51
|
Vickerman P, Quaife M, Kilbourne-Brook M, Mvundura M, Eakle R, Terris-Prestholt F. HIV prevention is not all about HIV - using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection. BMC Infect Dis 2020; 20:704. [PMID: 32977745 PMCID: PMC7517801 DOI: 10.1186/s12879-020-05399-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/06/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). METHODS A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women's HIV acquisition risk. RESULTS In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. CONCLUSIONS Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.
Collapse
Affiliation(s)
- Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, BS8 2BN, UK.
| | - Matthew Quaife
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Robyn Eakle
- London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|
52
|
West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
Collapse
Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | |
Collapse
|
53
|
Tokar A, Osborne J, Hengeveld R, Lazarus JV, Broerse JEW. 'I don't want anyone to know': Experiences of obtaining access to HIV testing by Eastern European, non-European Union sex workers in Amsterdam, the Netherlands. PLoS One 2020; 15:e0234551. [PMID: 32634136 PMCID: PMC7340317 DOI: 10.1371/journal.pone.0234551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Historically, the Netherlands has hosted a large number of migrant sex workers. Since sex work is considered a legal profession it might serve as an example of better access to health services, including HIV testing, at least for those working within the legal framework. However, migrant sex workers, especially non-European Union (EU) nationals, might not be eligible to register for official employment and thus face obstacles in obtaining access to health services, becoming essentially invisible. This study examined context-specific vulnerabilities of migrant female sex workers (FSWs) from Belarus, Moldova, Russia and Ukraine, whether and how they have access to HIV testing compared to other EE, non-EU migrant FSWs in Amsterdam in the Netherlands. We conducted a multi-stakeholder perspective study from November 2015 to September 2017 in Amsterdam. The study comprised 1) semi-structured interviews with key stakeholders (N = 19); 2) in-depth interviews with Eastern European, non-EU migrant FSWs (N = 5) and field observations of the escort agency working with them; and 3) in-depth interviews with key stakeholders (N = 12). We found six key barriers to HIV testing: 1) migration and sex-work policies; 2) stigma, including self-stigmatization; 3) lack of trust in healthcare providers or social workers; 4) low levels of Dutch or English languages; 5) negative experience in accessing healthcare services in the home country; and 6) low perceived risk and HIV-related knowledge. Having a family and children, social support and working at the licensed sex-work venues might facilitate HIV testing. However, Internet-based sex workers remain invisible in the sex-work industry. Our findings indicate the importance of addressing women’s diverse experiences, shaped by intrapersonal, interpersonal, community, network and policy-level factors, with stigma being at the core. We call for the scaling up of outreach interventions focusing on FSWs and, in particular, migrant FSWs working online.
Collapse
Affiliation(s)
- Anna Tokar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic–University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Jacob Osborne
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Robbert Hengeveld
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic–University of Barcelona, Barcelona, Spain
| | - Jacqueline E. W. Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| |
Collapse
|
54
|
Ma H, Loke AY. Knowledge of, attitudes towards, and willingness to care for sex workers: Differences between general and mental health nursing students. J Prof Nurs 2020; 36:264-277. [DOI: 10.1016/j.profnurs.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/26/2019] [Accepted: 01/08/2020] [Indexed: 02/01/2023]
|
55
|
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: 3] [Impact Index Per Article: 0.8] [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.
Collapse
|
56
|
Holmes LE, Kaufman MR, Casella A, Mudavanhu M, Mutunga L, Polzer T, Bassett J, Van Rie A, Schwartz S. Qualitative characterizations of relationships among South African adolescent girls and young women and male partners: implications for engagement across HIV self-testing and pre-exposure prophylaxis prevention cascades. J Int AIDS Soc 2020; 23 Suppl 3:e25521. [PMID: 32603025 PMCID: PMC7325584 DOI: 10.1002/jia2.25521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/22/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) in sub-Saharan Africa have emerged as a priority population in need of HIV prevention interventions. Secondary distribution of home-based HIV self-test kits by AGYW to male partners (MP) is a novel prevention strategy that complements pre-exposure prophylaxis (PrEP), a female-controlled prevention intervention. The objective of this analysis was to qualitatively operationalize two HIV prevention cascades through the lens of relationship dynamics for secondary distribution of HIV self-tests to MP and PrEP for AGYW. METHODS From April 2018 to December 2018, 2200 HIV-negative AGYW aged 16-24 years were enrolled into an HIV prevention intervention which involved secondary distribution of self-tests to MP and PrEP for AGYW; of these women, 91 participants or MP were sampled for in-depth interviews based on their degree of completion of the two HIV prevention cascades. A grounded theory approach was used to characterize participants' relationship profiles, which were mapped to participants' engagement with the interventions. RESULTS In cases where AGYW had a MP with multiple partners, AGYW perceived both interventions as inviting distrust into the relationship and insinuating non-monogamy. Many chose not to accept either intervention, while others accepted and attempted to deliver the self-test kit but received a negative reaction from their MP. In the few cases where AGYW held multiple partnerships, both interventions were viewed as mechanisms for protecting one's health, and these AGYW exhibited confidence in accepting and delivering the self-test kits and initiating PrEP. Women who indicated intimate partner violence experiences chose not to accept either intervention because they feared it would elicit a violent reaction from their MP. For AGYW in relationships described as committed and emotionally open, self-test kit delivery was completed with ease, but PrEP was viewed as unnecessary. MP experience with the cascade corroborated AGYW perspectives and demonstrated how men can perceive female-initiated HIV prevention options as beneficial for AGYW and a threat to MP masculinity. CONCLUSIONS Screening to identify AGYW relationship dynamics can support tailoring prevention services to relationship-driven barriers and facilitators. HIV prevention counseling for AGYW should address relationship goals or partner's influence, and engage with MP around female-controlled prevention interventions.
Collapse
Affiliation(s)
- Leah E Holmes
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Michelle R Kaufman
- Department of Health. Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Albert Casella
- Department of Health. Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | | | - Tara Polzer
- Social Surveys AfricaJohannesburgSouth Africa
| | - Jean Bassett
- Witkoppen Health and Welfare ClinicJohannesburgSouth Africa
| | - Annelies Van Rie
- Department of Epidemiology and Social MedicineUniversity of AntwerpAntwerpBelgium
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| |
Collapse
|
57
|
Mitchell MM, Gryczynski J, Mitchell SG, Kelly SM, O'Grady KE, Monico LB, Schwartz RP. A Latent Class Analysis of HIV Risk Factors Among Men and Women with Opioid Use Disorder in Pre-trial Detention. AIDS Behav 2020; 24:1776-1783. [PMID: 31748939 DOI: 10.1007/s10461-019-02726-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adults entering pre-trial detention who inject drugs are at high risk for acquiring HIV/AIDS. In the current study, we examined pre-incarceration HIV risk behaviors among 114 people with opioid use disorder who inject drugs. Participants were recruited from the Baltimore City Detention Center as part of a randomized controlled trial of pre-release methadone treatment. Using latent class analysis, we found three separate latent classes, which we identified as the sex exchange class (14.2%), drug equipment sharing class (36.8%) and lower risk class (49.0%). Women in the sex exchange class (n = 16) reported having multiple male partners and selling sex for money or drugs; however, this group also reported more consistent condom use and less frequent injection drug and equipment sharing than participants in the drug equipment sharing class. Our findings highlight distinct profiles of jail detainees with OUD based on their risks for HIV, and could inform more targeted interventions for each group.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.
Collapse
Affiliation(s)
- Mary M Mitchell
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA.
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| | - Kevin E O'Grady
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| | - Laura B Monico
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Ave, Suite 103, Baltimore, MD, 21201, USA
| |
Collapse
|
58
|
Readiness of female sex workers for HIV testing and its associated factors in Shire Endaselassie town, Tigray, Ethiopia: a cross-sectional study. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
59
|
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.
Collapse
|
60
|
Tokar A, Naniche D. Occupational barriers to HIV care in female sex workers living with HIV: structural or community solutions? Occup Environ Med 2020; 77:353-354. [PMID: 32393575 DOI: 10.1136/oemed-2019-106396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Anna Tokar
- ISGlobal (Barcelona Institute for Global Health) Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Denise Naniche
- ISGlobal (Barcelona Institute for Global Health) Hospital Clinic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
61
|
Human Immunodeficiency Virus Incidence Among Women at High-Risk of Human Immunodeficiency Virus Infection Attending a Dedicated Clinic in Kampala, Uganda: 2008-2017. Sex Transm Dis 2020; 46:407-415. [PMID: 31095103 DOI: 10.1097/olq.0000000000000978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High attrition and irregular testing for human immunodeficiency virus (HIV) in cohort studies for high-risk populations can bias incidence estimates. We compare incidence trends for high-risk women attending a dedicated HIV prevention and treatment clinic, using common methods for assigning when seroconversion occurs and whether seroconversion occurs among those with attrition. METHODS Between April 2008 and May 2009, women were enrolled into cohort 1 and from January 2013 into cohort 2, then scheduled for follow-up once every 3 months. Incidence trends based on assuming a midpoint in the seroconversion interval were compared with those of assigning a random-point. We also compared estimates based on the random-point with and without multiple imputation (MI) of serostatuses for participants with attrition. RESULTS By May 2017, 3084 HIV-negative women had been enrolled with 18,364 clinic visits. Before attrition, 27.6% (6990 of 25,354) were missed visits. By August 2017, 65.8% (426 of 647) of those enrolled in cohort 1 and 49.0% (1194 of 2437) in cohort 2 were defined with attrition. Among women with 1 or more follow-up visit, 93 of 605 in cohort 1 and 77 of 1601 in cohort 2 seroconverted. Periods with longer seroconversion intervals appeared to have noticeable differences in incidences when comparing the midpoint and random-point values. The MI for attrition is likely to have overestimated incidence after escalated attrition of participants. Based on random-point without MI for attrition, incidence at end of observation was 3.8/100 person-years in cohort 1 and 1.8/100 in cohort 2. CONCLUSIONS The random-point approach attenuated variation in incidence observed using midpoint. The high incidence after years of ongoing prevention efforts in this vulnerable population should be investigated to further reduce incidence.
Collapse
|
62
|
Glick JL, Russo R, Jivapong B, Rosman L, Pelaez D, Footer KHA, Sherman SG. The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review. AIDS Behav 2020; 24:1312-1333. [PMID: 31807973 DOI: 10.1007/s10461-019-02733-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.
Collapse
|
63
|
Lancaster KE, Lungu T, Bula A, Shea JM, Shoben A, Hosseinipour MC, Kohler RE, Hoffman IF, Go VF, Golin CE, Wheeler SB, Miller WC. Preferences for Pre-exposure Prophylaxis Service Delivery Among Female Sex Workers in Malawi: A Discrete Choice Experiment. AIDS Behav 2020; 24:1294-1303. [PMID: 31720955 DOI: 10.1007/s10461-019-02705-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Female sex workers (FSW) in Malawi have among the highest HIV prevalence estimates worldwide. Daily oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet preferences for PrEP delivery among FSW are lacking. Eight focus group discussions, a literature review, and cognitive interviews were conducted to identify modifiable PrEP delivery attributes and inform discrete-choice experiment (DCE) development for FSW in Lilongwe. Enrolled FSW received an interviewer-assisted DCE. Data were analyzed using mixed logit regression. Dispensing location was most preferred, followed by the provision of additional services. Women preferred receiving PrEP at family planning clinics or non-governmental organization run drop-in centers. Cervical cancer screening was the most preferred additional service, while pregnancy testing and partner risk reduction counseling were less valued. This study was the first study to examine PrEP delivery preferences in Malawi using DCE-a powerful elicitation tool to apply to other key populations at risk for HIV.
Collapse
Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA.
| | - Thandie Lungu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Agatha Bula
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Jaclyn M Shea
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abigail Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mina C Hosseinipour
- University of North Carolina Project-Malawi, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Irving F Hoffman
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 334 Cunz Hall, 1841 Neil Ave, Columbus, OH, USA
| |
Collapse
|
64
|
Busza J, Chiyaka T, Musemburi S, Fearon E, Davey C, Chabata S, Mushati P, Dirawo J, Napierala S, Phillips AN, Cowan FM, Hargreaves JR. Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial. Health Policy Plan 2020; 34:337-345. [PMID: 31157368 DOI: 10.1093/heapol/czz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.
Collapse
Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Elizabeth Fearon
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Calum Davey
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sungai Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sue Napierala
- RTI International, 351 California Street, Suite 500, San Francisco, CA, USA
| | - Andrew N Phillips
- Institute for Global Health, UCL, Royal Free Hospital, Rowland Hill Street, London, UK and
| | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - James R Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
65
|
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.
Collapse
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
| |
Collapse
|
66
|
Davey C, Dirawo J, Hargreaves JR, Cowan FM. Exploring the Association Between Mobility and Access to HIV Services Among Female Sex Workers in Zimbabwe. AIDS Behav 2020; 24:746-761. [PMID: 31256270 DOI: 10.1007/s10461-019-02559-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Female sex workers (FSW) face structural barriers to HIV-service access, however the effect of their mobility is uncertain. Using cross-sectional data from 2839 FSW in 14 sites in Zimbabwe, we explored the association between mobility (number of trips, distance, duration) in the past 12 months and five HIV-service-access outcomes: exposure to community mobilisation, clinic attendance, HIV testing, antiretroviral treatment initiation, and viral suppression (< 1000 copies per mL). We used modified-Poisson regression, and natural-effects models to estimate how the effect of trip frequency was mediated by distance and duration away. Each additional trip in 12 months was associated with increased community-mobilisation-event attendance (adjusted RR 1.08, 95% CI 1.04-1.12) and attending clinic two-or-more times (adjusted RR 1.02, 95% CI 1.00-1.05). There was little evidence of any other associations, or of mediation. Our findings are consistent with literature that found the effects of mobility to vary by context and outcome. This is the first study to consider many FSW-mobility and HIV-service-access measures together. Future research on mobility and health-related behaviour should use a spectrum of measures.
Collapse
Affiliation(s)
- Calum Davey
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK.
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
| | - James R Hargreaves
- London School of Hygiene and Tropical Medicine, 15 Tavistock Place, London, WC1H 9SH, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research, 9 Monmouth Rd, 5 Avondale West, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| |
Collapse
|
67
|
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.
Collapse
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
| |
Collapse
|
68
|
Carrasco MA, Rosen JG, Phelps R. Left behind?: male clients of female sex workers in Zambia. AIDS Care 2020; 32:1498-1505. [PMID: 31973578 DOI: 10.1080/09540121.2020.1718589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Male clients of female sex workers (CFSWs) are a key-affected group within the HIV epidemic. However, few studies have quantified HIV/STI burdens among CFSWs. This study used nationally representative data from the 2013-14 Zambia Demographic and Health Survey to estimate proxies for HIV and STI prevalence among sexually active men aged 15-59 paying for sex recently (past 12 months) [5%, n = 679] or in their lifetime [15%, n = 1,887]. Chi-square tests were calculated to assess differences in prevalence estimates between CFSWs and non-clients. Multivariable logistic regression models were generated to identify sociodemographic factors associated with prevention characteristics. CFSWs had higher odds of reporting HIV infection (recent: aOR 1.413, p < 0.05; lifetime: aOR 1.604, p < 0.001) and past-year STI symptomology (recent: aOR 3.342, p < 0.001; lifetime: aOR 2.266, p < 0.001) than non-clients, irrespective of transactional sex recency. Compared to non-clients, CFSWs were more likely to be <25yo (42% vs. 29%, p < 0.001), have a cohabitating partner (43% vs. 35%, p < 0.001), use condoms at last sex (31% vs. 27%, p < 0.001), and never test for HIV (36% vs. 29%, p < 0.001). When comparing CFSWs to non-clients, marital status was an effect modifier of HIV testing, medical circumcision, and condom use at last sex. Findings suggest high HIV/STI burdens and highlight the urgent need for differentiated HIV prevention programming for CFSWs in Zambia including the provision of PrEP.
Collapse
Affiliation(s)
- Maria A Carrasco
- Office of HIV/AIDS, United States Agency for International Development, Washington, D.C
| | - Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Phelps
- Office of HIV/AIDS, United States Agency for International Development, Washington, D.C
| |
Collapse
|
69
|
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: 3] [Impact Index Per Article: 0.6] [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.
Collapse
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
| |
Collapse
|
70
|
Brody C, Sok S, Tuot S, Pantelic M, Restoy E, Yi S. Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review. BMJ Glob Health 2019; 4:e001560. [PMID: 31673432 PMCID: PMC6797339 DOI: 10.1136/bmjgh-2019-001560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction This systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes. Methods An electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised. Results This review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome. Conclusion These findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes. PROSPERO registration number CRD42018106909
Collapse
Affiliation(s)
- Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, California, USA
| | - Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Marija Pantelic
- Department of Social Policy and Intervention, Oxford University, Oxford, UK.,Frontline AIDS, Brighton, UK.,Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Enrique Restoy
- Frontline AIDS, Brighton, UK.,School of Global Studies, Sussex University, Brighton, United Kingdom
| | - Siyan Yi
- Center for Global Health Research, Touro University California, Vallejo, California, USA.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
71
|
Benoit C, Smith M, Jansson M, Healey P, Magnuson D. "The Prostitution Problem": Claims, Evidence, and Policy Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1905-1923. [PMID: 30498916 DOI: 10.1007/s10508-018-1276-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 05/12/2023]
Abstract
Prostitution, payment for the exchange of sexual services, is deemed a major social problem in most countries around the world today, with little to no consensus on how to address it. In this Target Article, we unpack what we discern as the two primary positions that undergird academic thinking about the relationship between inequality and prostitution: (1) prostitution is principally an institution of hierarchal gender relations that legitimizes the sexual exploitation of women by men, and (2) prostitution is a form of exploited labor where multiple forms of social inequality (including class, gender, and race) intersect in neoliberal capitalist societies. Our main aims are to: (a) examine the key claims and empirical evidence available to support or refute each perspective; (b) outline the policy responses associated with each perspective; and (c) evaluate which responses have been the most effective in reducing social exclusion of sex workers in societal institutions and everyday practices. While the overall trend globally has been to accept the first perspective on the "prostitution problem" and enact repressive policies that aim to protect prostituted women, punish male buyers, and marginalize the sex sector, we argue that the strongest empirical evidence is for adoption of the second perspective that aims to develop integrative policies that reduce the intersecting social inequalities sex workers face in their struggle to make a living and be included as equals. We conclude with a call for more robust empirical studies that use strategic comparisons of the sex sector within and across regions and between sex work and other precarious occupations.
Collapse
Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada.
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave., Victoria, BC, V8N 5M8, Canada
| | - Priscilla Healey
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
| | - Doug Magnuson
- School of Child and Youth Care, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
72
|
Zhang C, McMahon J, Simmons J, Brown LL, Nash R, Liu Y. Suboptimal HIV Pre-exposure Prophylaxis Awareness and Willingness to Use Among Women Who Use Drugs in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2641-2653. [PMID: 31297684 DOI: 10.1007/s10461-019-02573-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% CI 8.7%, 32.4%) of WWUD were aware of PrEP, and 60.2% (95% CI 52.2%, 68.2%) of those aware were also willing to use PrEP. Notwithstanding study limitations, our findings suggest there may be potential to increase PrEP uptake among WWUD, but efforts must first concentrate on improving PrEP awareness among this population.
Collapse
Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA.
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA
| | - Janie Simmons
- Department of Social & Behavioral Sciences, College of Global Public Health, New York University, New York City, NY, USA
| | - L Lauren Brown
- Nashville CARES, Nashville, TN, USA
- Infectious Diseases Division, Vanderbilt University Medical Center, Nashville, USA
| | - Robertson Nash
- Vanderbilt Comprehensive Care Clinic, Nashville, TN, USA
| | - Yu Liu
- Division of Epidemiology, Department of Public Health Science, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
73
|
Shea J, Bula A, Dunda W, Hosseinipour MC, Golin CE, Hoffman IF, Miller WC, Go VF, Lungu T, Lancaster KE. "The Drug Will Help Protect My Tomorrow": Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:421-432. [PMID: 31550194 PMCID: PMC6793990 DOI: 10.1521/aeap.2019.31.5.421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Female sex workers (FSW) are disproportionately at risk for HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet approaches for incorporating PrEP within prevention strategies used by FSW are lacking. Semistructured focus group discussions were conducted with 44 HIV-negative FSW in Lilongwe, Malawi to explore perceptions of PrEP: acceptability, integration within HIV prevention behaviors, and barriers to use. Acceptability of PrEP was high. Motivation to use PrEP was rooted in love for one's life, anticipated negative economic effects associated with HIV acquisition. PrEP was viewed as complementary to existing norms for engaging in healthy sexual behaviors. Many felt PrEP may provide extra protection from HIV, along with condoms and frequent STI testing. Unpredictable daily lives, stigma, and side effects were barriers that could affect PrEP use. Leveraging existing HIV prevention strategies and social norms surrounding HIV prevention behaviors may positively impact PrEP uptake among FSW in Malawi and sub-Saharan Africa.
Collapse
Affiliation(s)
- Jaclyn Shea
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Mina C Hosseinipour
- UNC Project Malawi, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina
- UNC Center for AIDS Research, Lineberger Cancer Center, University of North Carolina at Chapel Hill
| | - Irving F Hoffman
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina (UNC) at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| |
Collapse
|
74
|
Mulberry N, Rutherford AR, Wittenberg RW, Williams BG. HIV control strategies for sex worker-client contact networks. J R Soc Interface 2019; 16:20190497. [PMID: 31551046 DOI: 10.1098/rsif.2019.0497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Controlling the spread of HIV among hidden, high-risk populations such as survival sex workers and their clients is becoming increasingly important in the ongoing fight against HIV/AIDS. Several sociological and structural factors render general control strategies ineffective in these settings; instead, focused prevention, testing and treatment strategies which take into account the nature of survival sex work are required. Using a dynamic bipartite network model of sexual contacts, we investigate the optimal distribution of treatment and preventative resources among sex workers and their clients; specifically, we consider control strategies that randomly allocate antiretroviral therapy and pre-exposure prophylaxis within each subpopulation separately. Motivated by historical data from a South African mining community, three main asymmetries between sex workers and clients are considered in our model: relative population sizes, migration rates and partner distributions. We find that preventative interventions targeted at female sex workers are the lowest cost strategies for reducing HIV prevalence, since the sex workers form a smaller population and have, on average, more sexual contacts. However, the high migration rate among survival sex workers limits the extent to which prevalence can be reduced using this strategy. To achieve a further reduction in HIV prevalence, testing and treatment in the client population cannot be ignored.
Collapse
Affiliation(s)
- Nicola Mulberry
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexander R Rutherford
- Department of Mathematics and SFU Big Data, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ralf W Wittenberg
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Brian G Williams
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
| |
Collapse
|
75
|
Case KK, Gomez GB, Hallett TB. The impact, cost and cost-effectiveness of oral pre-exposure prophylaxis in sub-Saharan Africa: a scoping review of modelling contributions and way forward. J Int AIDS Soc 2019; 22:e25390. [PMID: 31538407 PMCID: PMC6753289 DOI: 10.1002/jia2.25390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) is a new form of HIV prevention being considered for inclusion in national prevention portfolios. Many mathematical modelling studies have been undertaken that speak to the impact, cost and cost-effectiveness of PrEP programmes. We assess the available evidence from mathematical modelling studies to inform programme planning and policy decision making for PrEP and further research directions. METHODS We conducted a scoping review of the published modelling literature. Articles published in English which modelled oral PrEP in sub-Saharan Africa, or non-specific settings with relevance to generalized HIV epidemic settings, were included. Data were extracted for the strategies of PrEP use modelled, and the impact, cost and cost-effectiveness of PrEP for each strategy. We define an algorithm to assess the quality and relevance of studies included, summarize the available evidence and identify the current gaps in modelling. Recommendations are generated for future modelling applications and data collection. RESULTS AND DISCUSSION We reviewed 1924 abstracts and included 44 studies spanning 2007 to 2017. Modelling has reported that PrEP can be a cost-effective addition to HIV prevention portfolios for some use cases, but also that it would not be cost-effective to fund PrEP before other prevention interventions are expanded. However, our assessment of the quality of the modelling indicates cost-effectiveness analyses failed to comply with standards of reporting for economic evaluations and the assessment of relevance highlighted that both key parameters and scenarios are now outdated. Current evidence gaps include modelling to inform service development using updated programmatic information and ex post modelling to evaluate and inform efficient deployment of resources in support of PrEP, especially among key populations, using direct evidence of cost, adherence and uptake patterns. CONCLUSIONS Updated modelling which more appropriately captures PrEP programme delivery, uses current intervention scenarios, and is parameterized with data from demonstration and implementation projects is needed in support of more conclusive findings and actionable recommendations for programmes and policy. Future analyses should address these issues, aligning with countries to support the needs of programme planners and decision makers for models to more directly inform programme planning and policy.
Collapse
Affiliation(s)
- Kelsey K Case
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Gabriela B Gomez
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Timothy B Hallett
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| |
Collapse
|
76
|
Rojas Castro D, Delabre RM, Morel S, Michels D, Spire B. Community engagement in the provision of culturally competent HIV and STI prevention services: lessons from the French experience in the era of PrEP. J Int AIDS Soc 2019; 22 Suppl 6:e25350. [PMID: 31468710 PMCID: PMC6715944 DOI: 10.1002/jia2.25350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Daniela Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Stéphane Morel
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,AIDES, Pantin, France
| | - David Michels
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,AIDES, Pantin, France
| | - Bruno Spire
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,AIDES, Pantin, France
| |
Collapse
|
77
|
Ngale K, Cummings B, Horth R. Unseen, unheard and unprotected: prevalence and correlates of violence among female sex workers in Mozambique. CULTURE, HEALTH & SEXUALITY 2019; 21:898-913. [PMID: 30451098 DOI: 10.1080/13691058.2018.1524512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/09/2023]
Abstract
Violence against women, including female sex workers, is a public health concern worldwide. This is the first study in Mozambique to estimate the prevalence of and factors associated with physical and sexual violence against female sex workers. We used data collected from 1,250 women recruited using respondent-driven sampling in the cities of Maputo, Beira and Nampula in 2011-12. Participants were 15 years of age and reported having had sex for money in the preceding six months. Prevalence of physical or sexual violence (defined as being hit or battered or raped or forced to have sex within the last 6 months) ranged from 10.0% to 25.6%. Strangers (37.0%) and acquaintances (31.2%) were reported to be the most frequent perpetrators of sexual violence. Among participants who experienced sexual violence, 65.9% and 87.0% did not seek medical care and police assistance, respectively. Physical or sexual violence was associated with city (adjusted odds ratio [AOR] 2.6 and 2.0 Nampula and Beira vs Maputo), age (AOR 1.9, aged 15-24 years vs aged 25 and older), unprotected sex with last client (AOR 1.6) and self-reported sexually transmitted infections (AOR 2.1). The high prevalence of violence found confirms the need for interventions to mitigate this problem.
Collapse
Affiliation(s)
- Kátia Ngale
- a Pathfinder International , Maputo , Mozambique
| | - Beverley Cummings
- b US Centers for Disease Control and Prevention , Maputo , Mozambique
| | - Roberta Horth
- c Global Health Sciences , University of California San Francisco , Maputo , Mozambique
| |
Collapse
|
78
|
Ward H, Garnett GP, Mayer KH, Dallabetta GA. Maximizing the impact of HIV prevention technologies in sub-Saharan Africa. J Int AIDS Soc 2019; 22 Suppl 4:e25319. [PMID: 31328415 PMCID: PMC6643073 DOI: 10.1002/jia2.25319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/16/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Helen Ward
- Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
| | | | | | | |
Collapse
|
79
|
Modelling the potential impact of providing preexposure prophylaxis in pregnant and breastfeeding women in South Africa. AIDS 2019; 33:1391-1395. [PMID: 30950882 PMCID: PMC6561341 DOI: 10.1097/qad.0000000000002221] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE HIV-uninfected pregnant and breastfeeding women are at high risk of HIV acquisition, contributing to vertical transmission of HIV. Preexposure prophylaxis (PrEP) is safe in pregnancy, but PrEP in pregnancy is not policy in many countries including South Africa. We evaluated the potential impact of providing PrEP for pregnant/breastfeeding women using a HIV model for South Africa. METHODS Our model considers two scenarios: a conservative scenario that matches the experience reported in the Kenyan PrEP programme for pregnant women (probability of uptake = 32% and 11% in high-risk and low-risk women, respectively); and an optimistic scenario with PrEP initiated by 80% of all pregnant women. We compared this with PrEP for female sex workers, MSM and adolescent girls/young women. Women are assumed to remain on PrEP throughout pregnancy and breastfeeding, and an equivalent average PrEP duration (2 years) is assumed in other scenarios. RESULTS Between 2020 and 2030, if PrEP is provided to pregnant/breastfeeding mothers, we project a 2.5% reduction in total HIV transmission [95% credibility interval (CI): 2.4-2.6%] in the conservative scenario and 7.2% (95% CI: 6.8-7.5%) in the optimistic scenario, which is similar to that in the female sex worker and MSM PrEP scenarios (1.9% and 3.0%, respectively). Without PrEP, 76 000 (95% CI: 64 000-90 000) new cases of vertical transmission are expected; PrEP provision may reduce these infections by 13% (95% CI: 13-14%) in the conservative scenario and 41% (95% CI: 39-44%) in the optimistic scenario. CONCLUSION High levels of uptake of and adherence to PrEP among pregnant/breastfeeding women could substantially reduce maternal and infant HIV acquisition in South Africa.
Collapse
|
80
|
Palinkas LA, Um MY, Aarons GA, Rafful C, Chavarin CV, Mendoza DV, Staines H, Patterson TL. Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:57-68. [PMID: 31632894 PMCID: PMC6800729 DOI: 10.1007/s40609-018-0113-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable.
Collapse
Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Mee Young Um
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Gregory A. Aarons
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Claudia Rafful
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA USA
- School of Public Health, San Diego State University, San Diego, CA USA
| | - Claudia V. Chavarin
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| | - Doroteo V. Mendoza
- Research and Evaluation Unit, Mexican Foundation for Family Planning (MexFam), Mexico City, Mexico
| | - Hugo Staines
- Faculty of Biomedical Sciences, Autonomous University of Ciudad Juarez, Ciudad Juárez, Chihuahua, Mexico
| | - Thomas L. Patterson
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA USA
| |
Collapse
|
81
|
Twahirwa Rwema JO, Lyons CE, Ketende S, Bowring AL, Rao A, Comins C, Diouf D, Drame FM, Liestman B, Coly K, Ndour C, Turpin G, Mboup S, Toure-Kane C, Castor D, Leye-Diouf N, Diop-Ndiaye H, Baral S. Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal. J Acquir Immune Defic Syndr 2019; 81:63-71. [PMID: 30865185 PMCID: PMC6536305 DOI: 10.1097/qai.0000000000001991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.
Collapse
Affiliation(s)
- Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Carrie E. Lyons
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Sosthenes Ketende
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Anna L Bowring
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Carly Comins
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | | | - Fatou M. Drame
- Enda Santé, Dakar, Senegal
- Universite Gaston Berger de St. Louis (UGB)
| | - Benjamin Liestman
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Karleen Coly
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Cheikh Ndour
- Division de la Lutte contre le Sida et les IST, Ministry
of Health, Dakar, Sénégal
| | - Gnilane Turpin
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | | | - Delivette Castor
- USAID, Office of HIV/AIDS, Bureau for Global Health,
Arlington, VA
| | - Nafissatou Leye-Diouf
- Institut de Recherche en Santé, de Surveillance
Epidémiologique et de Formations, Dakar, Sénégal
| | | | - Stefan Baral
- Department of Epidemiology, Key Populations Program,
Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| |
Collapse
|
82
|
Eakle R, Bothma R, Bourne A, Gumede S, Motsosi K, Rees H. "I am still negative": Female sex workers' perspectives on uptake and use of daily pre-exposure prophylaxis for HIV prevention in South Africa. PLoS One 2019; 14:e0212271. [PMID: 30964874 PMCID: PMC6456175 DOI: 10.1371/journal.pone.0212271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
Women remain highly vulnerable to HIV infection in sub-Saharan Africa, with female sex workers (FSWs) facing some of the highest rates of HIV. Oral pre-exposure prophylaxis (PrEP) has the potential to reduce new infections among populations at highest risk and end-user perspectives of actual use in ‘real-world’ settings are critical to informing PrEP implementation. This paper presents findings from serial in-depth interviews (IDIs) conducted with FSW participants during the course of the Treatment And Prevention for Sex workers (TAPS) Demonstration Project in South Africa, exploring the lived experiences and perceptions of taking up and using PrEP. This research provides insight into risks and responsibilities facing FSWs perceived as prominent drivers in taking up and using PrEP, how PrEP was adopted to mitigate risk or ameliorate realities, and the characteristics of PrEP most valued, all of which are critical to consider in scale-up. Overall, distrust in the existence and/or efficacy of PrEP affected the motivation of women to come to the clinic and to maintain use. As one of the first reports of PrEP use among FSWs outside of a clinical trial setting, this research shows that it will be important to ensure accurate, relevant, and widespread messaging in communities to generate demand and support for PrEP.
Collapse
Affiliation(s)
- Robyn Eakle
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: ,
| | - Rutendo Bothma
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
| | - Sanele Gumede
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keneilwe Motsosi
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
83
|
Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Barnhart D, Mboggo E, Oldenburg CE, Bärnighausen T, Spiegelman D. HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey. BMJ Open 2019; 9:e023272. [PMID: 30898799 PMCID: PMC6475445 DOI: 10.1136/bmjopen-2018-023272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW's sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa. DESIGN Cross-sectional survey covering respondents' work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC). SETTING Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM). PARTICIPANTS 66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit. RESULTS Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive. CONCLUSIONS FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
Collapse
Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Aisa Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Katrina F Ortblad
- International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | - Irene Mashasi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Peter Dambach
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Dale Barnhart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric Mboggo
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Departments of Ophthalmology & Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
84
|
Recruitment of Female Sex Workers in HIV Prevention Trials: Can Efficacy Endpoints Be Reached More Efficiently? J Acquir Immune Defic Syndr 2019; 77:350-357. [PMID: 29206720 DOI: 10.1097/qai.0000000000001603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/SETTING Randomized controlled trials (RCTs) of HIV biomedical prevention interventions often enroll participants with varying levels of HIV exposure, including people never exposed to HIV. We assessed whether enrolling larger proportion of participants with consistently high exposure to HIV, such as female sex workers (FSWs), might reduce trial duration and improve the accuracy of product efficacy estimates in future HIV prevention trials. METHODS We used an individual-based stochastic model to simulate event-driven RCTs of an HIV prevention intervention providing 80% reduction in susceptibility per act under different proportions of FSW enrolled. A 5% annual dropout rate was assumed for both FSW and non-FSW in our main scenario, but rates of up to 50% for FSW were also explored. RESULTS Enrolling 20% and 50% FSW reduced the median-simulated trial duration from 30 months with 0% FSW enrolled to 22 months and 17 months, respectively. Estimated efficacy increased from 71% for RCTs without FSW to 74% and 76% for RCTs with 20% and 50% FSW enrolled, respectively. Increasing the FSW dropout rate to 50% increased the duration of RCTs by 1-2 months on average and preserved the gain in estimated efficacy. CONCLUSIONS Despite the potential logistical challenges of recruiting and retaining FSW, trialists should revisit the idea of enrolling FSW in settings where HIV incidence among FSW is higher than among non-FSW. Our analysis suggests that enrolling FSW would increase HIV incidence, reduce trial duration, and improve efficacy estimates, even if the annual dropout rate among FSW participants is high.
Collapse
|
85
|
Tomko C, Park JN, Allen ST, Glick J, Galai N, Decker MR, Footer KH, Sherman SG. Awareness and Interest in HIV Pre-Exposure Prophylaxis Among Street-Based Female Sex Workers: Results from a US Context. AIDS Patient Care STDS 2019; 33:49-57. [PMID: 30632769 PMCID: PMC6386071 DOI: 10.1089/apc.2018.0182] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66% were white, half were less than 35 years old, 59% injected drugs daily, and 66% sold sex daily. Only 21% of FSW were aware of PrEP, though 74% were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95% CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95% CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as "very easy" to take (aIRR = 1.91, 95% CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95% CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95% CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.
Collapse
Affiliation(s)
- Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sean T. Allen
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Glick
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine H.A. Footer
- Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
86
|
Jones AA, Dyer TV, Das A, Lasopa SO, Striley CW, Cottler LB. Risky Sexual Behaviors, Substance Use, and Perceptions of Risky Behaviors Among Criminal Justice Involved Women Who Trade Sex. JOURNAL OF DRUG ISSUES 2019; 49:15-27. [PMID: 33828337 PMCID: PMC8022863 DOI: 10.1177/0022042618795141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined risky sexual behaviors, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)-defined alcohol and substance use disorders, and perceptions of risky behaviors among community released, justice-involved women, who are currently trading sex (CTS), formerly traded sex (FTS), or have never traded sex. Data were derived from 266 sexually active women recruited from a Municipal Drug Court System in St. Louis, Missouri. In an adjusted multinomial regression model, being dependent on alcohol and cocaine was the most robust correlate of sex-trading status (adjusted odds ratio [AOR]: CTS = 4.21, FTS = 4.66). Perceptions of sexual risk and HIV were significantly associated with CTS (AOR = 3.39), however, not FTS. Other significant correlates of sex trading status included age, lifetime injection drug use, lower education, child sexual abuse, and unstable housing. Gender-specific interventions tailored toward currently and formerly sex-trading women are needed.
Collapse
Affiliation(s)
- Abenaa A. Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T. V. Dyer
- University of Maryland, College Park, USA
| | - A. Das
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S. O. Lasopa
- Sir Thutob Namgyal Memorial Hospital, Gangtok, India
| | | | | |
Collapse
|
87
|
Quaife M, Vickerman P, Manian S, Eakle R, Cabrera‐Escobar MA, Delany‐Moretlwe S, Terris‐Prestholt F. The effect of HIV prevention products on incentives to supply condomless commercial sex among female sex workers in South Africa. HEALTH ECONOMICS 2018; 27:1550-1566. [PMID: 29926508 PMCID: PMC6175015 DOI: 10.1002/hec.3784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/02/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
Evidence suggests that economic factors play an important role in commercial sex work, in particular that condomless sex commands a price premium relative to condom-protected sex. This paper explores whether the use of a new HIV prevention product, with 100% efficacy but modeled after pre-exposure prophylaxis (PrEP), could change the price and quantity of condomless commercial sex supplied. We collected stated preference data from 122 HIV-negative female sex workers in urban South Africa, using a repeated choice experiment to simulate the impact of using PrEP on choices. Results suggest that the price premium for condomless sex would decrease by 73% with PrEP use and the quantity of condomless sex is predicted to increase by a factor of 2.27. Act price does not significantly affect choices without protection but strongly influences choices under full HIV protection. The utility offered by condoms reduces by around 15% under PrEP use. Because new HIV prevention products do not protect against other STIs or pregnancy, the unintended consequences of introducing HIV prevention products should be closely monitored, whereas users should not face stigma or blame for reacting rationally to exogenous changes to market conditions.
Collapse
Affiliation(s)
- Matthew Quaife
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Peter Vickerman
- School of Social and Community MedicineUniversity of BristolBristolUK
| | | | - Robyn Eakle
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | - Fern Terris‐Prestholt
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
88
|
Roberts ST, Flaherty BP, Deya R, Masese L, Ngina J, McClelland RS, Simoni J, Graham SM. Patterns of Gender-Based Violence and Associations with Mental Health and HIV Risk Behavior Among Female Sex Workers in Mombasa, Kenya: A Latent Class Analysis. AIDS Behav 2018; 22:3273-3286. [PMID: 29603110 PMCID: PMC6146064 DOI: 10.1007/s10461-018-2107-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gender-based violence (GBV) is common among female sex workers (FSWs) and is associated with multiple HIV risk factors, including poor mental health, high-risk sexual behavior, and sexually transmitted infections (STIs). Prior studies have focused on GBV of one type (e.g. physical or sexual) or from one kind of perpetrator (e.g., clients or regular partners), but many FSWs experience overlapping types of violence from multiple perpetrators, with varying frequency and severity. We examined the association between lifetime patterns of GBV and HIV risk factors in 283 FSWs in Mombasa, Kenya. Patterns of GBV were identified with latent class analysis based on physical, sexual, or emotional violence from multiple perpetrators. Cross-sectional outcomes included depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, disordered alcohol and other drug use, number of sex partners, self-reported unprotected sex, prostate-specific antigen (PSA) in vaginal secretions, and a combined unprotected sex indicator based on self-report or PSA detection. We also measured HIV/STI incidence over 12 months following GBV assessment. Associations between GBV patterns and each outcome were modeled separately using linear regression for mental health outcomes and Poisson regression for sexual risk outcomes. Lifetime prevalence of GBV was 87%. We identified 4 GBV patterns, labeled Low (21% prevalence), Sexual (23%), Physical/Moderate Emotional (18%), and Severe (39%). Compared to women with Low GBV, those with Severe GBV had higher scores for depressive symptoms, PTSD symptoms, and disordered alcohol use, and had more sex partners. Women with Sexual GBV had higher scores for disordered alcohol use than women with Low GBV, but similar sexual risk behavior. Women with Physical/Moderate Emotional GBV had more sex partners and a higher prevalence of unprotected sex than women with Low GBV, but no differences in mental health. HIV/STI incidence did not differ significantly by GBV pattern. The prevalence of GBV was extremely high in this sample of Kenyan FSWs, and different GBV patterns were associated with distinct mental health and sexual risk outcomes. Increased understanding of how health consequences vary by GBV type and severity could lead to more effective programs to reduce HIV risk in this vulnerable population.
Collapse
Affiliation(s)
- Sarah T Roberts
- Women's Global Health Imperative, RTI International, 351 California St, Ste 500, San Francisco, CA, 94104, USA.
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Ruth Deya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Linnet Masese
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jacqueline Ngina
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - R Scott McClelland
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Susan M Graham
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
89
|
Doshi RH, Sande E, Ogwal M, Kiyingi H, McIntyre A, Kusiima J, Musinguzi G, Serwadda D, Hladik W. Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda. PLoS One 2018; 13:e0201352. [PMID: 30231030 PMCID: PMC6145590 DOI: 10.1371/journal.pone.0201352] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.
Collapse
Affiliation(s)
- Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Moses Ogwal
- Makerere University School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Anne McIntyre
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joy Kusiima
- Makerere University School of Public Health, Kampala, Uganda
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| |
Collapse
|
90
|
Musyoki H, Bhattacharjee P, Blanchard AK, Kioko J, Kaosa S, Anthony J, Javalkar P, Musimbi J, Malaba SJ, Olwande C, Blanchard JF, Sirengo M, Isac S, Moses S. Changes in HIV prevention programme outcomes among key populations in Kenya: Data from periodic surveys. PLoS One 2018; 13:e0203784. [PMID: 30231072 PMCID: PMC6145580 DOI: 10.1371/journal.pone.0203784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022] Open
Abstract
The Kenya National AIDS and STI Control Programme (NASCOP) conducted annual polling booth surveys (PBS) in 2014 and 2015 to measure outcomes from the national HIV prevention programme for key populations (KPs), comprising behavioural, biomedical and structural interventions. KPs included female sex workers (FSWs), men who have sex with men (MSM) and people who inject drugs (PWID). We compared survey results from the first and second rounds. Comparing the second to the first round, significantly more FSWs (93% vs. 88%, p<0.001) and MSM (77% vs. 58%, p<0.001) reported condom use at last sex with a paying client, and at last anal sex among MSM (80% vs. 77%, p<0.05) and PWID (48% vs. 27%, p<0.01). However, condom use with regular partners remained low, at less than 53% for FSWs and 69% for MSM. Among PWID, there was a significant increase in use of new needles and syringes at last injection (93% vs. 88%, p<0.001), and a significant decrease in reported non-availability of clean needles (23% vs. 36%, p<0.001). The number of overdoses in the past six months reduced significantly but remained high (40% vs. 51%, p<0.001). FSWs and MSM reported significantly higher HIV testing, and in all KP groups, over 93% reported ever having been tested for HIV. Among the respondents self-reporting to have tested HIV positive (24% of FSW, 22% of MSM and 19% of PWID), 80% of FSWs, 70% of MSM, and 73% of PWID reported currently taking antiretroviral therapy (ART). While the experience of forced intercourse by partners declined among FSWs (18% vs. 22%, p<0.01) and MSM (13% vs. 17%, p<0.01), more FSWs reported violence by law enforcement personnel (49% vs. 44%, p<0.001). These findings provide valuable information on the programme's progress, and a signpost for the integrated behavioural, biomedical and structural interventions to achieve their HIV prevention targets.
Collapse
Affiliation(s)
- Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Parinita Bhattacharjee
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Andrea K. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Shem Kaosa
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - John Anthony
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Carol Olwande
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - James F. Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Martin Sirengo
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - Shajy Isac
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
91
|
Coetzee J, Gray GE, Jewkes R. Prevalence and patterns of victimization and polyvictimization among female sex workers in Soweto, a South African township: a cross-sectional, respondent-driven sampling study. Glob Health Action 2018; 10:1403815. [PMID: 29211633 PMCID: PMC5727426 DOI: 10.1080/16549716.2017.1403815] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Female sex workers (FSWs) are disproportionately affected by violence from multiple partner categories. This increases their vulnerability to HIV. Objectives: To describe patterns of violence and polyvictimization among female SWs in Soweto. Methods: A respondent-driven sampling (RDS) recruitment methodology was used to enrol 508 Soweto-based FSWs using a survey instrument. Raw and RDS adjusted data were descriptively analysed, Spearman’s correlation and chi2 test of association were used to show associations. Polyvictimization patterns are shown within a modified Venn diagram. Results: The median age of FSWs in Soweto was 31 years, and most had an incomplete education (74.2%). The prevalence of exposure to physical/sexual intimate partner violence (IPV) in the past year was 53.8%, 46.8% by clients, and 18.5% by police. Past year prevalence of sexual/physical violence by any perpetrator category was 70.8% and lifetime exposure was 76.0%. Childhood sexual violence was reported by 44.3%. Lifetime non-partner rape was 55.5% and all rape exposure was 62.4%. As a result of engaging in sex work in the past year, 65.2% women had been discriminated against. Client, police, IPV, and childhood trauma were all significantly associated with one another, with IPV being the most common co-occurrence. Polyvictimization was seen in almost two-thirds of FSWs, and increased with exposure to discrimination. Conclusion: In Soweto, FSWs are exposed to high rates of violence in multiple forms across their lifetime. Our findings show that violence continues unabated into adulthood at levels far higher than in the general population and overall at higher levels than previously recorded among SWs in South Africa. We argue that violence against FSWs is rooted in discrimination. The disparate burden of violence on FSWs requires urgent interventions to proactively address and reframe the normalisation of violence against all women.
Collapse
Affiliation(s)
- J Coetzee
- a Perinatal HIV Research Unit , University of the Witwatersrand, Chris Hani Baragwanath Hospital , Johannesburg , South Africa.,b Department of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - G E Gray
- a Perinatal HIV Research Unit , University of the Witwatersrand, Chris Hani Baragwanath Hospital , Johannesburg , South Africa.,c Office of the President , South African Medical Research Council , Cape Town , South Africa
| | - R Jewkes
- b Department of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,c Office of the President , South African Medical Research Council , Cape Town , South Africa
| |
Collapse
|
92
|
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.
Collapse
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
| |
Collapse
|
93
|
Pines HA, Strathdee SA, Hendrix CW, Bristow CC, Harvey-Vera A, Magis-Rodríguez C, Martinez G, Semple SJ, Patterson TL. Oral and vaginal HIV pre-exposure prophylaxis product attribute preferences among female sex workers in the Mexico-US border region. Int J STD AIDS 2018; 30:45-55. [PMID: 30170533 DOI: 10.1177/0956462418793038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
To assess the potential uptake of HIV pre-exposure prophylaxis (PrEP) products among female sex workers (FSWs) vulnerable to HIV infection, we examined the influence of product attributes on willingness to use products among 271 HIV-negative FSWs in Tijuana and Ciudad Juarez, Mexico (2016-2017). Via five-point Likert scale ratings, participants indicated their willingness to use hypothetical products with six attributes: formulation (pill, gel, liquid, or ring), frequency of use (daily, on-demand, or monthly), cost per use (10 or 200 pesos), effectiveness (40% or 80%), side effects (none or mild), and access point (healthcare clinic or non-governmental organization). Conjoint analysis was used to determine the impact of attributes on product ratings and identify preferred product attributes. Multinomial logistic regression was used to identify factors associated with formulation preferences. In both cities, formulation and frequency of use had the greatest impact on ratings. Participants in Ciudad Juarez indicated a strong preference for oral pills, whereas participants in Tijuana indicated roughly equal preferences for oral pills and vaginal gels. Monthly product use was preferred in both cities. Compared to preferring oral pills (38%), preferring vaginal gels (28%) was associated with practicing vaginal lubrication (adjusted odds ratio = 2.08; 95% confidence interval: 1.07-4.04). Oral PrEP may be acceptable to many FSWs in Tijuana and Ciudad Juarez; however, continued development of behaviorally-congruent vaginal PrEP products may also facilitate uptake and ensure sufficient coverage.
Collapse
Affiliation(s)
- H A Pines
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - S A Strathdee
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C W Hendrix
- 2 Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C C Bristow
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - A Harvey-Vera
- 1 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C Magis-Rodríguez
- 3 Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA; National Center for HIV/AIDS Prevention and Control), Ministry of Health, Mexico City, Mexico
| | - G Martinez
- 4 Federacion Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - S J Semple
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - T L Patterson
- 5 Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
94
|
Shannon K, Crago AL, Baral SD, Bekker LG, Kerrigan D, Decker MR, Poteat T, Wirtz AL, Weir B, Boily MC, Butler J, Strathdee SA, Beyrer C. The global response and unmet actions for HIV and sex workers. Lancet 2018; 392:698-710. [PMID: 30037733 PMCID: PMC6384122 DOI: 10.1016/s0140-6736(18)31439-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/05/2023]
Abstract
Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.
Collapse
Affiliation(s)
- Kate Shannon
- Gender and Sexual Health Initiative, University of British Columbia, Vancouver, BC, Canada.
| | | | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Deanna Kerrigan
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Michele R Decker
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Weir
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
95
|
Pines HA, Semple SJ, Strathdee SA, Hendrix CW, Harvey-Vera A, Gorbach PM, Magis-Rodríguez C, Martinez G, Patterson TL. Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention. BMC Public Health 2018; 18:1009. [PMID: 30107833 PMCID: PMC6092873 DOI: 10.1186/s12889-018-5946-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/09/2018] [Indexed: 11/11/2022] Open
Abstract
Background To assess the potential acceptability and inform the development of behaviorally-congruent vaginal douche- or gel-based HIV pre-exposure prophylaxis (PrEP) products, we examined vaginal washing and lubrication practices among female sex workers (FSWs) in Tijuana and Ciudad Juarez, two northern Mexico cities bordering the United States (US). Methods Two hundred and ninety-five HIV-negative FSWs (145 Tijuana; 150 Ciudad Juarez) enrolled in a behavioral HIV prevention intervention trial completed surveys assessing vaginal washing and lubrication practices, as well as motivators and barriers to performing each practice. Logistic regression was used to identify potential predictors of each practice in the past month. Results In the past month, vaginal washing was performed by 56 and 22% of FSWs in Tijuana and Ciudad Juarez (p < 0.0001), respectively, while vaginal lubrication was performed by 64 and 45% of FSWs in Tijuana and Ciudad Juarez (p = 0.001), respectively. Vaginal washing was positively associated with living in Tijuana (adjusted odds ratio [AOR] = 4.35, 95% confidence interval [CI]: 2.60–7.30), older age (AOR = 1.04 per year, 95% CI: 1.01–1.06), and vaginal lubrication (AOR = 2.99, 95% CI: 1.67–5.35), while it was negatively associated with being born in the same state as the study site (AOR = 0.50, 95% CI: 0.31–0.82), earning a monthly income ≥3500 pesos (AOR = 0.53, 95% CI: 0.28–1.00), and hazardous alcohol consumption (AOR = 0.56, 95% CI: 0.33–0.95). Vaginal lubrication was positively associated with living in Tijuana (AOR = 2.21, 95% CI: 1.37–3.54) and vaginal washing (AOR = 2.91, 95% CI: 1.64–5.18), while it was negatively associated with being born in the same state as the study site (AOR = 0.47, 95% CI: 0.29–0.75). Conclusions The moderate and high prevalence of vaginal washing and lubrication, respectively, suggest behaviorally-congruent, multi-purpose, vaginal douche- and gel-based PrEP products that simultaneously address FSWs’ needs and prevent HIV infection may be acceptable to many FSWs along the Mexico-US border. Future product development and implementation should also consider the link between vaginal washing and lubrication to ensure existing practices do not undermine vaginal PrEP product effectiveness. Trial registration ClincialTrials.gov (NCT02447484). Electronic supplementary material The online version of this article (10.1186/s12889-018-5946-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Heather A Pines
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA.
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0680, La Jolla, CA, 92093, USA
| | - Steffanie A Strathdee
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | - Craig W Hendrix
- Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093, USA
| | - Pamina M Gorbach
- Department of Epidemiology, University of California, Los Angeles, 650 Charles E Young Drive S, BOX 951772, Los Angeles, CA, 90095, USA
| | - Carlos Magis-Rodríguez
- Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA) Ministry of Health, Mexico City, Mexico
| | - Gustavo Martinez
- Federacion Mexicana de Asociaciones Privadas, Ciudad Juarez, Chihuahua, Mexico
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0680, La Jolla, CA, 92093, USA
| |
Collapse
|
96
|
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.
Collapse
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
| |
Collapse
|
97
|
Tailoring combination HIV prevention for female sex workers. Lancet HIV 2018; 5:e406-e407. [PMID: 30030133 PMCID: PMC6361165 DOI: 10.1016/s2352-3018(18)30136-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 12/24/2022]
|
98
|
Bhattacharjee P, Morales GJ, Kilonzo TM, Dayton RL, Musundi RT, Mbole JM, Malaba SJ, Ogwang BE, Isac SK, Moses S, Musyoki HK. Can a national government implement a violence prevention and response strategy for key populations in a criminalized setting? A case study from Kenya. J Int AIDS Soc 2018; 21 Suppl 5:e25122. [PMID: 30033535 PMCID: PMC6055121 DOI: 10.1002/jia2.25122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Key population (KP) members frequently experience violence that violates their human rights, increases their risk of HIV, and acts as a barrier to access and uptake of HIV services. To be effective, HIV programmes for members of KPs need to prevent and respond to violence against them. We describe a violence prevention and response strategy led by the national KP programme in Kenya and examine trends in reports of and responses to violence (provision of support to an individual who reports violence within 24 hours of receiving the report). METHODS Quarterly programme monitoring data on the number of reports of violence and the number of responses to violence from 81 implementing partners between October 2013 and September 2017 were aggregated annually and analysed using simple trend analysis. Reports of violence relative to KP members reached, expressed as a percentage, and the percentage of reports of violence that received a response were also examined. RESULTS AND DISCUSSION Between 2013 and 2017, annual reports of violence increased from 4171 to 13,496 cases among female sex workers (FSWs), 910 to 1122 cases among men who have sex with men (MSM) and 121 to 873 cases among people who inject drugs (PWID). Reports of violence relative to KP members reached increased among FSWs (6.2% to 9.7%; p < 0.001) and PWID (2.1% to 6.0%; p < 0.001) and decreased among MSM (10.0% to 4.2%; p < 0.001). During the same period, timely responses to reports of violence increased from 53% to 84% (p < 0.001) among FSWs, 44% to 80% (p < 0.001) among MSM and 37% to 97% (p < 0.001) among PWID. CONCLUSIONS Over the past four years in Kenya, there has been an increase in violence reporting among FSWs and PWID and an increase in violence response among all KPs. This case study demonstrates that violence against KP members can be effectively addressed under the leadership of the national government, even in an environment where KP members' behaviours are criminalized. Creating an enabling environment to promote wellbeing and safety for KP members is a critical enabler for HIV prevention programmes to achieve 95-95-95 goals.
Collapse
Affiliation(s)
| | | | | | | | | | - Janet M Mbole
- Partners for Health and Development in AfricaNairobiKenya
| | - Serah J Malaba
- Partners for Health and Development in AfricaNairobiKenya
| | | | - Shajy K Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Helgar K Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| |
Collapse
|
99
|
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.
Collapse
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
| |
Collapse
|
100
|
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.
Collapse
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
| |
Collapse
|