1
|
Perdomo Sandoval LA, Goberna-Tricas J. Sexual health beliefs and prevention of sexually transmitted infections among cisgender women sex workers in Colombia. PLoS One 2024; 19:e0305293. [PMID: 38865312 PMCID: PMC11168633 DOI: 10.1371/journal.pone.0305293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION The stigma and social discrimination against cisgender women sex workers lead many of them to live in conditions characterized by social inequality, marginalization, persecution, and limited opportunities for sexual health literacy. Consequently, they are often compelled to establish a framework of preventive beliefs with little scientific validity, which they use to identify, mitigate, or avoid sexual health risks arising from their interactions with clients. This study investigates the sexual health beliefs that influence self-care practices aimed at preventing sexually transmitted infections among cisgender women sex workers in Colombia. METHODS We conducted a qualitative study framed in Hermeneutic Phenomenology. In-depth interviews and discussion groups were conducted with 34 cisgender women sex workers over 18 years of age in the center of the cities of Bogotá and Barranquilla in Colombia. RESULTS Seven themes emerged from the reflective and inductive thematic analysis of the narratives: (1) popular habits for the prevention of contagion, (2) ocular assessment of genitals, (3) condom lubrication, (4) suspicion of a hidden infection in the client, (5) saliva and oral contact as a source of contagion, (6) avoidance of semen contact, (7) and trust in God as protection. CONCLUSIONS The findings reflect the need for health and social professionals to promote participatory and inclusive cooperation with sex workers to update the framework of preventive beliefs that help them guide sexual health self-care with autonomy and self-efficacy, strengthening favorable beliefs and negotiating unfavorable ones. It is also essential to have a sex worker-informed sexual health policy that guides the promotion of sexual health that is sensitive to the needs and consistent with the risks of sex work and ensures friendly and non-oppressive preventive care environments for sex workers.
Collapse
Affiliation(s)
- Luis Albeiro Perdomo Sandoval
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing. Doctoral Program in Nursing and Health, University of Barcelona, Barcelona, Spain
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing. ADHUC. Research Center for Theory, Gender, Sexuality. University of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Frost E, Shannon K, Braschel M, Kestler M, Pearson J, Perry C, Goldenberg SM. Pandemic-related challenges accessing food and primary healthcare among sex workers during the COVID-19 pandemic: findings from a community-based cohort in Vancouver, Canada. BMC Public Health 2024; 24:1544. [PMID: 38849769 PMCID: PMC11162031 DOI: 10.1186/s12889-024-18959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Globally, the COVID-19 pandemic upended healthcare services and created economic vulnerability for many. Criminalization of sex work meant sex workers were largely ineligible for Canada's government-based financial pandemic relief, the Canadian Emergency Response Benefit. Sex workers' loss of income and inability to access financial support services during the pandemic resulted in many unable to pay rent or mortgage, and in need of assistance with basic needs items including food. Little is known about the unique experiences of sex workers who faced challenges in accessing food during the pandemic and its impact on healthcare access. Thus, we aimed to identify the association between pandemic-related challenges accessing food and primary healthcare among sex workers. METHODS Prospective data were drawn from a cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access, AESHA; 2010-present). Data were collected via questionnaires administered bi-annually from October 2020-August 2021. We used univariate and multivariable logistic regression with generalized estimating equations to assess the association between pandemic-related challenges accessing food and challenges accessing primary healthcare over the study period. RESULTS Of 170 participants, 41% experienced pandemic-related challenges in accessing food and 26% reported challenges accessing healthcare. Median age was 45 years (IQR:36-53), 56% were of Indigenous ancestry, 86% experienced intimate partner violence in the last six months, and 62% reported non-injection substance use in the last six months. Experiencing pandemic-related challenges accessing food was positively associated with challenges accessing primary healthcare (Adjusted Odds Ratio: 1.99, 95% Confidence Interval: 1.02-3.88) after adjustment for confounders. CONCLUSIONS Findings provide insight about the potential role community-based healthcare delivery settings (e.g., community clinics) can play in ameliorating access to basic needs such as food among those who are highly marginalized. Future pandemic response efforts should also take the most marginalized populations' needs into consideration by establishing strategies to ensure continuity of essential services providing food and other basic needs. Lastly, policies are needed establishing basic income support and improve access to food resources for marginalized women in times of crisis.
Collapse
Affiliation(s)
- Elizabeth Frost
- Joint Doctoral Program in Public Health, San Diego State University and UC San Diego, San Diego, USA
| | - Kate Shannon
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
- Division of Social Medicine, University of British Columbia, Vancouver, Canada
| | - Melissa Braschel
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | - Jennie Pearson
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Chelsey Perry
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Shira M Goldenberg
- Center for Gender and Sexual Health Equity, University of British Columbia Faculty of Medicine, Vancouver, Canada.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA.
| |
Collapse
|
3
|
Becker M, Mishra S, Bhattacharjee P, Musyoki H, Tennakoon A, Leung S, Cheuk E, Lorway R, Isac S, Ma H, Cholette F, Sandstrom P, Gichangi P, Mwatelah R, Mckinnon L, Blanchard J, Pickles M. Differential Burden of HIV Among Adolescent Girls and Young Women by Places Associated With Sex Work: An Observational Study in Mombasa, Kenya. J Acquir Immune Defic Syndr 2024; 96:121-129. [PMID: 38771751 DOI: 10.1097/qai.0000000000003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/02/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The design of HIV prevention programs for adolescent girls and young women (AGYW) are informed by data on who is at highest risk and where they can be reached. Places (hotspots) associated with selling sex are an established outreach strategy for sex work (SW) programs but could be used to reach other AGYW at high risk. SETTING This study took place in Mombasa, Kenya. METHODS We conducted a cross-sectional, bio-behavioural survey among (N = 1193) sexually active AGYW aged 14-24 years recruited at hotspots. We compared HIV prevalence by subgroup (SW; transactional sex, TS; and non-transactional sex), stratified by hotspot type (venues and nonvenues). We examined whether associations between HIV prevalence and hotspot/subgroup remained after adjustment for individual-level risk factors, and estimated HIV prevalence ratio with and without adjustment for these individual-level factors. RESULTS Overall HIV prevalence was 5.6%, 5.3% in venues and 7.3% in nonvenues. Overall SW HIV prevalence was 2-fold higher than among participants engaged in nontransactional sex. After adjusting for age and individual-level risk factors, HIV prevalence was 2.72 times higher among venue-based SWs (95% confidence interval: 1.56 to 4.85) and 2.11 times higher among nonvenue AGYW not engaged in SW (95% confidence interval: 0.97 to 4.30) compared with venue-based AGYW not engaged in SW. CONCLUSION AGYW who sell sex remain at high risk of HIV across types of hotspots. The residual pattern of elevated HIV burden by AGWY subgroup and hotspot type suggests that unmeasured, network-level factors underscore differential risks. As such, hotspots constitute a "place" to reach AGYW at high risk of HIV.
Collapse
Affiliation(s)
- Marissa Becker
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Aruni Tennakoon
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stella Leung
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Eve Cheuk
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Lorway
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- India Health Action Trust, New Delhi, India
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, J.C. Wilt Infectious Diseases Research Centre at the National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | | | - Ruth Mwatelah
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lyle Mckinnon
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya; and
| | - James Blanchard
- Department of Community Health Sciences, Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
4
|
Nwosu KD, Kalaiwo A, Ngambi WF, Estill J, Omo-Emmanuel UK, Emmanuel G, Keiser O. Factors associated with viral load testing and viral suppression among HIV-positive female sex workers in Nigeria. PLoS One 2024; 19:e0304487. [PMID: 38820395 PMCID: PMC11142602 DOI: 10.1371/journal.pone.0304487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Female sex workers (FSWs) are at high risk for HIV infection and face unique barriers to receiving and adhering to testing and treatment. Early viral suppression and consistent viral load testing are critical to optimizing health and reducing transmission in this population. However, the factors associated with testing and successful viral suppression among FSWs are poorly understood, especially in Sub-Saharan Africa. Our study aimed to examine factors, including social, demographic, and clinical characteristics, associated with viral load testing and suppression among female sex workers initiating antiretroviral therapy in Nigeria. METHODS In this retrospective study, we analyzed routine programmatic data from FSWs enrolled in the National HIV Key Populations (KP) program in Nigeria. We included FSWs who were newly diagnosed with HIV and registered between January 2016 and January 2022. Primary outcomes of interest were a), receiving a viral load test at any point after treatment initiation and b), viral suppression (<1000 copies/ml) at the test closest to 6 months after treatment initiation. To identify factors associated with the outcomes of interest, we used univariable and multivariable logistic regression, with random intercepts for care facilities, and multiple imputation for missing values. FINDINGS Out of 34,976 FSWs, 97.1% (n = 33,945) received at least one viral load test, with 94.5% (n = 32,092) indicating viral suppression. The odds of receiving at least one viral load test were higher for those who entered treatment in more recent years, those with formal education and those with advanced HIV stages at baseline (adjusted odds ratios [aOR]: 1.17 [1.14-1.19] for those who entered treatment in 2020 vs. 2016; 1.02 [1.01-1.03] for post-secondary vs. no education; and 1.05 [1.01-1.10] for WHO clinical stage 3/4 vs. stage 1 respectively). The odds of successful viral suppression were higher for those who entered treatment in more recent years, but lower for those with advanced HIV stages at baseline (aOR: 1.13 [1.09-1.18] for 2022 vs. 2016; and 0.92 [0.87-0.98] for WHO clinical stage 3/4 vs. stage 1 respectively). CONCLUSIONS The study underscored the relevance of timely diagnosis and ART initiation for optimal outcomes among HIV-positive FSWs in Nigeria. We also observed significant improvements in the likelihood of early viral load testing and suppression over the study period, reflecting advancements in the KP program. Further research should clarify factors driving these trends to further strengthen the HIV care pipeline for female sex workers.
Collapse
Affiliation(s)
- Kene David Nwosu
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Abiye Kalaiwo
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Office of HIV/AIDS and TB, US Agency for International Development, Abuja, Nigeria
| | - Wingston Felix Ngambi
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Department of Health Systems and Policy, Health Economics and Policy Unit, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | | | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| |
Collapse
|
5
|
Comins CA, Baral S, Mcingana M, Shipp L, Phetlhu DR, Young K, Guddera V, Hausler H, Schwartz S. ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002783. [PMID: 38776334 PMCID: PMC11111033 DOI: 10.1371/journal.pgph.0002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/04/2024] [Indexed: 05/24/2024]
Abstract
In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.
Collapse
Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Lily Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Deliwe Rene Phetlhu
- Department of Nursing, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | - Harry Hausler
- TB HIV Care, Cape Town, South Africa
- University of Pretoria, Pretoria, South Africa
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
6
|
Gedefie A, Debash H, Asmamaw S, Getaneh FB, Alemayehu E, Molla A, Kassaw AB, Kebede B. Epidemiology of an overlapping and parallel infection of Sexually Transmitted Infections among pregnant women in North-east Ethiopia: Its implication for prevention of mother to child transmission. PLoS One 2024; 19:e0300149. [PMID: 38768132 PMCID: PMC11104588 DOI: 10.1371/journal.pone.0300149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/22/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The burden of parallel and overlapping infections of Sexually Transmitted Infections (STIs), particularly HIV, syphilis, hepatitis B (HBV), and hepatitis C virus (HCV) are disproportionately higher among pregnant women globally, leading to unwanted consequences. These infections pose significant public health challenges as they can be transmitted vertically to the offspring. This study aimed to determine the sero-epidemiological patterns and predictors of STIs (HIV, syphilis, HBV, and HCV) among pregnant women attending antenatal care clinics at ten health facilities in North-eastern Ethiopia. METHODS An institution-based multi-center cross-sectional study was conducted from May to November 2022 among 422 pregnant women selected using simple random sampling technique. Semi-structured questionnaire was used to collect socio-demographic characteristics and predictor variables of STIs through face-to-face interviews. Venous blood was collected and it was tested for anti-HIV, HBsAg, anti-HCV, and anti-Treponemal antibodies using immunochromatographic test kits. Multinomial logistic regression analysis was used to identify associated factors of STIs. Variables with an adjusted odds ratio (AOR) and a p-value <0.05 were considered statistically significant. RESULTS The overall prevalence of STIs was 23.9% (95% CI = 20.08-28.25). The prevalence of parallel infections of HIV, hepatitis B, hepatitis C, and syphilis were 6.4%, 9%, 1.7%, and 6.9%, respectively. The overlapping infections for HIV-HBV was 4% but HIV-HCV overlapping infection wasn't found. Increased age, tattooing, multiple sexual partners, exposure to unsafe sex, and RH status were independent factors of HBV. Likewise, increased age, rural residence, illiteracy, and tattooing were independently associated with HCV. Moreover, rural residence and a history of tattooing were independent predictors for the acquisition of HIV, whereas multiple sexual partners and RH status were found to be significant predictors of syphilis infection among pregnant women. CONCLUSION The magnitude of overlapping and parallel STD infections is still continued to be a problem among pregnant women. Moreover, there were overlapping infections of HBV-HIV. Therefore, continuous screening of pregnant women for HIV, syphilis, hepatitis B, and C infections should be performed, and special attention should be given to pregnant women who have co-infections.
Collapse
Affiliation(s)
- Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shambel Asmamaw
- Department of Medical Laboratory Sciences, Tropical College of Medicine, Dessie, Ethiopia
| | - Fekadesilassie Belege Getaneh
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asressie Molla
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Altaseb Beyene Kassaw
- Department of Biochemistry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Berhanu Kebede
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| |
Collapse
|
7
|
Tozan Y, Kiyingi J, Kim S, Nabayinda J, Namuwonge F, Nsubuga E, Nakabuye F, Sensoy OB, Nabunya P, Mayo-Wilson LJ, McKay MM, Witte SS, Ssewamala FM. Costing of a Combination Intervention (Kyaterekera) Addressing Sexual Risk-Taking Behaviors among Vulnerable Women in Southern Uganda. Am J Trop Med Hyg 2024; 110:1046-1056. [PMID: 38579695 PMCID: PMC11066365 DOI: 10.4269/ajtmh.23-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/25/2024] [Indexed: 04/07/2024] Open
Abstract
In Uganda, women engaged in sex work (WESW) are a marginalized population at the intersection of multiple vulnerabilities. The Kyaterekera intervention is targeted at WESW in Rakai and the greater Masaka regions in Uganda and combines a traditional HIV risk-reduction approach with a savings-led economic empowerment intervention and financial literacy training. We estimated the economic costs of the Kyaterekera intervention from a program provider perspective using a prospective activity-based micro-costing method. All program activities and resource uses were measured and valued across the control arm receiving a traditional HIV risk-reduction intervention and the treatment arm receiving a matched individual development savings account and financial literacy training on top of HIV risk reduction. The total per-participant cost by arm was adjusted for inflation and discounted at an annual rate of 3% and presented in 2019 US dollars. The total per-participant costs of the control and intervention arms were estimated at $323 and $1,435, respectively, using the per-protocol sample. When calculated based on the intent-to-treat sample, the per-participant costs were reduced to $183 and $588, respectively. The key cost drivers were the capital invested in individual development accounts and personnel and transportation costs for program operations, linked to WESW's higher mobility and the dispersed pattern of hot spot locations. The findings provide evidence of the economic costs of implementing a targeted intervention for this marginalized population in resource-constrained settings and shed light on the scale of potential investment needed to better achieve the health equity goal of HIV prevention strategies.
Collapse
Affiliation(s)
- Yesim Tozan
- School of Global Public Health, New York University, New York, New York
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Sooyoung Kim
- School of Global Public Health, New York University, New York, New York
| | | | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Edward Nsubuga
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Fatuma Nakabuye
- International Center for Child Health and Development, Masaka, Uganda
| | - Ozge Bahar Sensoy
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Susan S. Witte
- Columbia University School of Social Work, New York, New York
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
8
|
Walker JG, Elmes J, Grenfell P, Eastham J, Hill K, Stuart R, Boily MC, Platt L, Vickerman P. The impact of policing and homelessness on violence experienced by women who sell sex in London: a modelling study. Sci Rep 2024; 14:8191. [PMID: 38589373 PMCID: PMC11002010 DOI: 10.1038/s41598-023-44663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/11/2023] [Indexed: 04/10/2024] Open
Abstract
Street-based sex workers experience considerable homelessness, drug use and police enforcement, making them vulnerable to violence from clients and other perpetrators. We used a deterministic compartmental model of street-based sex workers in London to estimate whether displacement by police and unstable housing/homelessness increases client violence. The model was parameterized and calibrated using data from a cohort study of sex workers, to the baseline percentage homeless (64%), experiencing recent client violence (72%), or recent displacement (78%), and the odds ratios of experiencing violence if homeless (1.97, 95% confidence interval 0.88-4.43) or displaced (4.79, 1.99-12.11), or of experiencing displacement if homeless (3.60, 1.59-8.17). Ending homelessness and police displacement reduces violence by 67% (95% credible interval 53-81%). The effects are non-linear; halving the rate of policing or becoming homeless reduces violence by 5.7% (3.5-10.3%) or 6.7% (3.7-10.2%), respectively. Modelled interventions have small impact with violence reducing by: 5.1% (2.1-11.4%) if the rate of becoming housed increases from 1.4 to 3.2 per person-year (Housing First initiative); 3.9% (2.4-6.9%) if the rate of policing reduces by 39% (level if recent increases had not occurred); and 10.2% (5.9-19.6%) in combination. Violence reduces by 26.5% (22.6-28.2%) if half of housed sex workers transition to indoor sex work. If homelessness decreased and policing increased as occurred during the COVID-19 pandemic in 2020, the impact on violence is negligible, decreasing by 0.7% (8.7% decrease-4.1% increase). Increasing housing and reducing policing among street-based sex workers could substantially reduce violence, but large changes are needed.
Collapse
Affiliation(s)
- Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kathleen Hill
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| |
Collapse
|
9
|
Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
10
|
Parmley LE, Miller SS, Chingombe I, Mapingure M, Mugurungi O, Rogers JH, Musuka G, Samba C, Hakim AJ, Harris TG. Social and structural drivers of HIV vulnerability among a respondent-driven sample of feminine and non-feminine presenting transgender women who have sex with men in Zimbabwe. J Int AIDS Soc 2024; 27:e26231. [PMID: 38627887 PMCID: PMC11021625 DOI: 10.1002/jia2.26231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation. METHODS A secondary analysis was conducted with a sub-sample of participants recruited from a 2019 respondent-driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio-demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi-square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation. RESULTS Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20-26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non-injection drug use (38.3% vs. 20.2%) than non-feminine presenting TGW (all p-value <0.05). CONCLUSIONS Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender-affirming, psychosocial and legal support services for TGW, might mitigate risk.
Collapse
Affiliation(s)
| | | | | | | | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child CareHarareZimbabwe
| | - John H. Rogers
- Division of Global HIV & TBU.S. Centers for Disease ControlHarareZimbabwe
| | | | | | - Avi J. Hakim
- Division of Global HIV & TBU.S. Centers for Disease ControlAtlantaGeorgiaUSA
| | - Tiffany G. Harris
- ICAP at Columbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
| |
Collapse
|
11
|
Vergara CI, Solymosi R. Correlates of Client-Perpetrated Violence Against Female Sex Workers in Bogotá. Violence Against Women 2024; 30:743-767. [PMID: 36482734 PMCID: PMC10854203 DOI: 10.1177/10778012221142919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
This paper aims to estimate the prevalence of client-perpetrated violence against female sex workers (FSWs) in Bogotá and to understand what structural and environmental factors are associated with such victimization. The project used secondary data from interviews with 2,684 FSWs. Multivariable binary logistic regression was used to test for associations with client-perpetrated violence. Findings reveal that factors such as experiencing police harassment and social stigma were positively associated with client-perpetrated violence. Situational factors such as providing services in motels, hotels, on the street, and in cars were also associated with increased odds of becoming a victim of violence.
Collapse
Affiliation(s)
| | - Reka Solymosi
- Department of Criminology, University of Manchester, Manchester, UK
| |
Collapse
|
12
|
Rosen JG, Knox JR, Rucinski KB, Mcingana M, Mulumba N, Comins CA, Shipp L, Makama S, Beckham SW, Hausler H, Baral SD, Schwartz SR. Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis. J Acquir Immune Defic Syndr 2024; 95:222-230. [PMID: 38032752 PMCID: PMC10922222 DOI: 10.1097/qai.0000000000003356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/14/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW. SETTING A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018-2020). METHODS We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga . We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL). RESULTS Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only , HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86). CONCLUSION HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
Collapse
Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Justin R. Knox
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Katherine B. Rucinski
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - Carly A. Comins
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lillian Shipp
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Siyanda Makama
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry Hausler
- Department of Psychiatry, Irving Medical Center, Columbia University, New York, New York, United States
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheree R. Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| |
Collapse
|
13
|
Salazar M, Silverman JG, Rangel Gómez MG, Urada LA, Brouwer KC, Reed E. Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico. Int J STD AIDS 2024; 35:147-154. [PMID: 37934459 DOI: 10.1177/09564624231214287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.
Collapse
Affiliation(s)
- Marissa Salazar
- School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - María Gudelia Rangel Gómez
- US-Mexico Border Health Commission, Tijuana, Mexico
- El Colegio de la Frontera Norte (COLEF), Tijuana, Mexico
| | - Lianne A Urada
- School of Social Work, San Diego State University, San Diego, CA, USA
| | | | - Elizabeth Reed
- School of Public Health, San Diego State University, San Diego, CA, USA
| |
Collapse
|
14
|
Ssenyonjo J, Mistler C, Adler T, Shrestha R, Kyambadde P, Copenhaver M. Examining HIV Knowledge and Sexually Risky Behaviors among Female Sex Workers in Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:163. [PMID: 38397654 PMCID: PMC10888220 DOI: 10.3390/ijerph21020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
HIV incidence remains alarmingly high among female sex workers (FSWs) in Uganda, necessitating targeted interventions. This study aimed to identify individual and provider-level barriers and facilitators to primary HIV prevention among FSWs in an urban setting. Focus groups involving FSWs and healthcare providers (HCPs) were conducted to inform the development of tailored prevention interventions. Results revealed that all participants had mobile phones, recent sexual activity, and a history of HIV testing, with high rates of sexually transmitted infections and varying HIV test results. FSWs displayed a well-informed awareness of HIV transmission risks, emphasizing the threat for those not testing positive. They unanimously recognized the crucial role of HIV testing in informing, mitigating risks, promoting ART use, and endorsing consistent condom usage. Despite heightened awareness, HCPs noted potential underestimation of vulnerability. Various challenges, including inadequate condom usage, substance abuse, and client dynamics, underscored the complexity of safeguarding against HIV transmission among FSWs. Widespread alcohol and drug use, including marijuana, kuber, and khat, served as coping mechanisms and social facilitators. Some FSWs successfully reduced alcohol intake, highlighting challenges in addressing substance use. FSWs preferred group discussions in health education programs, emphasizing peer interactions and the effectiveness of visual aids in HIV prevention education. This study provides comprehensive insights to guide the development of targeted interventions addressing the multi-faceted challenges FSWs face in HIV prevention.
Collapse
Affiliation(s)
- Jude Ssenyonjo
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen Mistler
- Division of Prevention and Community Research, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Tanya Adler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Peter Kyambadde
- Most At-Risk Populations Initiative-MARPI, Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
15
|
Kawser M, Khan MNI, Hossain KJ, Islam SN. Social and structural determinants associated with the prevalence of sexually transmitted infections among female commercial sex workers in Dhaka City, Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002797. [PMID: 38236834 PMCID: PMC10796017 DOI: 10.1371/journal.pgph.0002797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/16/2023] [Indexed: 01/22/2024]
Abstract
Female commercial sex workers (FCSWs) bear higher rates of sexually transmitted infections (STIs) among key populations. The association of structural determinants and STIs among FCSWs was not at the forefront of research earlier in Bangladesh. This study examined how structural factors correlate with the prevalence of STIs at physical/social/economic/policy levels among FCSWs in Dhaka city. 495 FCSWs were screened for HIV, hepatitis B, and syphilis. Structural variables (Individual risks, high-risk sexual behaviors, work environments) were extracted from the previous multi-level study on FCSWs and analyzed in 2020 to determine whether macro/micro-structural factors were associated with STIs. The prevalence of STIs was 43.6% (95% CI: 39.1%-48). Most (n = 207/495) FCSWs were infected with Syphilis or Hepatitis B, only 1.8% had co-infection, and none was positive for HIV. Multiple logistic regression revealed that 'Individual risk' factors like age (≤18 years, adjusted odds ratio = AOR = .28; 18.1-29.9 years, AOR = .57), years in the sex industry (<1 year AOR = .15; 1-5 years, AOR = .39), and condoms as contraceptives (AOR = 2.7) were significantly associated with STIs. Considering 'High-risk behaviors' like monthly coitus with regular clients (AOR = .33), performing no anal sex ever (AOR = .03), and consistent condom use (AOR = .13) were less likely to be associated with STIs (P<0.05), while the association of ever group sex with STIs reported to double (AOR = 2.1). 'Work environment' like sex on roads/parks/shrines/markets (AOR = 2.6) and ever HIV-testing (AOR = 2.5) were significantly linked with STIs. However, micro-level factors like experiencing forced sex in the past year (AOR = 1.79) and condoms collected from hotel boys (AOR = .34) were significantly associated with STIs in the 'Hierarchical- model' with increasing model-power. 'Micro-structural' determinants predominated over 'Macro/policy-level factors' and profoundly influenced STIs. FCSWs need comprehensive and integrated interventions to promote accurate condom use perception, eliminate risky sexual behaviors, and provide quality reproductive health care. Necessary steps at the policy level are urgently needed to decriminalize commercial sex work.
Collapse
Affiliation(s)
- Mahbuba Kawser
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | | | - Kazi Jahangir Hossain
- National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, Bangladesh
| | - Sheikh Nazrul Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| |
Collapse
|
16
|
Beattie TS, Adhiambo W, Kabuti R, Beksinska A, Ngurukiri P, Babu H, Kung’u M, Nyamweya C, Mahero A, Irungu E, Muthoga P, Seeley J, Kimani J, Weiss HA, Kaul R. The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001529. [PMID: 38190358 PMCID: PMC10773933 DOI: 10.1371/journal.pgph.0001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/26/2023] [Indexed: 01/10/2024]
Abstract
High HIV prevalence among female sex workers (FSWs) is heavily influenced by structural determinants (e.g. criminalisation of sex work; violence) and significant life events (e.g. orphanhood, teenage pregnancy). This study aims to understand the epidemiology of HIV among FSWs in Nairobi, Kenya using a structural determinants and life-course perspective. Baseline cross-sectional survey data were collected June-December 2019 for the Maisha Fiti study with 1003 FSWs (aged 18-45 years). Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression with a hierarchical modelling approach. HIV prevalence was 28.0%, and increased with age (<25 years 5.7%, 25-34 years 19.0%, ≥35 years 40.6%). In adjusted analyses, HIV seroprevalence was associated with childhood and adolescence including violence from militia or soldiers (AOR = 1.60; 95%CI:1.00-2.53), young age at sexual debut (≤15 years old vs. ≥18 years AOR = 0.57; 95%CI:0.39-0.84) and teenage pregnancy (AOR = 1.37; 95%CI:1.00-1.88). For adulthood the factors included lower SES score (lowest vs. highest tertile AOR = 0.63; 95%CI:0.40-0.98); reduced housing insecurity (AOR = 0.52; 95%CI:0.54-0.79); lower alcohol/drug use score (AOR = 0.44; 95%CI:0.31-0.61); and a longer duration of selling sex (0-5 years vs. ≥11 years AOR = 2.35; 95%CI:1.44-3.82). Among HIV-negative FSWs, prevalence of HIV risk factors was high (recent hunger 32.3%; internalised 67.7% and experienced 66.0% sex work stigma; recent police arrest 30.1%; recent physical or sexual violence 65.6%, condomless last sex intimate partner 71.1%; harmful alcohol or substance use 49.1%). Only 24.6% of HIV-negative FSWs reported taking PrEP. Taken together, adverse events in childhood and adolescence were associated with increased odds of living with HIV, and were more strongly associated with HIV serostatus than adulthood structural or behavioural risk factors. HIV-negative FSWs remain at high risk of HIV acquisition. This study highlights the importance of addressing adverse events throughout the life course to reduce HIV risk, and the need to continue multi-level HIV prevention and treatment efforts.
Collapse
Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- UNITID, University of Nairobi, Nairobi, Kenya
| | - Helen A. Weiss
- Department of Infectious Disease Epidemiology and International Health, MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rupert Kaul
- Department of Immunology, University of Toronto, Ontario, Canada
| |
Collapse
|
17
|
Barreto D, Deering K, Krüsi A, Ranville F, Safford H, Pooyak S, Braschel M, Kestler M, Ogilvie G, Shoveller J, Shannon K. HIV disclosure without consent linked to increased violence against women living with HIV in a Canadian setting. AIDS Care 2024; 36:98-106. [PMID: 37217168 PMCID: PMC10663381 DOI: 10.1080/09540121.2023.2209304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
Our study examined the association between HIV disclosure without consent and verbal and/or physical violence due to HIV status among women living with HIV (WLWH). This study draws on baseline data of a sample (N = 316) from SHAWNA, a longitudinal community-based open cohort with WLWH in Metro Vancouver, Canada (2010-2019). Bivariate and multivariable logistic regression was used to investigate factors associated with physical and/or verbal violence due to HIV status. Adjusted odds ratios (AOR) and 95% confidence intervals [95%CIs] are reported. In total, 46.5% experienced non-consensual disclosure of HIV status without consent and 34.2% experienced physical and/or verbal violence related to HIV status in their lifetime. In multivariable analysis, HIV disclosure without consent was associated with increased odds of experiencing HIV-related physical and/or verbal violence (AOR: 7.46[4.21-13.21]). Lifetime exposure to homelessness was also associated with increased odds of physical and/or verbal violence due to HIV status (AOR: 2.15[1.03-4.49]). This research underscores the reality of HIV stigmatization and criminalization and suggests a critical need to remove HIV disclosure from the reach of criminal law and ensure women's rights to confidentiality. Governments and organizations must work to identify and address the drivers of various levels of stigma and gender-based violence and invest in inclusive, trauma-informed, culturally safe support and care programs and policies designed in collaboration with WLWH.
Collapse
Affiliation(s)
- Daniella Barreto
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
| | - Heidi Safford
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
| | | | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Mary Kestler
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
- Oak Tree Clinic, BC Women’s Hospital
and Health Centre, Vancouver, Canada
| | - Gina Ogilvie
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
- Oak Tree Clinic, BC Women’s Hospital
and Health Centre, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, BC,
Canada
| | - Jeannie Shoveller
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver,
Canada
- University of British Columbia, Faculty of Medicine,
Vancouver, Canada
| |
Collapse
|
18
|
Mulenga DM, Rosen JG, Banda L, Musheke M, Mbizvo MT, Raymond HF, Keating R, Witola H, Phiri L, Geibel S, Tun W, Pilgrim N. "I Have to Do It in Secrecy": Provider Perspectives on HIV Service Delivery and Quality of Care for Key Populations in Zambia. J Assoc Nurses AIDS Care 2024; 35:27-39. [PMID: 38019138 PMCID: PMC10842367 DOI: 10.1097/jnc.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
ABSTRACT Key populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers.
Collapse
Affiliation(s)
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Henry F. Raymond
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ryan Keating
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Harold Witola
- National HIV/AIDS/STI/TB Council, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | | | | |
Collapse
|
19
|
Alonso D, Vallès X. A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. Infect Dis Poverty 2023; 12:112. [PMID: 38057918 DOI: 10.1186/s40249-023-01164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study. METHODS We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers. RESULTS The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar. CONCLUSIONS These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.
Collapse
Affiliation(s)
- David Alonso
- Computational and Theoretical Ecology, Spanish Council for Scientific Research (CEAB-CSI)C, C/Access Cala Francesc, 14, 17300, Blanes, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), North Metropolitan Health Area From Barcelona, Hospital Universitari Germans Trias i Pujol, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, C/Canyet s/n, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, C/Canyet s/n, 08916, Badalona, Spain.
| |
Collapse
|
20
|
Decriminalisation and the end of AIDS: keep the promise, follow the science, and fulfill human rights. Sex Reprod Health Matters 2023; 31:2194188. [PMID: 37351922 PMCID: PMC10291907 DOI: 10.1080/26410397.2023.2194188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
|
21
|
Emanuel E, Slater L, Croxford S, Edmundson C, Ibitoye A, Njoroge J, Ijaz S, Hope V, Platt L, Phipps E, Desai M. Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey. Public Health 2023; 225:79-86. [PMID: 37922590 DOI: 10.1016/j.puhe.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. STUDY DESIGN The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. METHODS Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. RESULTS Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043). CONCLUSIONS Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.
Collapse
Affiliation(s)
- E Emanuel
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - L Slater
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom.
| | - S Croxford
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - A Ibitoye
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - J Njoroge
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Ijaz
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V Hope
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom; Liverpool John Moores University, Liverpool, United Kingdom
| | - L Platt
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E Phipps
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Desai
- Blood Safety, Hepatitis, STI and HIV Service, UK Health Security Agency, London, United Kingdom
| |
Collapse
|
22
|
Longo JDD, Woromogo SH, Diemer HSC, Tekpa G, Nambei WS, Grésenguet G. Young women who sell sex in Bangui, Central African Republic: a neglected group highly vulnerable to HIV. J Public Health (Oxf) 2023; 45:e630-e638. [PMID: 37477242 DOI: 10.1093/pubmed/fdad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15-24 years) and adult sex workers, engaged in consensual sex for money (AFSW). METHODS A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model. RESULTS The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR = 1.43 [1.07-1.91]). Consistent condoms use last 3 months were very low at 22.3% and 41.2%, respectively (PR = 0.52 [0.37-0.74]), the low education level among YWSS versus AFSW (PR = 0.55 [0.40-0.76]); YWSS having been a victim of sexual violence in the last 12 months (PR = 2.00 [1.52-2.63]), were also more likely to be HIV positive. CONCLUSIONS The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk.
Collapse
Affiliation(s)
- Jean de Dieu Longo
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
| | - Sylvain Honoré Woromogo
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
- Communicable Diseases Unit, Inter-State Centre for Higher Education in Public Health of Central Africa, Brazzaville, Republic of Congo
| | - Henri Saint-Calvaire Diemer
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
| | - Gaspard Tekpa
- Department of Infectious and Tropical Diseases, University Hospital of Friendship, Bangui, Central African Republic
| | | | - Gérard Grésenguet
- National Reference Centre for Sexually Transmitted Diseases and Antiretroviral Therapy, Bangui, Central African Republic
- Department of Public Health, Faculty of Health Sciences, Unit for Research and Intervention in Public Health, Bangui, Central African Republic
| |
Collapse
|
23
|
Guure C, Dery S, Afagbedzi S, Maya E, da-Costa Vroom FB, Torpey K. Correlates of prevalent HIV infection among adolescents, young adults, and older adult female sex workers in Ghana: Analysis of data from the Ghana biobehavioral survey. PLoS One 2023; 18:e0292686. [PMID: 37976280 PMCID: PMC10655993 DOI: 10.1371/journal.pone.0292686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus infection remains a high burden among key populations such as female sex workers in the world. We aimed to provide distribution of prevalence and correlates of Human immunodeficiency virus infection among adolescent, young, and older adult FSWs in Ghana. METHODS This data was obtained from the biobehavioral survey of female sex workers (2020) in Ghana based on a time location sampling approach for the selection of respondents. A sampling frame was developed taking into consideration list of venues, days, and time that sex workers operate across all the regions of Ghana. These lists were derived from a sampling universe which was obtained during a mapping exercise. All sex workers aged 16 years and above and eligible on the day of visit participated. Human immunodeficiency virus testing was done based on First Response and Oraquick. To obtain estimates for sex workers, sampling weights were calculated and applied to the dataset. Inferential analyses using Bayesian regression models were applied with interaction effects. RESULTS A total of 5,990 participants completed both the biological and behavioral aspects of the study. The HIV prevalence among female sex workers in Ghana was 4.67% (CI: 4.05%, 5.40%). About 70% of the respondents who tested positive for Human immunodeficiency virus were among the older adults (= >25 years) group. Generally, there was a high prevalence variation across the 16 regions of Ghana, from 0.00% to 8.40%. Respondents' age was a significant contributor to the prevalence of HIV. Respondents who were forced into having sex had higher odds (38%) of being positive in the combined analysis. Respondents who had comprehensive knowledge of HIV had lower odds (39%) of testing positive. CONCLUSION The findings suggest a low prevalence of HIV among sex workers in 2020 compared to the 2011 and 2015 biobehavioral survey results but higher than the general population. Specifically, older adults have a higher prevalence of HIV. There is generally low level of comprehensive knowledge among sex workers. Interventions geared towards increasing FSW knowledge on risky behavior should be vigorously pursued.
Collapse
Affiliation(s)
- Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
- AND Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Seth Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Ernest Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| |
Collapse
|
24
|
Aung SWKH, Kingston H, Mbogo LW, Sambai B, Monroe-Wise A, Ludwig-Barron NT, Bukusi D, Sinkele W, Gitau E, Masyuko S, Herbeck JT, Farquhar C, Guthrie BL. Prevalence and correlates of violence among sexual and injecting partners of people who inject drugs living with HIV in Kenya: a cross-sectional study. Harm Reduct J 2023; 20:164. [PMID: 37919736 PMCID: PMC10623850 DOI: 10.1186/s12954-023-00895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In Kenya, violence is common among people who inject drugs (PWID) living with HIV and their sexual and injecting partners and may lead to decreased uptake of HIV services, increased HIV risk behaviors, and increased HIV transmission. Violence is defined as any physical harm, threatened harm, or forced sexual acts inflicted on a person in the past year. Understanding the nature of violence and its correlates among PWID and their partners will inform population-specific public health interventions and policy recommendations. METHODS This is a cross-sectional study nested in a prospective cohort study conducted in eight public health centers, methadone clinics, and needle syringe programs in Nairobi, Kilifi, and Mombasa counties in Kenya. 3,302 sexual and/or injecting partners of PWID living with HIV were recruited through assisted partner services and participated in the study. Prevalence and correlates of violence were identified using the Wald test and negative binomial regression. RESULTS Out of 3302 study participants, 1439 (44%) had experienced violence within the past year. Physical violence was the most common form of violence experienced (35%), followed by being threatened (23%) or subjected to sexual violence (7%). In an adjusted analysis, female participants reported higher experiences of sexual violence (prevalence ratio [PR] = 2.46; 95% confidence interval [CI] 1.62, 3.74; p < 0.001) compared to male participants. In adjusted analysis, coastal residents had a higher experience of overall violence (PR = 1.48; 95% CI 1.27, 1.72; p < 0.001) than those living in Nairobi. This regional effect was relatively stronger among the female respondents (pinteraction = 0.025). Participants' sex modified the association between region and experiencing violence after adjusting potential confounding factors. CONCLUSIONS The study reveals the prevalence of violence among PWID and identifies high-risk sub-groups, including women, specifically for sexual violence, and coastal residents. Tailored interventions addressing their unique needs are essential. A holistic approach that combines violence prevention and response, comprehensive harm reduction, healthcare access, and community support is crucial to address the complex issue of drug use and HIV burden among PWID in Kenya for improved health outcomes.
Collapse
Affiliation(s)
| | | | - Loice W Mbogo
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | - Betsy Sambai
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | | | | | | | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Esther Gitau
- Support for Addiction Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Sarah Masyuko
- University of Washington, Seattle, WA, USA
- National AIDS and STI Control Programme (NASCOP), Kenya Ministry of Health, Nairobi, Kenya
| | | | | | | |
Collapse
|
25
|
Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
Collapse
Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
| |
Collapse
|
26
|
Perry C, Goldenberg S, Deering K, Patrick L, Braschel M, Shannon K, Bingham B. Structural racism and violence: Routine healthcare access in a cohort of marginalized Indigenous women and Two-Spirit Peoples during the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3450143. [PMID: 37961370 PMCID: PMC10635380 DOI: 10.21203/rs.3.rs-3450143/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objectives Historical and ongoing colonial violence, racism, discrimination, criminalization, and intergenerational trauma continues to impact the health of Indigenous women (cisgender and transgender) and Two-Spirit Peoples. Previous and ongoing work clearly articulate the deeply harmful roles of colonialism and racism in continuing to systemically exclude Indigenous Peoples from accessing equitable and culturally safe healthcare. While the COVID-19 pandemic has amplified structural inequities, little attention has been paid to how the pandemic impacts healthcare access for Indigenous women and Two-Spirit Peoples living in urban settings. The aim of this study was to evaluate factors associated with experiencing difficulty accessing routine healthcare in a cohort of marginalized urban Indigenous women and Two-Spirit Peoples on the ancestral, occupied territories of the Musqueam, Squamish and Tsleil-Waututh Nations in what is now referred to as Metro Vancouver, Canada during the COVID-19 pandemic. Methods Data were drawn from AMPLIFY, a study of Indigenous cis and trans women and Two-Spirit Peoples in Metro Vancouver. Analyses drew on baseline and semi-annual questionnaire data collected with sex workers and women living with HIV from October 2020-August 2021. We used bivariate and multivariable logistic regression with generalized estimating equations (GEE) to model correlates of experiencing difficulty accessing a family doctor, nurse, or clinic for routine healthcare during the COVID-19 pandemic in the last 6-months. Results Amongst 142 marginalized Indigenous women and Two-Spirit Peoples (199 observations), 27.5% reported difficulty accessing routine healthcare. In multivariable GEE logistic regression, participants who had ever been pregnant (AOR:4.71, 95% CI:1.33-16.66) experienced negative changes in psychological and emotional well-being (AOR: 3.99, 95% CI: 1.33-11.98), lacked access to culturally safe health services (AOR:4.67, 95% CI:1.43-15.25), and had concerns regarding safety or violence in their community (AOR:2.72, 95% CI:1.06-6.94) had higher odds of experiencing recent difficulty accessing routine healthcare. Discussion Findings are in line with the BC Commissioned In Plain Sight report which recommends the need for accessible, culturally safe, anti-racist, and trauma-informed routine healthcare for marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples during the current and future pandemics. More community-based research is needed to understand access needs for culturally safe routine healthcare amongst marginalized Indigenous cisgender and transgender women and Two-Spirit Peoples.
Collapse
|
27
|
McCrimmon T, Frye V, Darisheva M, Starbird L, Cordingley O, Terlikbayeva A, Primbetova S, Gilbert L, El-Bassel N, West BS. "Protected Means Armed": Perspectives on Pre-Exposure Prophylaxis (PrEP) Among Women Who Engage in Sex Work and Use Drugs in Kazakhstan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:347-361. [PMID: 37843909 PMCID: PMC10901454 DOI: 10.1521/aeap.2023.35.5.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention has recently become available in Kazakhstan, but women engaged in sex work who use drugs (WESW-UD) could benefit from tailored approaches to support uptake and adherence. To better understand how best to support WESW-UD at each stage of the PrEP continuum (awareness, acceptability, uptake, and adherence), we analyzed data from 30 in-depth interviews and four focus groups with 48 WESW-UD from two cities in Kazakhstan. We conducted thematic analysis to characterize perceptions, barriers, and motivators within each step of the PrEP continuum. Participants reported low awareness, but high interest in PrEP. Motivating factors included optimizing health and increased confidence. Participants expressed many preferences and concerns regarding PrEP modality and delivery. Participants also described how organizational mistrust and social support can prevent or facilitate PrEP uptake or adherence. Kazakhstan's scale-up of PrEP should consider the needs and preferences of WESW-UD to ensure equitable access.
Collapse
Affiliation(s)
- Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Victoria Frye
- Social Intervention Group, Columbia University School of Social Work, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Laura Starbird
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Olivia Cordingley
- Social Intervention Group, Columbia University School of Social Work, New York, New York
| | | | | | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Brooke S West
- Social Intervention Group, Columbia University School of Social Work, New York, New York
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| |
Collapse
|
28
|
Hinman K, Amon JJ. Human rights and HIV: rhetoric or determinants? BMJ Glob Health 2023; 8:e013571. [PMID: 37827727 PMCID: PMC10583038 DOI: 10.1136/bmjgh-2023-013571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
International donors and UN agencies emphasise the importance of human rights as a key determinant of HIV vulnerability and of access, uptake and retention in HIV prevention and treatment services. Yet, the extent to which HIV researchers are incorporating rights into their research, the specific rights being examined and the frequency of research assessing rights-based approaches, is unknown. METHODS We examined all articles published in the five highest impact-factor HIV journals: (1) Lancet HIV; (2) AIDS and Behavior; (3) AIDS; (4) Journal of the International AIDS Society (JIAS); and (5) Journal of Acquired Immune Deficiency Syndromes (JAIDS), between 1 January 2017 and 31 December 2022, for reference to 'human right(s)' or 'right(s)'. We analysed articles to assess: (1) what populations were identified in relation to specific human rights concerns; (2) what specific rights were mentioned; (3) whether researchers cited specific legal frameworks; and (4) if and what types of rights-based interventions were examined. RESULTS Overall, 2.8% (n=224) of the 8080 articles reviewed included a mention of 'human right(s)' or 'right(s)'. Forty-two per cent of these (n=94) were original research articles. The most common key population discussed was men who have sex with men (33 articles), followed by sex workers (21 articles) and transgender people (14 articles). Of the 94 articles, 11 mentioned the right to health and nine referenced reproductive rights. Few articles identified a specific authority-whether in national, regional or international law-for the basis of the rights cited. Fourteen articles discussed rights-based interventions. CONCLUSION Despite global recognition of the importance of human rights to HIV outcomes, few HIV researchers publishing in the top five cited HIV journals include attention to human rights, or rights-based interventions, in their research. When rights are mentioned, it is often without specificity or recognition of the legal basis for human rights.
Collapse
Affiliation(s)
- Kati Hinman
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Joseph J Amon
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| |
Collapse
|
29
|
Khezri M, Tavakoli F, Schwartz S, Karamouzian M, Sharifi H, McKnight CA, Jarlais DD, Baral S, Shokoohi M. Global epidemiology of abortion among female sex workers: a systematic review, meta-analysis, and meta-regression. Ann Epidemiol 2023; 85:13-37. [PMID: 37356778 DOI: 10.1016/j.annepidem.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/11/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Despite the evidence of a high rate of unintended pregnancy, there remains limited information about the prevalence and experiences of abortion among female sex workers (FSWs). In response, we aimed to summarize the available evidence on abortion among FSWs. METHODS We searched Medline, Embase, PsycINFO, CINAHL, Scopus, and Web of Science from inception to January 29, 2023 . We pooled data from the included studies using random-effects meta-analyses. We also grouped countries for the legality of elective abortion stratified by the United Nations database on abortion laws and policies. RESULTS We identified 60 eligible studies from 2031 potentially eligible records. The pooled lifetime prevalence of at least one and multiple induced abortions was 37.7% (95% confidence interval, 31.8-43.7) and 21.7% (14.9-29.2), respectively. Among FSWs recruited in countries where elective abortion is illegal, at least one induced abortion prevalence was 35.1% (28.1-42.4), and multiple induced abortion prevalence was 23.1% (12.4-35.9). In countries where elective abortion is legal, at least one induced abortion prevalence was 44.6% (34.8-54.6), and multiple induced abortion prevalence was 19.9% (11.9-29.3). Among FSWs experiencing abortion, self-managed abortion prevalence was estimated at 32.8% (23.6-42.7) overall, 42.8% (37.2-48.5) for countries where elective abortion is illegal, and 15.6% (3.9-32.7) for countries that legally allow elective abortion. CONCLUSIONS Induced abortion is prevalent among FSWs, highlighting the need for interventions to increase access to effective contraception and safe abortion care. While induced abortion prevalence did not significantly differ across the legal grounds for abortion, self-managed abortion prevalence was higher in countries where elective abortion was illegal, highlighting the urgent need for accessible abortion services for FSWs in criminalized settings. Moving forward necessitates implementing and evaluating culturally acceptable models of safe abortion and post-abortion care for FSWs to increase access to the full spectrum of sexual and reproductive health services.
Collapse
Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Courtney A McKnight
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York; Center for Drug Use and HIV/HCV Research, New York, NY
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.
| |
Collapse
|
30
|
Rock A, McNaughton Reyes HL, Go V, Maman S, Perez M, Donastorg Y, Kerrigan D, Barrington C. Relationships Between Stigma and Intimate Partner Violence Among Female Sex Workers Living With HIV: Social and Economic Exclusion. Violence Against Women 2023; 29:1971-1997. [PMID: 36344251 PMCID: PMC10387732 DOI: 10.1177/10778012221127722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Violence against female sex workers (FSWs) perpetrated by their intimate (i.e., non-commercial) partners, particularly against FSWs living with HIV, is understudied. Stigma can deplete the economic resources, social relationships, and mental well-being of stigmatized people, which may increase their intimate partner violence (IPV) risk. We quantitatively assessed relationships between HIV stigma and sex work stigma and IPV victimization among FSWs living with HIV in the Dominican Republic (n = 266). Enacted HIV stigma, in the form of job loss, and anticipated HIV stigma, in the form of fear of exclusion by family, were associated with increased IPV risk. Potential association mechanisms, including increased economic vulnerability and social isolation, and programmatic responses are discussed.
Collapse
Affiliation(s)
- Amelia Rock
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | | | - Vivian Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Suzanne Maman
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirurgia de Piel Dr. Humberto Bogaert Diaz, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, GWU Milken Institute School of Public Health, USA
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, USA
| |
Collapse
|
31
|
Semple SJ, Pines HA, Pitpitan EV, Harvey-Vera A, Martinez G, Rangel MG, Strathdee SA, Patterson TL. Correlates of impulsivity among female sex workers in Mexico. Health Care Women Int 2023; 44:1119-1135. [PMID: 34427544 PMCID: PMC8866522 DOI: 10.1080/07399332.2021.1958816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016-2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population.
Collapse
Affiliation(s)
- Shirley J. Semple
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| | - Heather A. Pines
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Eileen V. Pitpitan
- Department of Medicine, University of California San Diego, La Jolla, California USA
- School of Social Work, San Diego State University, San Diego, California USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California San Diego, La Jolla, California USA
| | - Gustavo Martinez
- Federación Méxicana de Asociaciones Privadas (FEMAP), Ciudad Juarez, Chihuahua, Mexico
| | - M. Gudelia Rangel
- US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
| | | | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California USA
| |
Collapse
|
32
|
Shaw SY, Leung S, Isac S, Musyoki H, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Melon M, Emmanuel F, Moses S, Blanchard JF, Pickles M, Lazarus L, Lorway RR, Becker ML, Mishra S, Bhattacharjee P. Assessing awareness and use of HIV self-testing kits after the introduction of a community-based HIV self-testing programme among men who have sex with men in Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001547. [PMID: 37594918 PMCID: PMC10437899 DOI: 10.1371/journal.pgph.0001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/18/2023] [Indexed: 08/20/2023]
Abstract
Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups.
Collapse
Affiliation(s)
- Souradet Y. Shaw
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stella Leung
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Helgar Musyoki
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Mary Mugambi
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | | | | | - Memory Melon
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Faran Emmanuel
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James F. Blanchard
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, England
| | - Lisa Lazarus
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert R. Lorway
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marissa L. Becker
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharmistha Mishra
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Parinita Bhattacharjee
- Institute for Global Public Health, Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
33
|
Poxon A, Leis M, McDermott M, Kariri A, Kaul R, Kimani J. Emergency departments as under-utilized venues to provide HIV prevention services to female sex workers in Nairobi, Kenya. Int J Emerg Med 2023; 16:47. [PMID: 37537558 PMCID: PMC10399019 DOI: 10.1186/s12245-023-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/02/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and remain a key target population for efforts to reduce transmission. While HIV prevention tools such as PEP and PrEP are available through outpatient FSW clinics, these services are underused. Emergency medicine is a rapidly expanding field in Kenya and may provide a novel venue for initiating or optimizing HIV prevention services. This study examined the characteristics of FSW from Nairobi, Kenya, who had utilized an emergency department (ED) during the past year to broaden our understanding of the patient factors related to usage. METHODS An anonymous questionnaire was administered to a convenience sample of 220 Nairobi FSW attending dedicated clinics from June to July 2019. The participants were categorized into those who attended an ED over the past year (acute care users) and clinic-only users (control). A modified version of the WHO Violence Against Women Instrument assessed gender-based violence. Multivariable negative binomial logistic regressions evaluated predictors of health care use among these populations. RESULTS Of the total 220 women (median [IQR] age 32 [27-39]), 101 and 116 were acute care and control populations, respectively. Acute care users had 12.7 ± 8.5 healthcare visits over a 12-month period, and the control population had 9.1 ± 7.0 (p < 0.05). ED attendance did not improve the PrEP usage, with 48.5%, and 51% of acute care and clinic users indicated appropriate PrEP use. Patient factors that correlated with health care utilization among acute care users included client sexual violence (OR 2.2 [1.64-2.94], p < 0.01), PrEP use (OR 1.54 (1.25-1.91), < 0.01), and client HIV status (OR 1.35 (1.02-1.69), p < 0.01). CONCLUSIONS Many FSW at high risk for HIV were not accessing HIV prevention tools despite attending a dedicated FSW clinic offering such services. FSW who had attended an ED over the past year had a higher prevalence of HIV risk factors, demonstrating that emergency departments may be important acute intervention venues to prevent HIV transmission in this population. These results can guide policy design, health care provider training, and facility preparedness to support strategies aimed at improving HIV prevention strategies for FSW in Kenyan ED's.
Collapse
Affiliation(s)
- Amanda Poxon
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada.
| | - Maria Leis
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Miranda McDermott
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Antony Kariri
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S1A8, Canada
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology, University of Manitoba, Manitoba, Canada
| |
Collapse
|
34
|
Jain JP, Hill M, Gamarel KE, Santos GM, Johnson MO, Neilands TB, Dilworth SE, Reback CJ, Sevelius J. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 2023; 27:2523-2534. [PMID: 36682008 PMCID: PMC10362091 DOI: 10.1007/s10461-023-03979-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.
Collapse
Affiliation(s)
- Jennifer P Jain
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Miranda Hill
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Samantha E Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Cathy J Reback
- Friends Research Institute, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Jae Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry, Columbia University, New York, USA
| |
Collapse
|
35
|
Rosas Cancio-Suárez M, Díaz-Álvarez J, Ron R, Martínez-Sanz J, Serrano-Villar S, Moreno S, Sánchez-Conde M. From Innovation to Implementation: The Evolution of HIV Pre-Exposure Prophylaxis and Future Implications. Pathogens 2023; 12:924. [PMID: 37513771 PMCID: PMC10384104 DOI: 10.3390/pathogens12070924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective HIV-prevention strategy that involves the continuous administration of antiretroviral drugs to HIV-negative individuals with a substantial risk of contracting an HIV infection. The use of PrEP has shown a reduction in the risk of HIV acquisition through sexual intercourse by up to 99%. Despite its effectiveness, PrEP uptake remains low among populations at high risk of HIV infection. This highlights the need for further research in strategies to enhance awareness and uptake of PrEP amongst these specific populations. This article presents a comprehensive overview of the existing literature on the effectiveness of PrEP in reducing HIV transmission rates. Additionally, we examine the obstacles related to PrEP implementation and uptake and put forward potential strategies to raise awareness and improve its use among populations at an increased risk of contracting HIV.
Collapse
Affiliation(s)
- Marta Rosas Cancio-Suárez
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Guadalajara Campus, 28801 Alcalá de Henares, Spain
| | - Jorge Díaz-Álvarez
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Raquel Ron
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Javier Martínez-Sanz
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Sergio Serrano-Villar
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Guadalajara Campus, 28801 Alcalá de Henares, Spain
| | - Matilde Sánchez-Conde
- Infectious Diseases Department, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- Ramón y Cajal Research Institute (IRYCIS), 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| |
Collapse
|
36
|
Choi JY, Poonkasetwattana M, Phanuphak N. Overcoming challenges across the HIV care continuum in the Asia-Pacific region: expert recommendations. BMJ Glob Health 2023; 8:e012722. [PMID: 37402512 DOI: 10.1136/bmjgh-2023-012722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/10/2023] [Indexed: 07/06/2023] Open
Affiliation(s)
- Jun Yong Choi
- Internal Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | | | | |
Collapse
|
37
|
Kloek M, Chabata ST, van Noord L, Machingura F, Makandwa R, Dirawo J, Takaruza A, Matambanadzo P, de Vlas SJ, Hontelez JAC, Cowan FM. HIV prevalence, risk behaviour, and treatment and prevention cascade outcomes among cisgender men, transgender women, and transgender men who sell sex in Zimbabwe: a cross-sectional analysis of programme data. Lancet HIV 2023; 10:e453-e460. [PMID: 37329898 DOI: 10.1016/s2352-3018(23)00088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is a paucity of evidence on HIV vulnerabilities and service engagements among people who sell sex in sub-Saharan Africa and identify as cisgender men, transgender women, or transgender men. We aimed to describe sexual risk behaviours, HIV prevalence, and access to HIV services among cisgender men, transgender women, and transgender men who sell sex in Zimbabwe. METHODS We did a cross-sectional analysis of routine programme data that were collected between July 1, 2018, and June 30, 2020, from cisgender men who sell sex, transgender women who sell sex, and transgender men who sell sex, as part of accessing sexual and reproductive health and HIV services provided through the Sisters with a Voice programme, at 31 sites across Zimbabwe. All people who sell sex reached by the programme had routine data collected, including routine HIV testing, and were referred using a network of peer educators. Sexual risk behaviours, HIV prevalence, and HIV services uptake during the period from July, 2018, to June, 2020, were analysed through descriptive statistics by gender group. FINDINGS A total of 1003 people who sell sex were included in our analysis: 423 (42·2%) cisgender men, 343 (34·2%) transgender women, and 237 (23·6%) transgender men. Age-standardised HIV prevalence estimates were 26·2% (95% CI 22·0-30·7) among cisgender men, 39·4% (34·1-44·9) among transgender women, and 38·4% (32·1-45·0) among transgender men. Among people living with HIV, 66·0% (95% CI 55·7-75·3) of cisgender men, 74·8% (65·8-82·4) of transgender women, and 70·2% (59·3-79·7) of transgender men knew their HIV status, and 15·5% (8·9-24·2), 15·7% (9·5-23·6), and 11·9% (5·9-20·8) were on antiretroviral therapy, respectively. Self-reported condom use was consistently low across gender groups, ranging from 26% (95% CI 22-32) for anal sex among transgender women to 32% (27-37) for vaginal sex among cisgender men. INTERPRETATION These unique data show that people who sell sex and identify as cisgender men, transgender women, or transgender men in sub-Saharan Africa have high HIV prevalences and risk of infection, with alarmingly low access to HIV prevention, testing, and treatment services. There is an urgent need for people-centred HIV interventions for these high-risk groups and for more inclusive HIV policies and research to ensure we truly attain universal access for all. FUNDING Aidsfonds Netherlands.
Collapse
Affiliation(s)
- Mariëlle Kloek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sungai T Chabata
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Laura van Noord
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fortunate Machingura
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Rumbidzo Makandwa
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan A C Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany.
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
38
|
Tordoff DM, Minalga B, Trejo A, Shook A, Kerani RP, Herbeck JT. Lessons learned from community engagement regarding phylodynamic research with molecular HIV surveillance data. J Int AIDS Soc 2023; 26 Suppl 1:e26111. [PMID: 37408448 PMCID: PMC10323319 DOI: 10.1002/jia2.26111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION The widespread implementation of molecular HIV surveillance (MHS) has resulted in an increased discussion about the ethical, human rights and public health implications of MHS. We narrate our process of pausing our research that uses data collected through MHS in response to these growing concerns and summarize the key lessons we learned through conversations with community members. METHODS The original study aimed to describe HIV transmission patterns by age and race/ethnicity among men who have sex with men in King County, Washington, by applying probabilistic phylodynamic modelling methods to HIV-1 pol gene sequences collected through MHS. In September 2020, we paused the publication of this research to conduct community engagement: we held two public-facing online presentations, met with a national community coalition that included representatives of networks of people living with HIV, and invited two members of this coalition to provide feedback on our manuscript. During each of these meetings, we shared a brief presentation of our methods and findings and explicitly solicited feedback on the perceived public health benefit and potential harm of our analyses and results. RESULTS Some community concerns about MHS in public health practice also apply to research using MHS data, namely those related to informed consent, inference of transmission directionality and criminalization. Other critiques were specific to our research study and included feedback about the use of phylogenetic analyses to study assortativity by race/ethnicity and the importance of considering the broader context of stigma and structural racism. We ultimately decided the potential harms of publishing our study-perpetuating racialized stigma about men who have sex with men and eroding the trust between phylogenetics researchers and communities of people living with HIV-outweighed the potential benefits. CONCLUSIONS HIV phylogenetics research using data collected through MHS data is a powerful scientific technology with the potential to benefit and harm communities of people living with HIV. Addressing criminalization and including people living with HIV in decision-making processes have the potential to meaningfully address community concerns and strengthen the ethical justification for using MHS data in both research and public health practice. We close with specific opportunities for action and advocacy by researchers.
Collapse
Affiliation(s)
- Diana M. Tordoff
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Brian Minalga
- Fred Hutch, Office of HIV/AIDS Network CoordinationSeattleWashingtonUSA
| | - Alfredo Trejo
- Department of Political ScienceUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Alic Shook
- Seattle University, College of NursingSeattleWashingtonUSA
- Seattle Children's Center for Pediatric Nursing ResearchSeattleWashingtonUSA
| | - Roxanne P. Kerani
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Public Health – Seattle & King County, HIV/STD ProgramSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Joshua T. Herbeck
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| |
Collapse
|
39
|
Mulinge MM, Oluoch JO, Abisi HK, Otieno LE, Anzala O, Wamalwa DC, Nduati RW, Kimani J, Herbeck J, McKinnon L. Age and CD4+ T cell counts are inversely associated with HIV drug resistance mutations in treatment naive female sex workers. Medicine (Baltimore) 2023; 102:e34060. [PMID: 37327289 PMCID: PMC10270489 DOI: 10.1097/md.0000000000034060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
The increasing prevalence of human immunodeficiency virus (HIV) drug resistance mutations (HIVDRM) in untreated seropositive persons has consequences for future treatment options. This is extremely important in key populations such as female sex workers (FSWs), where the prevalence of pretreatment drug resistance (PDR) and associated risk factors are unknown. In this study, we analyzed PDR and associated risk factors in recently diagnosed and treatment-naive FSWs in Nairobi, Kenya. In this cross-sectional study, we used 64 HIV-seropositive plasma samples collected from FSWs between November 2020 and April 2021. To identify HIVDRM, the pol gene was amplified and genotyped using sanger sequencing. The effects of age, tropism, CD4+ T cell count, subtype, and location on HIVDRM counts were examined using Poisson regression. Overall, the prevalence of PDR was 35.9% (95% CI: 24.3-48.9), which was strongly influenced by K103N and M184V mutations, which confer resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTI), respectively. Subtype A1 was predominant followed by subtype D with a notable increase in inter-subtype recombinants. We found statistically significant evidence that age was inversely related to HIVDRM. A FSW who is 1 year older had 12% less HIVDRM (incidence rate ratios [IRR]: 0.88; 95% CI: 0.82-0.95; P < .001), after adjusting for CD4+ T cell count, subtype, location, and tropism. Similarly, an increase in CD4+ T cell count by 1 unit, was associated with 0.4% fewer HIVDRM (IRR: 0.996; 95% CI: 0.994-0.998; P = .001), while controlling for the other variables. HIV-1 tropism was not associated with HIVDRM counts. In conclusion, our findings show a high prevalence of NNRTIs. Lower CD4+ T cell counts and younger age were significant risk factors that influenced HIVDRM loads. This finding underscores the relevance of targeted interventions and the importance of continuing to focus on FSWs as a way of addressing the HIV epidemic.
Collapse
Affiliation(s)
- Martin M. Mulinge
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Jeff O. Oluoch
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Hellen K. Abisi
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
| | - Leon E. Otieno
- Molecular Medicine and Infectious Diseases Laboratory, University of Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Ruth W. Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, WA
| | - Lyle McKinnon
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
40
|
Beattie TS, Kabuti R, Beksinska A, Babu H, Kung’u M, Shah P, Nyariki E, Nyamweya C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J. Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6046. [PMID: 37297650 PMCID: PMC10253020 DOI: 10.3390/ijerph20116046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
We examined violence experiences among Female Sex Workers (FSWs) in Nairobi, Kenya, and how these relate to HIV risk using a life course perspective. Baseline behavioural-biological surveys were conducted with 1003 FSWs June-December 2019. Multivariable logistic regression models were used to estimate the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for associations of life course factors with reported experience of physical or sexual violence in the past 6 months. We found substantial overlap between violence in childhood, and recent intimate and non-intimate partner violence in adulthood, with 86.9% reporting one or more types of violence and 18.7% reporting all three. Recent physical or sexual violence (64.9%) was independently associated with life course factors, including a high WHO Adverse Childhood Experiences (ACE) score (AOR = 7.92; 95% CI:4.93-12.74) and forced sexual debut (AOR = 1.97; 95% CI:1.18-3.29), as well as having an intimate partner (AOR = 1.67; 95% CI:1.25-2.23), not having an additional income to sex work (AOR = 1.54; 95% CI:1.15-2.05), having four or more dependents (AOR = 1.52; 95% CI:0.98-2.34), recent hunger (AOR = 1.39; 95% CI:1.01-1.92), police arrest in the past 6 months (AOR = 2.40; 95% CI:1.71-3.39), condomless last sex (AOR = 1.46; 95% CI:1.02-2.09), and harmful alcohol use (AOR = 3.34; 95% CI:1.74-6.42). Interventions that focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including violence experience and HIV acquisition.
Collapse
Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | | | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Chrispo Nyamweya
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| |
Collapse
|
41
|
Singer R, Abboud S, Johnson AK, Zemlak JL, Crooks N, Lee S, Wilson J, Gorvine D, Stamps J, Bruce D, Sherman SG, Matthews AK, Patil CL. Experiences of Sex Workers in Chicago during COVID-19: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5948. [PMID: 37297552 PMCID: PMC10252736 DOI: 10.3390/ijerph20115948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.
Collapse
Affiliation(s)
- Randi Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Amy K. Johnson
- Ann & Robert H. Lurie Children’s, Chicago, IL 60611, USA
| | | | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Sangeun Lee
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | | | - Della Gorvine
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL 60653, USA
| | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL 60614, USA
| | | | | | - Crystal L. Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA
| |
Collapse
|
42
|
Ayamah P, Aheto JMK, Atuahene KS, Annang DA, Nartey DT, Amuasi SA, Abrefa‐Gyan T. Multiple indicators of violence against female sex workers and its associated factors in Ghana: Evidence from the 2015 integrated bio-behavioral surveillance survey cross-sectional study. Health Sci Rep 2023; 6:e1243. [PMID: 37152230 PMCID: PMC10158782 DOI: 10.1002/hsr2.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. The study examined the prevalence and the associated factors of multiple indicators of violence against FSWs. Methods The study utilized a cross-sectional secondary data from the 2015 Integrated Bio-Behavioral Surveillance Survey conducted among FSWs and their nonpaying partners by Ghana AIDS Commission. We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15. Results Of the 4279 FSWs, 433 (10%) and 1059 (25%) suffered physical and sexual violence, respectively. The predictors of physical violence are being a seater (adjusted odds ratio [aOR] = 0.53, 95% confidence interval [CI]: 0.36-0.74), aged ≥40 (aOR = 0.23, 95% CI: 0.08-0.64), nonuse of drugs (aOR = 0.56, 95% CI: 0.44-0.70), not using alcohol before sex (aOR = 0.69, 95% CI: 0.56-0.86) and petty business (aOR = 1.39, 95% CI: 1.05-1.82). Sexual violence was predicted by those aged 31-40 (aOR = 0.68, 95% CI: 0.49-0.94) and age ≥40 (aOR = 0.38, 95% CI: 0.22-0.66), currently married (aOR = 0.42, 95% CI: 0.27-0.67), having no living children (aOR = 0.69, 95% CI: 0.51-0.94), nonuse of drugs (aOR = 0.80, 95% CI: 0.68-0.94), and not using alcohol before sex (aOR = 0.74, 95% CI: 0.63-0.86). Region was associated with both physical and sexual violence. Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs. Conclusion Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace.
Collapse
Affiliation(s)
| | - Justice Moses K. Aheto
- Department of Biostatistics, School of Public Health, College of Health SciencesUniversity of GhanaAccraGhana
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
- Epidemiology and Biostatistics, College of Public HealthUniversity of South FloridaTampaFloridaUSA
| | | | | | - David T. Nartey
- Research, Monitoring and EvaluationJSI Research and Training Institute Inc.BostonMassachusettsUSA
| | - Sue A. Amuasi
- Physician Assistantship and Public Health, School of Medicine and Health SciencesCentral UniversityAccraGhana
| | - Tina Abrefa‐Gyan
- Department of SociologyGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| |
Collapse
|
43
|
Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Page KR, Celentano DD, Smith KC, Kerrigan D. Exploring the dynamics of the quality of HIV care experienced by female sex workers living in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001479. [PMID: 37115734 PMCID: PMC10146439 DOI: 10.1371/journal.pgph.0001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
Abstract
Despite increased attention and efforts to improve HIV care among female sex workers (FSWs), they continue to have suboptimal HIV outcomes. Exploring the socio-structural dynamics related to the quality of HIV care received by FSWs is critical to further strengthen interventions to improve their HIV care continuum outcomes. In this study, we conducted two rounds of qualitative in-depth interviews with 20 FSWs living with HIV in the Dominican Republic to explore how healthcare experiences contributed to their quality of HIV care. Data was analyzed using a thematic analytic approach exploring diverse structural and relational aspects of the quality of HIV care affecting FSWs as they navigate the clinic environment. Results indicated that quality of HIV care was influenced by both structural and relational factors within clinics. At the structural level, insufficient stock of antiretroviral therapy and the financial burden created by HIV care related costs hindered FSWs' satisfaction with their current HIV care and presented a barrier in FSWs' ability to access HIV care services. Quality of care was also closely linked to relational aspects of the HIV care environment, including FSWs' relationship and communication with their clinical providers, as FSWs often expressed their satisfaction with HIV care experiences based on these interpersonal factors. Lastly, personal agency emerged as an important factor contributing to the quality of HIV care, specifically as FSWs' treatment literacy resulted in greater advocacy and demands for quality care. Programmatic efforts should be directed to improving the quality of HIV care experiences of FSWs in the clinic environment. These include addressing resource shortages, promoting positive and effective patient-provider relationships, and facilitating HIV treatment education opportunities for FSWs.
Collapse
Affiliation(s)
- Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Yeycy Donastorg
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dermatológico y Cirugía de la Piel “Dr. Huberto Bogaert Díaz”, HIV Vaccine Trials Research Unit, Santo Domingo, Dominican Republic
| | - Kathleen R. Page
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - David D. Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, United States of America
| |
Collapse
|
44
|
Bolo A, Ochira P, Hakim AJ, Katoro J, Bunga S, Lako R, Anib V, Arkangelo GC, Lobojo BN, Okiria AG. Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan. BMC Public Health 2023; 23:692. [PMID: 37059971 PMCID: PMC10103365 DOI: 10.1186/s12889-023-15593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan. METHODS Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13-18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13. RESULTS A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%. CONCLUSION Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
Collapse
Affiliation(s)
- Alex Bolo
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan.
| | | | - Avi J Hakim
- United States Centers for Disease Control and Prevention, DGHT, Atlanta, GA, USA
| | - Joel Katoro
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Sudhir Bunga
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | | |
Collapse
|
45
|
Shah P, Beattie TS, Kabuti R, Liku J, Kung'u M, Babu H, Jama Z, Kaul R, Weiss HA, Kyegombe N, Medley GF, Devries K, Gafos M, Nyariki E, Kimani J, Seeley J. Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya. BMJ Open 2023; 13:e068886. [PMID: 37045579 PMCID: PMC10106030 DOI: 10.1136/bmjopen-2022-068886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya. DESIGN Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural-biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management. RESULTS 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency. CONCLUSIONS This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options.
Collapse
Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Jennifer Liku
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Mary Kung'u
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Anne Weiss
- MRC International and Statistics Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham F Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| |
Collapse
|
46
|
Kim RS, Wickersham JA, Maviglia F, Galka JM, Azwa I, Gautam K, Shrestha R. Drivers of HIV self-testing among female sex workers: Findings from a multi-state study in Malaysia. Front Med (Lausanne) 2023; 10:1022746. [PMID: 37089614 PMCID: PMC10117675 DOI: 10.3389/fmed.2023.1022746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundAlthough research on HIV self-testing (HIVST) has rapidly increased, few studies have explored HIVST uptake in female sex workers (FSW), and none in Malaysia. Therefore, we endeavored to assess the willingness to use HIVST in this at-risk, vulnerable population.MethodsA cross-sectional survey study was conducted among 113 HIV-negative Malaysian FSW in 2017. Participants were recruited using advertisements on social media, flyers, and direct referrals from community-based organizations. Data were collected using self-administered surveys. Multivariable logistic regression was used to identify correlates of willingness to use HIVST.ResultsNearly a third of participants (30.1%) reported they would be willing to use HIVST. Multivariable analyses adjusting for Malay ethnicity, stable housing, living in Kuala Lumpur (KL), years in sex work, age of first sex work, childhood sexual assault, history of HIV testing, and previously in prison indicated that living in KL [adjusted odds ratio (aOR) = 5.214, p = 0.0137] was associated with a greater willingness to use HIVST. In contrast, having stable housing (aOR = 0.100, p = 0.0064) was negatively associated with willingness to use HIVST.ConclusionsOur results indicate that HIVST may potentially enhance the uptake of HIV testing among FSWs living in an urban environment and experiencing unstable housing, but an overall willingness to use HIVST is low. These findings highlight the need for efforts to increase awareness of HIVST among FSWs and additional research on the effective implementation of HIVST for FSW.
Collapse
Affiliation(s)
- Rayne S. Kim
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jeffrey A. Wickersham
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Francesca Maviglia
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan M. Galka
- Department of the History of Science, Harvard University, Cambridge, MA, United States
| | - Iskandar Azwa
- Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Roman Shrestha
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- *Correspondence: Roman Shrestha,
| |
Collapse
|
47
|
Goldenberg SM, Pearson J, Moreheart S, Nazaroff H, Krüsi A, Braschel M, Bingham B, Shannon K. Prevalence and structural correlates of HIV and STI testing among a community-based cohort of women sex workers in Vancouver Canada. PLoS One 2023; 18:e0283729. [PMID: 36996154 PMCID: PMC10062647 DOI: 10.1371/journal.pone.0283729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In light of the stark inequities in HIV and sexually transmitted infections (STIs) experienced by women sex workers, empirical evidence is needed to inform accessible and sex worker-friendly models of voluntary, confidential and non-coercive HIV and STI testing. We evaluated the prevalence and structural correlates of HIV/STI testing in the last 6 months in a large, community-based cohort of women sex workers in Vancouver, Canada. METHODS Data were drawn from an open community-based open cohort of women sex workers (January 2010-August 2021) working across diverse street, indoor, and online environments in Vancouver, Canada. Using questionnaire data collected by experiential (sex workers) and community-based staff, we measured prevalence and used bivariate and multivariable logistic regression to model correlates of recent HIV/STI testing at enrollment. RESULTS Of 897 participants, 37.2% (n = 334) identified as Indigenous, 31.4% as Women of Color/Black (n = 282), and 31.3% (n = 281) as White. At enrollment, 45.5% (n = 408) reported HIV testing, 44.9% (n = 403) reported STI testing, 32.6% (n = 292) reported receiving both HIV and STI testing, and 57.9% (n = 519) had received an HIV and/or STI test in the last 6 months. In adjusted multivariable analysis, women accessing sex worker-led/specific services had higher odds of recent HIV/STI testing, (Adjusted Odds Ratio (AOR): 1.91, 95% Confidence Interval (CI): 1.33-2.75), whereas Women of Color and Black women (AOR: 0.52, 95%CI: 0.28-0.98) faced significantly lower odds of recent HIV/STI testing. CONCLUSIONS Scaling-up community-based, sex worker-led and tailored services is recommended to enhance voluntary, confidential, and safe access to integrated HIV/STI testing, particularly for Women of Color and Black Women. Culturally safe, multilingual HIV/STI testing services and broader efforts to address systemic racism within and beyond the health system are needed to reduce inequities and promote safe engagement in services for racialized sex workers.
Collapse
Affiliation(s)
- Shira M. Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennie Pearson
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Moreheart
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Hannah Nazaroff
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Brittany Bingham
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Indigenous Health, Vancouver, BC, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
48
|
Abuelezam NN, Michel I, Marshall BD, Galea S. Accounting for historical injustices in mathematical models of infectious disease transmission: An analytic overview. Epidemics 2023; 43:100679. [PMID: 36924757 DOI: 10.1016/j.epidem.2023.100679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
Differences in infectious disease risk, acquisition, and severity arise from intersectional systems of oppression and resulting historical injustices that shape individual behavior and circumstance. We define historical injustices as distinct events and policies that arise out of intersectional systems of oppression. We view historical injustices as a medium through which structural forces affect health both directly and indirectly, and are thus important to study in the context of infectious disease disparities. In this critical analysis we aim to highlight the importance of incorporating historical injustices into mathematical models of infectious disease transmission and provide context on the methodologies to do so. We offer two illustrations of elements of model building (i.e., parameterization, validation and calibration) that can allow for a better understanding of health disparities in infectious disease outcomes. Mathematical models that do not recognize the historical forces that underlie infectious disease dynamics inevitably lead to the individualization of our focus and the recommendation of untenable individual-behavioral prescriptions to address the burden of infectious disease.
Collapse
Affiliation(s)
- Nadia N Abuelezam
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | - Isaacson Michel
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA.
| | - Brandon Dl Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Sandro Galea
- Boston University, School of Public Health, Boston, MA, USA.
| |
Collapse
|
49
|
Ohtsuka MS, Shannon K, Zucchet A, Krüsi A, Bingham B, King D, Axl-Rose T, Braschel M, Deering KN. Prevalence and Social-Structural Correlates of Gender-Based Violence Against Women Living With HIV in Metro Vancouver, Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4562-4588. [PMID: 36317864 PMCID: PMC9899311 DOI: 10.1177/08862605221118611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment "SHAWNA"). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.
Collapse
Affiliation(s)
- Mika S. Ohtsuka
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alyssa Zucchet
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Bingham
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Desire King
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Tara Axl-Rose
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | | | - Kathleen N. Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
50
|
Kiyingi J, Nabunya P, Kizito S, Nabayinda J, Nsubuga E, Bahar OS, Jennings Mayo-Wilson L, Namuwonge F, Nattabi J, Magorokosho N, Tozan Y, Witte SS, Ssewamala FM. Self-Reported Adherence to Antiretroviral Therapy (ART) Among Women Engaged in Commercial Sex Work in Southern Uganda. AIDS Behav 2023; 27:1004-1012. [PMID: 36066764 PMCID: PMC9974600 DOI: 10.1007/s10461-022-03837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
We examined the correlates of self-reported adherence to antiretroviral therapy (ART) among women engaged in commercial sex work (WESW) in Uganda. We used baseline data from a longitudinal study, which recruited 542 WESW in Southern Uganda. We used nested regression models to determine the individual and family, and economic level correlates of self-reported adherence. Study findings show that older age (OR = 1.07, 95% CI = 1.013, 1.139), secondary education (OR = 2.01, 95% CI = 1.306, 3.084), large household size (OR = 1.08, 95% CI = 1.020, 1.136), high family cohesion (OR = 1.06, 95% CI = 1.052, 1.065), and high financial self-efficacy (OR = 1.07, 95% CI = 1.006, 1.130) were associated with good self-reported adherence to ART. Married women (OR=-0.39, 95% CI = 0.197, 0.774), depression (OR = 0.85, 95% CI = 0.744, 0.969), alcohol use (OR = 0.72, 95% CI = 0.548, 0.954), ever been arrested (OR = 0.58, 95% CI = 0.341, 0.997), and high household assets ownership (OR = 0.48, 95% CI = 0.313, 0.724) were associated with poor self-reported adherence to ART. Findings suggest a need to adopt a multi-level approach to address gaps in ART adherence among WESW.
Collapse
Affiliation(s)
- Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- University of North Carolina Gillings School of Global Public Health, 170 Rosenau Hall, 27599, Chapel Hill, NC, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Yesim Tozan
- New York University College of Global Public Health, 14 East 4th street, 3rd floor, 10003, New York, NY, USA
| | - Susan S Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
| |
Collapse
|