Evaluation and mechanism analysis of HIV prevention programme using resilience framework among female sex workers: A randomised controlled trial

Examining the mediating and moderating roles of social marketing behavioural enhancers regarding consistent condom use

Since their importance was highlighted by Ayikwa and De Jager, social marketing behavioural enhancers (SMBEs) have been investigated in terms of their causal and correlational relationships with the intention to use condoms (IUC) and consistent condom use (CCU), as people often fail to act on their intentions. However, scrutiny of their mediating and moderating roles could provide insights pertinent to the design of effective HIV and AIDS preventative programmes. This study examined whether perceived behavioural control (PBC) and IUC interact with exposure to HIV and AIDS information (EI), ease of access to condoms (EAC) and level of related knowledge (KN) in determining CCU. It also investigated whether PBC and IUC predict CCU through increasing EI, EAC, and KN. A quantitative approach was adopted and data were collected from 607 participants, aged at least 18, living in Gauteng Province, South Africa. The questionnaire administered included pre-existing items, validated through exploratory and confirmatory factor analysis procedures. Regression analyses of the data for mediation and moderation testing were performed using PROCESS macro software for SPSS. The results indicated that none of the SMBEs mediated the non-significant PBC-CCU relationship: B = -0.0258, SE = 0.0199, p = 0.195. Nor did they mediate the significant IUC-CCU relationship: B = 0.0395, SE = 0.0195, p = 0.043. Similarly, none of the SMBEs were found to moderate the PBC-CCU relationship (EI*PBC: B = 0.0034, SE = 0.0056, p = 0.540; KN*PBC: B = -0.0006, SE = 0.0064, p = 0.931; EAC*PBC: B = 0.0011, SE = 0.0059, p = 0.854) as IUC-CCU relationship (EI*IUC: B = 0.0036, SE = 0.0054, p = 0.513; KN*IUC: B = -0.0096, SE = 0.0060, p = 0.111; EAC*IUC: B = 0.0044, SE = 0.0061, p = 0.469). A recommendation is made to scrutinise the mediating and moderating roles of SMBEs in the context of health behavioural models other than the theory of planned behaviour, which was considered in this study.

Correlation analysis between sleep quality and the mental health status of female sex workers during the COVID-19 pandemic in Hubei Province

Objective

Female sex workers (FSWs) in entertainment venues are subject to condemnation and rejection by their families and the outside world. As a result, they are prone to psychological problems, including anxiety and even suicidal tendencies. The aim of the current study was to understand the sleep and mental health status of local FSWs and to identify associated risk factors, so as to provide a scientific basis for improving the social recognition of FSWs and establishing effective psychological interventions.

Methods

A stratified cluster random sampling method was used to select women engaged in commercial sex in bathing, sauna, karaoke halls and other entertainment venues. A self-designed questionnaire assessing mental health-related factors was administered face-to-face with the respondents. 90 participants were randomly selected for blood tests to analyze the relationship between biological indicators and sleep quality.

Results

The rates of depression, anxiety and somnipathy among FSWs were 32.7%, 43.1% and 8.6%, respectively. The correlation coefficients (r) between sleep quality and depression, anxiety and social support were 0.07, 0.09 and -0.09, respectively. Divorce or widowhood, technical secondary school education, alcohol consumption and exercise were independent risk factors for depression in FSWs (p< 0.05) while living in urban areas and counties and having a sense of social support were protective factors (P< 0.05). Quarantining due to the pandemic and exercise were independent risk factors for anxiety in FSWs (P< 0.05) while living in counties and having a sense of social support were protective factors (P< 0.05). Quarantining due to the pandemic was an independent risk factor for somnipathy in FSWs (P< 0.05) while being married was a protective factor (P< 0.05). NE/NA was a protective factor for sleep disorders (OR=0.042, P=0.05), with an AUC of 0.87.

Conclusion

FSWs should appropriately adjust their work form during the pandemic period, maintain a positive and optimistic attitude, establish long-term stable social relationships, and seek a greater sense of social support. The government should provide comprehensive bio-psycho-social interventions to address the mental and physical health status of this population.

Interventions to improve health and the determinants of health among sex workers in high-income countries: a systematic review

Many sex worker populations face high morbidity and mortality, but data are scarce on interventions to improve their health. We did a systematic review of health and social interventions to improve the health and wider determinants of health among adult sex workers in high-income countries. We searched MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science, EthOS, OpenGrey, and Social Care Online, as well as the Global Network of Sex Work Projects and the Sex Work Research Hub for studies published between Jan 1, 2005 and Dec 16, 2021 (PROSPERO CRD42019158674). Quantitative studies reporting disaggregated data for sex workers were included and no comparators were specified. We assessed rigour using the Quality Assessment Tool for Quantitative Studies. We summarised studies using vote counting and a narrative synthesis. 20 studies were included. Most reported findings exclusively for female sex workers (n=17) and street-based sex workers (n=11). Intervention components were divided into education and empowerment (n=14), drug treatment (n=4), sexual and reproductive health care (n=7), other health care (n=5), and welfare (n=5). Interventions affected a range of mental health, physical health, and health behaviour outcomes. Multicomponent interventions and interventions that were focused on education and empowerment were of benefit. Interventions that used peer design and peer delivery were effective. An outreach or drop-in component might be beneficial in some contexts. Sex workers who were new to working in an area faced greater challenges accessing services. Data were scarce for male, transgender, and indoor-based sex workers. Co-designed and co-delivered interventions that are either multicomponent or focus on education and empowerment are likely to be effective. Policy makers and health-care providers should improve access to services for all genders of sex workers and those new to an area. Future research should develop interventions for a greater diversity of sex worker populations and for wider health and social needs.

"I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis": barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda

Background

Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda.

Methods

Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis.

Results

Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators.

Conclusions

HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.

Individual Resilience Interventions: A Systematic Review in Adult Population Samples over the Last Decade

Resilience interventions have been gaining importance among researchers due to their potential to provide well-being and reduce the prevalence of mental disorders that are becoming an increasing concern, especially in Western countries, because of the costs associated. The purpose of this systematic review is to identify the intervention studies carried out in the last decade in adult population samples, evaluate their methodological quality and highlight the trends of these types of interventions. This review was performed using systematic literature searches in the following electronic databases: B-on, PubMed, PsycNet and Science Direct. The application of eligibility criteria resulted in the inclusion of 38 articles, of which 33 were randomized controlled trials and the other five were nonrandomized controlled studies. Although most studies showed statistical significance for their results, these were constrained by the great heterogeneity of the studies, the lack of power of the samples and their fair methodological quality. Therefore, it is important to consolidate the theoretical basis and standardize certain methodologies so that the effects of the interventions can be compared through a meta-analysis.

Reduction in Stigma Drivers Partially Mediates the Effect of a Stigma Reduction Intervention Among Nursing Students in India: The DriSti Cluster Randomized Controlled Trial

BACKGROUND

HIV stigma in health care settings acts as a significant barrier to health care. Stigma drivers among health professionals include transmission fears and misconceptions and pre-existing negative attitudes toward marginalized groups vulnerable to HIV. The DriSti intervention, consisted of 2 sessions with videos and interactive exercises on a computer tablet and one interactive face-to-face group session, mostly tablet administered, was designed to target key stigma drivers that included instrumental stigma, symbolic stigma, transmission misconceptions and blame to reduce HIV stigma, and discrimination among nursing students (NS) and ward staff and tested in a cluster randomized trial.

SETTING

This report focuses on second and third year NS recruited from a range of nursing schools that included private, nonprofit, and government-run nursing schools in south India.

RESULTS

Six hundred seventy-nine NS received intervention and 813 NS were in the wait-list control group. Twelve months outcome analyses showed significant reduction among intervention participants in endorsement of coercive policies (P < 0.001) and in the number of situations in which NS intended to discriminate against PLWH (P < 0.001). Mediation analysis revealed that the effects of intervention on endorsement of coercive policies and intent to discriminate against PLWH were partially mediated by reductions in key stigma drivers.

CONCLUSIONS

This brief scalable stigma reduction intervention targeting key stigma drivers fills a critical gap in identifying the mechanistic pathways that aid in stigma reduction among health professionals.