africa: A Community Assessment. Ann Glob Health 2020; 86:68. [PMID: 32676297 PMCID: PMC7333549 DOI: 10.5334/aogh.2706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: In the Limpopo province of South Africa, access and availability of women’s health services are limited and many challenges exist for a growing population of transient sex workers. This study was developed to place communities at the forefront to more specifically understand regional barriers and attitudes regarding reproductive health care needs. Objective: To build strong community partnerships, gain understanding of issues in women’s health services, and collaborate with community members to address those issues. Methods: A mixed-methods study approach was used in rural South Africa. Participants were recruited through voluntary interest from a local health clinic performing outreach for migrant female sex workers. We (1) created partnerships and built trust within the community and (2) worked collaboratively to collect both qualitative and quantitative data, using community groups to discuss health needs as well as “knowledge, attitude, and practice” (KAP) surveys. Findings: Ninety-four sex workers participated. The survey data identified risk factors to poor reproductive healthcare outcomes, including limited education, young age at first sexual contact, large number of sexual partners, little knowledge of sexually transmitted infections, distrust in the use of healthcare facilities, and limited use of contraception. Community discussion groups revealed a desire for easier and more accessible healthcare, showing the biggest barriers to care are lack of money and transportation, and safety concerns related to profession, including fear of violence from partner and/or client. With input from civic leaders, public interest, and community outreach groups, a community advisory board was successfully formed for future collaboration. Conclusion: By working with local stakeholders and sex workers, we created an interactive and tailored assessment to discuss healthcare disparities. We helped foster community ownership, setting the stage for future implementation of sustainable and cooperative health programming.
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26
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Hakim AJ, Callahan T, Benech I, Patel M, Adler M, Modi S, Bateganya M, Parris KA, Bingham T. Addressing Vulnerable Population Needs in the Last Mile to the elimination of mother to child transmission of HIV: (Re)Claiming the HIV Response for Female Sex Workers and Their Children. BMC Public Health 2020; 20:1015. [PMID: 32590975 PMCID: PMC7320569 DOI: 10.1186/s12889-020-09114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
As countries strive to eliminate mother-to-child transmission of HIV, female sex workers (FSW) and their children still face barriers to accessing these essential services. Data on FSW uptake of HIV and reproductive health services before, during, and after pregnancy reveal inadequate service utilization. Stigma encountered by FSW in healthcare settings may contribute to low uptake of HIV testing, antiretroviral therapy (ART), and other prevention of mother-to-child HIV transmission (PMTCT) services. Coordination between community-based FSW and facility-based PMTCT programs can facilitate successful linkage of pregnant FSW to antenatal services to support PMTCT efforts. We offer a way forward to reach 90-90-90 targets for FSW and their families and eliminate mother-to-child transmission of HIV.
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Affiliation(s)
- Avi J Hakim
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA.
| | - Tegan Callahan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Irene Benech
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Monita Patel
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Michelle Adler
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Moses Bateganya
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Kae Anne Parris
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Trista Bingham
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
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27
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Farghaly AG, Alkassabany YM, El-Ghitany EM. HBV, HCV and HIV among female sex workers; is it a health problem? SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1778165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Azza Galal Farghaly
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | - Engy Mohamed El-Ghitany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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28
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Ampt FH, L'Engle K, Lim MSC, Plourde KF, Mangone E, Mukanya CM, Gichangi P, Manguro G, Hellard M, Stoové M, Chersich MF, Jaoko W, Agius PA, Temmerman M, Wangari W, Luchters S. A Mobile Phone-Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e15096. [PMID: 32469326 PMCID: PMC7293053 DOI: 10.2196/15096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/24/2019] [Accepted: 02/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. OBJECTIVE This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants' responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. METHODS The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. RESULTS The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. CONCLUSIONS Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs' lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kelly L'Engle
- University of San Francisco, San Francisco, CA, United States
| | - Megan S C Lim
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Emily Mangone
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya.,Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,International Centre for Reproductive Health, Mombasa, Kenya
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew F Chersich
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paul A Agius
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marleen Temmerman
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,International Centre for Reproductive Health, Mombasa, Kenya.,Aga Khan University, Nairobi, Kenya
| | - Winnie Wangari
- International Centre for Reproductive Health, Mombasa, Kenya
| | - Stanley Luchters
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
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Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda. J Acquir Immune Defic Syndr 2020; 82:343-354. [PMID: 31658178 DOI: 10.1097/qai.0000000000002143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited evidence on the relationship between sustained exposure of female sex workers (FSWs) to targeted HIV programmes and HIV incidence. We investigate the relationship between the number of missed study visits (MSVs) within each episode of 2 consecutively attended visits (MSVs) and subsequent HIV risk in a predominantly FSW cohort. METHODS Women at high risk of HIV are invited to attend an ongoing dedicated clinic offering a combination HIV prevention intervention in Kampala, Uganda. Study visits are scheduled once every 3 months. The analysis included HIV-seronegative women with ≥1 follow-up visit from enrollment (between April 2008 and May 2017) to August 2017. Cox regression models were fitted adjusted for characteristics on sociodemographic, reproductive, behavioral, and sexually transmitted infections (through clinical examination and serological testing for syphilis). FINDINGS Among 2206 participants, HIV incidence was 3.1/100 (170/5540) person-years [95% confidence interval (CI): 2.6 to 3.5]. Incidence increased from 2.6/100 person-years (95% CI: 2.1 to 3.2) in episodes without a MSV to 3.0/100 (95% CI: 2.2 to 4.1) for 1-2 MSVs and 4.3/100 (95% CI: 3.3 to 5.6) for ≥3 MSVs. Relative to episodes without a MSV, the hazard ratios (adjusted for confounding variables) were 1.40 (95% CI: 0.93 to 2.12) for 1-2 MSVs and 2.00 (95% CI: 1.35 to 2.95) for ≥3 MSVs (P-trend = 0.001). CONCLUSION Missing study visits was associated with increased subsequent HIV risk. Although several factors may underlie this association, the finding suggests effectiveness of targeted combination HIV prevention. But exposure to targeted interventions needs to be monitored, facilitated, and sustained in FSWs.
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Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya. Int J Public Health 2020; 65:425-432. [PMID: 32337631 PMCID: PMC7275021 DOI: 10.1007/s00038-020-01373-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/03/2020] [Accepted: 03/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The objective of this study is to identify enablers and barriers in access of HIV and sexual reproductive health (SRH) services among adolescent key populations (KP) in Kenya. METHODS A cross-sectional study using qualitative methods was conducted between October 2015 and April 2016. A total of 9 focus group discussions and 18 in-depth interviews were conducted with 108 adolescent KPs in Mombasa, Kisumu and Nairobi Counties of Kenya. Data were recorded digitally, translated, transcribed and coded in NVivo10 prior to analysis. RESULTS Adolescent KPs preferred to access services in private health due to increased confidentiality, limited stigma and discrimination, access to adequate amount of condoms, friendly and fast-tracked services. Negative health provider attitudes made adolescent KPs dislike accessing health care in public health facilities. There was a lack of adolescent key population's policies and guidelines on HIV and SRH. CONCLUSIONS The study has demonstrated existing enablers and barriers to provision of HIV/SRH services for an at-risk population for which limited data exist. The results provide a basis for program redesign involving the adolescent KPs to minimize barriers for access to HIV/SRH services.
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Bowring AL, Schwartz S, Lyons C, Rao A, Olawore O, Njindam IM, Nzau J, Fouda G, Fako GH, Turpin G, Levitt D, Georges S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi AC, Baral S. Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:82-99. [PMID: 32234842 PMCID: PMC7108938 DOI: 10.9745/ghsp-d-19-00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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Affiliation(s)
- Anna L Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Burnet Institute, Melbourne, Australia
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Metabiota, Yaounde, Cameroon
| | | | | | | | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Serge C Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Anne-Cécile Zoung-Kanyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.,Division of Operations Research, Ministry of Health, Yaounde, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Gadoth A, Mvumbi G, Hoff NA, Musene K, Mukadi P, Ashbaugh HR, Doshi RH, Javanbakht M, Gorbach P, Okitolonda-Wemakoy E, Klausner JD, Rimoin AW. Urogenital Schistosomiasis and Sexually Transmitted Coinfections among Pregnant Women in a Schistosome-Endemic Region of the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 101:828-836. [PMID: 31392943 DOI: 10.4269/ajtmh.19-0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.
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Affiliation(s)
- Adva Gadoth
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Gisèle Mvumbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Kamy Musene
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Hayley R Ashbaugh
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Pamina Gorbach
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | | | - Jeffrey D Klausner
- Department of Medicine, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.,Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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Bowring AL, Ampt FH, Schwartz S, Stoové MA, Luchters S, Baral S, Hellard M. HIV pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind. J Int AIDS Soc 2020; 23:e25442. [PMID: 32064765 PMCID: PMC7025091 DOI: 10.1002/jia2.25442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. DISCUSSION FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. CONCLUSIONS As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights.
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Affiliation(s)
- Anna L Bowring
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
- Burnet InstituteMelbourneVictoriaAustralia
| | - Frances H Ampt
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Mark A Stoové
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stanley Luchters
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Population HealthAga Khan UniversityNairobiKenya
- International Centre for Reproductive HealthDepartment of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Margaret Hellard
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneVictoriaAustralia
- Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Becquet V, Nouaman M, Plazy M, Masumbuko JM, Anoma C, Kouame S, Danel C, Eholie SP, Larmarange J. Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention. BMJ Open 2020; 10:e028508. [PMID: 31919122 PMCID: PMC6955511 DOI: 10.1136/bmjopen-2018-028508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. DESIGN AND SETTING The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire. PARTICIPANTS A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. RESULTS Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication. CONCLUSIONS Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.
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Affiliation(s)
- Valentine Becquet
- INED (French Institute for Demographic Studies), Paris, France
- CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France
| | | | - Mélanie Plazy
- ISPED, Inserm Research Center 1219 (Bordeaux Population Health), Université de Bordeaux, Bordeaux, France
| | | | | | | | | | | | - Joseph Larmarange
- CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France
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Makhakhe NF, Meyer-Weitz A, Struthers H, McIntyre J. The role of health and advocacy organisations in assisting female sex workers to gain access to health care in South Africa. BMC Health Serv Res 2019; 19:746. [PMID: 31651300 PMCID: PMC6814112 DOI: 10.1186/s12913-019-4552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services. METHODS Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically. RESULTS The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours. CONCLUSION This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs' engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.
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Affiliation(s)
- Nosipho Faith Makhakhe
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Howard College Campus, Memorial Tower Building, 238 Mazisi Kunene Road Glenwood, Durban, 4041, South Africa.
| | - Anna Meyer-Weitz
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Howard College Campus, Memorial Tower Building, 238 Mazisi Kunene Road Glenwood, Durban, 4041, South Africa
| | - Helen Struthers
- Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, 2193, South Africa.,Anova Health Institute, Honorary research associate in the Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - James McIntyre
- Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, 2193, South Africa.,Anova Health Institute, Honorary professor in the School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Dulli L, Field S, Masaba R, Ndiritu J. Addressing broader reproductive health needs of female sex workers through integrated family planning/ HIV prevention services: A non-randomized trial of a health-services intervention designed to improve uptake of family planning services in Kenya. PLoS One 2019; 14:e0219813. [PMID: 31339919 PMCID: PMC6655688 DOI: 10.1371/journal.pone.0219813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC. METHODS We conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use. RESULTS The intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners. CONCLUSIONS Self-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW. TRIAL REGISTRATION Clinicaltrials.gov NCT01957813.
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Affiliation(s)
- Lisa Dulli
- Family Health International (FHI 360), Durham, NC, United States of America
- * E-mail:
| | - Samuel Field
- Family Health International (FHI 360), Durham, NC, United States of America
| | - Rose Masaba
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi, Kenya
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Reza-Paul S, Lazarus L, Maiya R, Venukumar KT, Lakshmi B, Roy A, Haldar P, Andina M, Lafort Y, Lorway R. Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India. PLoS One 2019; 14:e0218654. [PMID: 31226141 PMCID: PMC6588234 DOI: 10.1371/journal.pone.0218654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Methods Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016. Results The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up. Conclusion The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- * E-mail:
| | - Lisa Lazarus
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Yves Lafort
- Department Uro-Gynaecology, International Centre for Reproductive Health, WHO Collaborating Centre, Ghent University, Ghent, Belgium
| | - Robert Lorway
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Long JE, Waruguru G, Yuhas K, Wilson KS, Masese LN, Wanje G, Kinuthia J, Jaoko W, Mandaliya KN, McClelland RS. Prevalence and predictors of unmet contraceptive need in HIV-positive female sex workers in Mombasa, Kenya. PLoS One 2019; 14:e0218291. [PMID: 31216298 PMCID: PMC6583985 DOI: 10.1371/journal.pone.0218291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs. STUDY DESIGN This cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need. RESULTS Among 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8-68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0-1.5), desire for (more) children (PR 1.3, 95%CI 1.1-1.5), and having 2-3 previous pregnancies compared to 0-1 prior pregnancies (PR 0.8, 95%CI 0.6-0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need. CONCLUSIONS Unmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0-1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.
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Affiliation(s)
- Jessica E. Long
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | | | - Krista Yuhas
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kate S. Wilson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Linnet N. Masese
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - George Wanje
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, GPO, Nairobi, Kenya
| | | | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
- * E-mail:
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Ampt FH, Lim MSC, Agius PA, Chersich MF, Manguro G, Gichuki CM, Stoové M, Temmerman M, Jaoko W, Hellard M, Gichangi P, Luchters S. Use of long-acting reversible contraception in a cluster-random sample of female sex workers in Kenya. Int J Gynaecol Obstet 2019; 146:184-191. [PMID: 31090059 DOI: 10.1002/ijgo.12862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 11/20/2018] [Accepted: 05/13/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess correlates of long-acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya. METHODS Baseline cross-sectional data were collected between September 2016 and May 2017 in a cluster-randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16-34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex-work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues. RESULTS Among 879 participants, the prevalence of contraceptive use was 22.6% for implants and 1.6% for intra-uterine devices (IUDs). LARC use was independently associated with previous pregnancy (adjusted odds ratio for one pregnancy, 11.4; 95% confidence interval, 4.25-30.8), positive attitude to and better knowledge of family planning, younger age, and lower education. High rates of adverse effects were reported for all methods. CONCLUSION The findings suggest that implant use has increased among FSWs in Kenya. Unintended pregnancy risks remain high and IUD use is negligible. Although LARC rates are encouraging, further intervention is required to improve both uptake (particularly of IUDs) and greater access to family planning services.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, SA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, SA, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, SA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, SA, Australia.,Melbourne School of Global and Population Health, University of Melbourne, Melbourne, SA, Australia
| | - Paul A Agius
- Burnet Institute, Melbourne, SA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, SA, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, SA, Australia
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,International Centre for Reproductive Health, Department of Primary Care and Public Health, Ghent University, Ghent, Belgium
| | | | | | | | - Marleen Temmerman
- International Centre for Reproductive Health, Mombasa, Kenya.,International Centre for Reproductive Health, Department of Primary Care and Public Health, Ghent University, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
| | | | | | - Peter Gichangi
- International Centre for Reproductive Health, Mombasa, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Stanley Luchters
- Burnet Institute, Melbourne, SA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, SA, Australia.,International Centre for Reproductive Health, Department of Primary Care and Public Health, Ghent University, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
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Ingabire R, Parker R, Nyombayire J, Ko JE, Mukamuyango J, Bizimana J, Price MA, Laufer D, Tichacek A, Wall K, Allen S, Karita E. Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy. Int J STD AIDS 2019; 30:557-568. [PMID: 30727831 PMCID: PMC6512058 DOI: 10.1177/0956462418817050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
Female sex workers (FSWs) were recruited from known hotspots in Kigali, Rwanda, and offered free, anonymous human immunodeficiency virus (HIV) counseling and testing, diagnosis and treatment of sexually transmitted infections (STIs) and long-acting reversible contraception (LARC). From September 2012 to March 2015, 1168 FSWs sought services, including 587 (50%) who were HIV-positive. More than 90% had previously tested for HIV, and 26% who reported previously testing negative had seroconverted. Of the 349 who already knew their HIV-positive status, 74% were on antiretroviral treatment. The prevalence of serologic syphilis was 43% in HIV-positive and 19% in HIV-negative FSWs (p < 0.0001), and Trichomonas vaginalis was found in vaginal wet mounts in 21% of HIV-positive and 13% of HIV-negative FSWs (p < 0.0001). Signs and symptoms of STIs were found in 35% of HIV-positive compared with 21% of HIV-negative FSWs (p < 0.0001). Only one-third reported consistent condom use in the last month. Modern contraceptive use was reported by 43% of HIV-positive and 56% of HIV-negative FSWs (p < 0.0001). Current pregnancy was reported by 4% of HIV-positive and 6% of HIV-negative FSWs (p = 0.0409). Despite Rwanda's successes with preventing 70% of new infections in the general population through nationwide couples' testing in antenatal clinics, prevention and timely treatment in key populations including FSWs are lacking. The prevalence of HIV - including many new cases - and STIs among FSWs in Kigali is high and condom and contraceptive use are low. Tailored and integrated HIV/STIs and family planning programs are urgently needed for FSWs.
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Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Jasmine E Ko
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | | | - Jean Bizimana
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of
California at San Francisco, San Francisco, CA, USA
| | - Dagna Laufer
- International AIDS Vaccine Initiative, New York, NY, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Kristin Wall
- Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
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Prevalence and distribution of Human Papillomavirus (HPV) genotypes among HIV infected women in Lomé, Togo. PLoS One 2019; 14:e0212516. [PMID: 30811454 PMCID: PMC6392291 DOI: 10.1371/journal.pone.0212516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/04/2019] [Indexed: 01/06/2023] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide, and it particularly affects people living with human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HPV and to describe HPV genotypes in HIV-1 infected women in Lomé, Togo. From September 2014 to September 2015, a cross-sectional study was conducted in two treatment and care centers for people living with HIV: the Centre Hospitalier Universitaire Sylvanus Olympio and the non-profit organization ‘Espoir Vie Togo’. Women living with HIV-1, aged 18 years and older, receiving a combination antiretroviral therapy for at least 12 months, and who gave their informed consent to participate in the study were recruited. Cervical swabs were collected using a cytobrush, and cells were stored in a preservative solution. HPV testing was performed using e-BRID equipment. Blood samples were collected for CD4+ count using a flow cytometer and for HIV viral load using polymerase chain reaction. A total of 221 HIV-1 infected women were enrolled. The prevalence of any type and oncogenic HPV was 22.2%, 95% confidence interval (95% CI): [17.1–28.2] and 16.7% (95%CI: 12.3–22.3), respectively. The most prevalent genotypes were: 18 (8.6%), 68 (4.1%), and 62/81 (2.7%). Only 1.3% (3/221) of participants were infected with HPV16. In regression analysis, no factor was associated with HRHPV.
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Goldenberg SM, Muzaaya G, Akello M, Braschel M, Birungi J, Shannon K. High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda. Int J STD AIDS 2018; 30:275-283. [PMID: 30417750 DOI: 10.1177/0956462418804658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.
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Affiliation(s)
- Shira M Goldenberg
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,2 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | | | - Melissa Braschel
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kate Shannon
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,5 Department of Medicine, University of British Columbia, Vancouver, Canada
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Ilesanmi RE, Kehinde DR. Pattern of Utilization of Cervical Cancer Screening Services among Female Sex Workers in Some Selected Brothels in Abuja, Nigeria. Asia Pac J Oncol Nurs 2018; 5:415-420. [PMID: 30271825 PMCID: PMC6103198 DOI: 10.4103/apjon.apjon_31_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective The utilization of cervical cancer screening services remains low among Female Sex Workers (FSWs) in Sub-Saharan Africa, with few or no studies conducted in Nigeria. However, the prevalence of human papillomavirus in this population is reportedly high because of associated risk factors. This study examined the pattern of cervical cancer screening service utilizations among FSWs in the Abuja metropolis. Methods This descriptive cross-sectional survey used a purposive sampling technique to select 406 respondents via a structured questionnaire including questions regarding whether they had been screened for cervical cancer, the frequency of screening and type of screening method. Data were analyzed using SPSS version 22 and presented using frequency tables and percentages. Results The response rate among the participants was 97.6%. The mean age of the FSWs was 32 ± 5.1 years. Regarding the pattern of screening age, the mean age at the first screening was 28 ± 4.3 years. Only 81 (20%) participants had been screened annually, and visual inspection with acetic acid was most frequently used (20.9%). Respondents preferred to undergo screening in their brothels. The awareness of screening services was high (n = 290, 71.4%); however, the utilization of cervical cancer screening services remained low, as 246 (60.6%) FSWs had never been screened. The nonutilization of screening services was related to poor accessibility and a lack of awareness and interest. Conclusions Although a high level of awareness that would be expected to influence uptake, cervical cancer screening services were rather underutilized by the study respondents. Therefore, a concerted effort is needed to ensure that FSWs understand cervical cancer and its consequences. Hopefully, this effort will improve the uptake.
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Affiliation(s)
| | - Dayo Ruth Kehinde
- Federal Capital Territory School of Nursing, Gwagwalada, Abuja-FCT, Nigeria
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Feasibility, acceptability and potential sustainability of a 'diagonal' approach to health services for female sex workers in Mozambique. BMC Health Serv Res 2018; 18:752. [PMID: 30285725 PMCID: PMC6171127 DOI: 10.1186/s12913-018-3555-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background Female sex workers (FSWs) in many settings have restricted access to sexual and reproductive health (SRH) services. We therefore conducted an implementation study to test a ‘diagonal’ intervention which combined strengthening of FSW-targeted services (vertical) with making public health facilities more FSW-friendly (horizontal). We piloted it over 18 months and then assessed its performance. Methods Applying a convergent parallel mixed-methods design, we triangulated the results of the analysis of process indicators, semi-structured interviews with policy makers and health managers, structured interviews with health care providers and group discussions with peer outreach workers. We then formulated integrated conclusions on the interventions’ feasibility, acceptability by providers, managers and policy makers, and potential sustainability. Results The intervention, as designed, was considered theoretically feasible by all informants, but in practice the expansion of some of the targeted services was hampered by insufficient financial resources, institutional capacity and buy-in from local government and private partners, and could not be fully actualised. In terms of acceptability, there was broad consensus on the need to ensure FSWs have access to SRH services, but not on how this might be achieved. Targeted clinical services were no longer endorsed by national government, which now prefers a strategy of making public services more friendly for key populations. Stakeholders judged that the piloted model was not fully sustainable, nor replicable elsewhere in the country, given its dependency on short-term project-based funding, lack of government endorsement for targeted clinical services, and viewing the provision of community activities as a responsibility of civil society. Conclusions In the current Mozambican context, a ‘diagonal’ approach to ensure adequate access to sexual and reproductive health care for female sex workers is not fully feasible, acceptable or sustainable, because of insufficient resources and lack of endorsement by national policy makers for the targeted, vertical component.
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De Vasconcelos S, Toskin I, Cooper B, Chollier M, Stephenson R, Blondeel K, Troussier T, Kiarie J. Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies: A systematic review. PLoS One 2018; 13:e0204088. [PMID: 30260991 PMCID: PMC6159869 DOI: 10.1371/journal.pone.0204088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behaviour-change interventions have been consistently considered an essential part of comprehensive HIV, STI and unintended pregnancy prevention. In 2015, the World Health Organization reviewed and assessed existing evidence on brief behavioural interventions, leading to the publication of Brief sexuality-related communication: recommendations for a public health approach. This guideline recommends the use of brief behaviour intervention and communication programmes to promote sexual health and to prevent HIV, STIs, and unintended pregnancies in primary health services, particularly sexual and reproductive health services. OBJECTIVE With the purpose of informing the development of a brief behaviour intervention in sexual and reproductive health, we conducted a systematic review of brief intervention to prevent HIV, STI and unintended pregnancies, to identify behaviour change techniques (BCTs) used in health care settings. METHODS Participants from all ages and genders were included. Brief interventions delivered in ≤ 60 minutes were included. Data was extracted, and interventions were coded following the Behaviour Change Techniques Taxonomy (BCTTv1) guidelines. RESULTS Of the 6.687 articles identified, 355 were reviewed and 37 studies were included. In effective interventions, we identified 48 behaviour change techniques (BCTs). A core set of 8 frequently used behaviour change techniques was identified: "Problem solving", "Feedback on behaviour", "Social support (unspecified)", "Instructions on how to perform the behaviour", "Information about health consequences", "Information about social and environmental consequences", "Demonstration of the behaviour" and "Credible source". CONCLUSIONS The technical content of brief behaviour interventions was identified in a reliable and standardized way providing preliminary indications on potentially effective techniques to achieve behaviour change.
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Affiliation(s)
- Sofia De Vasconcelos
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bergen Cooper
- Center for Health and Gender Equity (CHANGE), Washington, D.C., United States of America
| | - Marie Chollier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
- Manchester Metropolitan University, Manchester, United Kingdom
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thierry Troussier
- UNESCO Chair for Sexual Health and Human Rights (UCSHHR), Paris, France
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ampt FH, Willenberg L, Agius PA, Chersich M, Luchters S, Lim MSC. Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e021779. [PMID: 30224388 PMCID: PMC6144321 DOI: 10.1136/bmjopen-2018-021779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the incidence of unintended pregnancy among female sex workers (FSWs) in low-income and middle-income countries (LMICs). DESIGN We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity. PARTICIPANTS Eligible studies targeted FSWs aged 15-49 years living or working in an LMIC. OUTCOME MEASURES Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence of pregnancy where intention is undefined. Secondary outcomes were also extracted when they were reported in included studies: incidence of induced abortion; incidence of birth; and correlates/predictors of pregnancy or unintended pregnancy. RESULTS Twenty-five eligible studies were identified from 3866 articles. Methodological quality was low overall. Unintended pregnancy incidence showed high heterogeneity (I²>95%), ranging from 7.2 to 59.6 per 100 person-years across 10 studies. Study design and duration were found to account for heterogeneity. On subgroup analysis, the three cohort studies in which no intervention was introduced had a pooled incidence of 27.1 per 100 person-years (95% CI 24.4 to 29.8; I2=0%). Incidence of pregnancy (intention undefined) was also highly heterogeneous, ranging from 2.0 to 23.4 per 100 person-years (15 studies). CONCLUSIONS Of the many studies examining FSWs' sexual and reproductive health in LMICs, very few measured pregnancy and fewer assessed pregnancy intention. Incidence varied widely, likely due to differences in study design, duration and baseline population risk, but was high in most studies, representing a considerable concern for this key population. Evidence-based approaches that place greater importance on unintended pregnancy prevention need to be incorporated into existing sexual and reproductive health programmes for FSWs. PROSPERO REGISTRATION NUMBER CRD42016029185.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Paul A Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew Chersich
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Universiteit Gent, Ghent, Belgium
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
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Makhakhe NF, Lane T, McIntyre J, Struthers H. Sexual transactions between long distance truck drivers and female sex workers in South Africa. Glob Health Action 2018; 10:1346164. [PMID: 28764585 PMCID: PMC5645692 DOI: 10.1080/16549716.2017.1346164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Female sex workers (FSWs) and long distance truck drivers (LDTDs) are considered key populations at high risk for HIV transmission due to high prevalence. The intersection of these mobile populations presents unique challenges in the fight against HIV and the movement towards reducing new infections. Objective: The purpose of this study was to explore the nature of sex trade along a particular transport route. Sexual transactions and the vulnerabilities that exist between these two groups with regards to HIV/AIDS are described, with the purpose of furthering the agenda for targeted interventions. Methods: Qualitative in-depth interviews were conducted with 14 participants, seven FSWs and seven LDTDs. We recruited FSWs through snowballing, and LDTDs through intercepts at truck stops. Semi-structured interview guides were used for data collection, and thematic analysis was conducted. Results: The sex trade in this study is characterized by competition, fuelled by money-driven and age-disparate rivalry. Despite widespread HIV knowledge, FSWs contend with persistent challenges regarding condom use negotiation, induced by more money in the exchange for unsafe sex. Despite the placement of wellness centres in truck stops along the highway, LDTDs face stigma related challenges with regards to testing for HIV and personal acknowledgement of their involvement in the sex trade. Conclusion: The nature of the sex trade along the highway continues to be risky despite the availability of HIV testing and antiretroviral treatment (ART). The sex trade is perceived to be increasing along trucking routes, in spite of measures instituted to limit access to FSWs. FSWs struggle to cope with the pressure of unprotected sex because of the need to generate more income, as well as avoid incidents of violence and threats. Interventions along transport routes need to be inclusive of FSWs who could play a vital role in stigma reduction amongst LDTDs through peer education.
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Affiliation(s)
- Nosipho Faith Makhakhe
- a Department of Psychology, School of Applied Human Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Tim Lane
- b Department of Medicine , Center for AIDS Prevention Studies , San Francisco , CA , USA
| | - James McIntyre
- c Anova Health Institute , Johannesburg , South Africa.,d School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Helen Struthers
- c Anova Health Institute , Johannesburg , South Africa.,e Division of Infectious Diseases & HIV Medicine, Department of Medicine , University of Cape Town , Cape Town , South Africa
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48
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Longo JDD, Simaléko MM, Ngbale R, Grésenguet G, Brücker G, Bélec L. Spectrum of female commercial sex work in Bangui, Central African Republic. SAHARA J 2018; 14:171-184. [PMID: 29092678 PMCID: PMC5678296 DOI: 10.1080/17290376.2017.1394907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Classification of professional and non-professional female sex workers (FSWs) into different categories, never previously reported in the Central African Republic (CAR), may be useful to assess the dynamics of the human immunodeficiency virus (HIV) epidemic, design operational intervention programmes to combat HIV and other sexually transmitted infections (STIs) and to adapt these programmes to the broad spectrum of sexual transactions in the CAR. Our study proposes a socio-behavioural classification of FSWs living in the CAR and engaged in transactional and commercial sex. Thus, the aims of the study were these: (i) to categorize FSWs according to socio-anthropologic criteria in Bangui and (ii) to examine the association between a selection of demographic and risk variables with the different categories of female sex work as an outcome. A cross-sectional questionnaire survey was conducted in 2013 to describe the spectrum of commercial sex work (CSW) in Bangui among 345 sexually active women having more than 2 sexual partners, other than their regular partner, during the prior 3 months and reporting to have received money or gifts in return for their sexual relationships. According to socio-behavioural characteristics, FSWs were classified into six different categories. Professional FSWs, constituting 32.5% of the interviewed women, were divided in two categories: pupulenge (13.9%), i.e., dragonflies (sometimes called gba moundjou, meaning literally look at the White) consisting of roamers, who travel around the city to hotels and nightclubs seeking wealthy clients, with a preference for French men; and the category of kata (18.6%), i.e., FSWs working in poor neighbourhoods. Non-professional FSWs, constituting 67.5% of the interviewed women, were divided into four categories: street and market vendors (20.8%), students (19.1%), housewives (15.7%) and unskilled civil servants (11.9%). In general, CSW in the CAR presents a remarkably heterogeneous phenomenon. Risk-taking behaviour regarding STI/HIV infection appears to be different according to the different categories of female CSW. The groups of katas and street vendors were poorer and less educated, consumed more alcohol or other psycho-active substances (cannabis, tramadol and glue) and, consequently, were more exposed to STI. Our results emphasise the high level of vulnerability of both poor professional FSWs (kata) and non-professional sex workers, especially street vendors, who should be taken into account when designing prevention programmes targeting this population for STI/HIV control purposes.
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Affiliation(s)
- Jean De Dieu Longo
- a MD, MSc, PhD in Public Health, at the Centre National de Référence des Maladies Sexuellement Transmissibles et de la Thérapie Antirétrovirale , Bangui , Central African Republic
| | - Marcel Mbéko Simaléko
- a MD, MSc, PhD in Public Health, at the Centre National de Référence des Maladies Sexuellement Transmissibles et de la Thérapie Antirétrovirale , Bangui , Central African Republic
| | - Richard Ngbale
- b MD at the Service de Gynéco-obstétrique, hôpital Communautaire , Bangui , Central African Republic
| | - Gérard Grésenguet
- a MD, MSc, PhD in Public Health, at the Centre National de Référence des Maladies Sexuellement Transmissibles et de la Thérapie Antirétrovirale , Bangui , Central African Republic
| | - Gilles Brücker
- c MD, MPH, PhD at the Department of Public Health, hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris , Paris Sud University , Le Kremlin-Bicêtre , France
| | - Laurent Bélec
- d MD, MPH, MSc, PhD at the Laboratoire de Microbiologie, hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Faculté de Médecine Paris Descartes , Université Paris Descartes (Paris V), Sorbonne Paris Cité , Paris , France
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49
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Ndori‐Mharadze T, Fearon E, Busza J, Dirawo J, Musemburi S, Davey C, Acharya X, Mtetwa S, Hargreaves JR, Cowan F. Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015. J Int AIDS Soc 2018; 21 Suppl 5:e25138. [PMID: 30033558 PMCID: PMC6055130 DOI: 10.1002/jia2.25138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION 'Sisters with a Voice', Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation. METHODS We used mixed methods to collect data at three sites: in-depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS-1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education. RESULTS 870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio-demographic differences, we found higher estimates of the proportion of HIV-positive FSWs and HIV-positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV-negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites. CONCLUSIONS Improvements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90-90-90 targets.
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Affiliation(s)
| | - Elizabeth Fearon
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Joanna Busza
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Jeffrey Dirawo
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | | | - Calum Davey
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Xeno Acharya
- Epidemiology and Public HealthHarvard TH Chan School of Public HealthBostonMA
| | - Sibongile Mtetwa
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | - James R Hargreaves
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Frances Cowan
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
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50
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Wilson KS, Wanje G, Masese L, Simoni JM, Shafi J, Adala L, Overbaugh J, Jaoko W, Richardson BA, McClelland RS. A Prospective Cohort Study of Fertility Desire, Unprotected Sex, and Detectable Viral Load in HIV-Positive Female Sex Workers in Mombasa, Kenya. J Acquir Immune Defic Syndr 2018; 78:276-282. [PMID: 29543635 PMCID: PMC5997523 DOI: 10.1097/qai.0000000000001680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known about fertility desire in HIV-positive female sex workers. Fertility desire could increase HIV transmission risk if it was associated with condomless sex or lower adherence to antiretroviral therapy. METHODS A prospective cohort study was conducted among 255 HIV-positive female sex workers in Mombasa, Kenya. Using generalized estimating equations, fertility desire was evaluated as a risk factor for semen detection in vaginal secretions by prostate-specific antigen (PSA) test, a biomarker of condomless sex, detectable plasma viral load (VL), and HIV transmission potential, defined as visits with positive PSA and detectable VL. RESULTS The effect of fertility desire on PSA detection varied significantly by nonbarrier contraception use (P-interaction < 0.01). At visits when women reported not using nonbarrier contraception, fertility desire was associated with higher risk of semen detection [82/385, 21.3% vs. 158/1007, 15.7%; adjusted relative risk (aRR) 1.58, 95% confidence interval (CI): 1.12 to 2.23]. However, when women used nonbarrier contraception, fertility desire was associated with lower risk of PSA detection (10/77, 13.0% vs. 121/536, 22.6%; aRR 0.58, 95% CI: 0.35 to 0.94). Fertility desire was not associated with detectable VL (31/219, 14.2% vs. 128/776, 16.5%; aRR 0.82, 95% CI: 0.46 to 1.45) or higher absolute risk of transmission potential (10/218, 4.6% vs. 21/769, 2.7%; adjusted risk difference = 0.011, 95% CI -0.031 to 0.050). CONCLUSIONS Fertility desire was associated with higher risk of biological evidence of semen exposure when women were not using nonbarrier contraceptives. Low HIV transmission potential regardless of fertility desire suggests that the combination of condoms and antiretroviral therapy adherence was effective.
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Affiliation(s)
| | | | | | | | | | | | - Julie Overbaugh
- Human Biology and Public Health Sciences Divisions, Fred Hutchison Cancer Research Center, Seattle, WA
| | | | - Barbra A Richardson
- Human Biology and Public Health Sciences Divisions, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Raymond S McClelland
- Medicine
- Epidemiology, University of Washington, Seattle, WA
- University of Nairobi, Nairobi, Kenya
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