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Perrault Sullivan G, Guédou FA, Tounkara FK, Béhanzin L, Camara N, Aza-Gnandji M, Keita BD, Azonnadou O, Thera I, Avery L, Alary M. Longitudinal study of pregnancy intention and its association with pregnancy occurrence among female sex workers in Benin and Mali. Reprod Health 2023; 20:25. [PMID: 36717914 PMCID: PMC9887776 DOI: 10.1186/s12978-023-01565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The intention of becoming pregnant has an evident impact on the prenatal and postnatal period. For female sex workers (FSWs) in West Africa, among whom pregnancies are frequent as are HIV and sexually transmitted infections, a better understanding of their pregnancy intention and its influence on pregnancy occurrence could help prevent unwanted pregnancies and adverse effects on wanted pregnancies. METHODS We recruited 330 FSWs in Benin and 322 in Mali and followed them for 12 months. We evaluated their pregnancy intention at recruitment and 6-month follow-up, using a multidimensional prospective measure that we developed. We assessed pregnancy occurrence with a pregnancy test and a retrospective questionnaire at 6 and 12 months. A Cox proportional hazard model was used to estimate the association between intention and pregnancy. We carried out an analysis to take losses to follow-up into account using the inverse of probability of censoring weights and a cluster analysis to corroborate that the multidimensional measure of pregnancy intention fitted the data. RESULTS 407 FSWs were included in the first 6-month analysis and 284 at 12 months. Mean age was 30.9 years. The pregnancy intention distribution was similar between the two periods: 15.2% in the first period and 16.3% in the second had a positive intention. One out of four were ambivalent and almost 60% (57.7% and 56.3%) had a negative intention. For 38.2% of the FSWs, the intention changed between the two periods. The global incidence rate (to first event) was 19.1 pregnancies per 100 person-years. There was a borderline significant trend (p = 0.0529) of decreased pregnancy incidence with decreasing intention. Compared to positive intention, the adjusted hazard ratio (aHR) for ambivalent and negative intentions were 0.71 [95% confidence interval (95% CI) 0.32-1.60] and 0.46 (95% CI 0.21-1.01), respectively. CONCLUSION The level of pregnancy intention influences its occurrence among FSWs and nearly one out of six wants a baby despite working in the sex trade. Programmatically, early identification of these women could facilitate provision of quality antenatal and postnatal care. Given other health risks associated with sex work this care may decrease potential risks of adverse maternal, fetal and neonatal outcomes.
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Affiliation(s)
- Gentiane Perrault Sullivan
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada ,grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,grid.434819.30000 0000 8929 2775Institut National de Santé Publique, Québec, Canada
| | - Fernand Aimé Guédou
- grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | - Fatoumata Korika Tounkara
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Luc Béhanzin
- grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin ,grid.440525.20000 0004 0457 5047École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | | | | | | | - Odette Azonnadou
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | | | - Lisa Avery
- grid.21613.370000 0004 1936 9609Institute for Global Public Health, Dept. Obstetrics, Gynecology and Reproductive Sciences, Max Rady Medical College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michel Alary
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada ,grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,grid.434819.30000 0000 8929 2775Institut National de Santé Publique, Québec, Canada
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2
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Perrault Sullivan G, Guédou FA, Batona G, Kintin F, Béhanzin L, Avery L, Bédard E, Gagnon MP, Zannou DM, Kpatchavi A, Alary M. Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin. BMC WOMENS HEALTH 2020; 20:248. [PMID: 33167931 PMCID: PMC7650197 DOI: 10.1186/s12905-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. Methods Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. Results Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. Conclusion One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Fernand Aimé Guédou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Georges Batona
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Frédéric Kintin
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Luc Béhanzin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Lisa Avery
- Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emmanuelle Bédard
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Marie-Pierre Gagnon
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département des sciences infirmières, Université Laval, Québec, Canada
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre national hospitalier universitaire HMK de Cotonou, Cotonou, Bénin
| | - Adolphe Kpatchavi
- Département de Sociologie - Anthropologie, Faculté des Lettres, Arts et Sciences Humaines, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
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3
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du Plessis E, Chevrier C, Lazarus L, Reza-Paul S, Rahman SHU, Ramaiah M, Avery L, Lorway R. Pragmatic women: negotiating sex work, pregnancy, and parenting in Mysore, South India. CULTURE, HEALTH & SEXUALITY 2020; 22:1177-1190. [PMID: 31549914 DOI: 10.1080/13691058.2019.1662946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
Persisting inequities in maternal health pose a particular burden for marginalised populations such as sex workers. However, current literature on pregnancy and sex work is limited to mostly quantitative studies focusing on contraception use, unplanned and/or undesired pregnancies and unsafe abortions. Additionally, emphasis has been placed on the prevention, treatment and care of STIs and HIV with less attention accorded to women's pregnancy desires and implications to work. In this paper, we explore sex workers' conflicted experiences surrounding pregnancy, parenthood, and work. Forty-six women participated in in-depth interviews as part of a qualitative exploratory study conducted in close collaboration with a sex worker collective in the city of Mysore (South India). Our analysis focuses on women's pragmatic responses to pregnancy desires, workplace challenges during and after pregnancy, strategies for managing risk and approaches to managing work and childcare. We show that women confront various intersecting challenges with respect to pregnancy and sex work. Women's complex decision-making balances multiple considerations while highlighting the temporal dimension of pragmatism as women respond not only to the immediacy of an encounter but also in anticipation of a better future.
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Affiliation(s)
- Elsabé du Plessis
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Claudyne Chevrier
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Lisa Avery
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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4
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Yam EA, Kahabuka C, Mbita G, Winani K, Apicella L, Casalini C, Mbuguni Z. Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services. PLoS One 2020; 15:e0235739. [PMID: 32692777 PMCID: PMC7373272 DOI: 10.1371/journal.pone.0235739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire. Conclusions Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
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Affiliation(s)
- Eileen A. Yam
- Population Council, Washington, DC, United States of America
- * E-mail:
| | | | | | - Koheleth Winani
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Zuhura Mbuguni
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Decker MR, Park JN, Allen ST, Silberzahn B, Footer K, Huettner S, Galai N, Sherman SG. Inconsistent Condom Use Among Female Sex Workers: Partner-specific Influences of Substance Use, Violence, and Condom Coercion. AIDS Behav 2020; 24:762-774. [PMID: 31254189 PMCID: PMC10132468 DOI: 10.1007/s10461-019-02569-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Female sex workers (FSWs) are disproportionately affected by HIV. Inconsistent condom use (ICU) represents the most proximal risk for acquisition and transmission. We evaluate associations of partner-specific factors including physical and sexual violence, coercion, and substance use with ICU with clients and regular non-paying partners, respectively, among FSWs. Baseline survey data from a prospective cohort of 250 street-based FSW in Baltimore, Maryland, USA included partner-level drug and alcohol use, violence, condom coercion and ICU, in addition to individual and structural exposures. Logistic regression analyses were stratified by partner type, followed by path analysis where indicated. Within client and regular non-paying partnerships, FSWs reported prevalent recent violence (34.8%, 16%, respectively), condom coercion (42.4%, 9.9%, respectively) and ICU (39.2%, 44.4%, respectively). Recent physical or sexual violence enabled coercive condom negotiation (AORclient 8.22, 95% CI 4.30, 15.73; AORnonpayingpartner 3.01 95% CI 1.05, 8.63). ICU with clients was associated with client condom coercion (AOR 1.76, 95% CI 1.03, 3.02), and client intoxication during sex (AOR 2.25, 95% CI 1.13, 4.45). In path analysis of client-FSW partnerships, condom coercion fully mediated the influences of both sex worker intoxication and recent violence on ICU. ICU with non-paying partners was associated with FSW intoxication during sex (AOR 8.66, 95% CI 3.73, 20.10), and past-year police violence (AOR 2.92, 1.30, 6.57). Partner-level substance use and gendered power differentials influenced FSWs' ICU patterns differently by partner type. ICU with clients was rooted solely in partner factors, and coercive condom negotiation mediated the roles of violence and partner-level substance use on ICU. By contrast, ICU with non-paying partners was rooted in partner-level substance use and police violence as a structural determinant. Addressing HIV risk behavior for FSWs requires condom promotion efforts tailored to partner type that addresses power differentials.
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Affiliation(s)
- Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. .,Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Bradley Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Steven Huettner
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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6
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Becquet V, Nouaman M, Plazy M, Masumbuko JM, Anoma C, Kouame S, Danel C, Eholie SP, Larmarange J. Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention. BMJ Open 2020; 10:e028508. [PMID: 31919122 PMCID: PMC6955511 DOI: 10.1136/bmjopen-2018-028508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. DESIGN AND SETTING The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire. PARTICIPANTS A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. RESULTS Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication. CONCLUSIONS Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.
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Affiliation(s)
- Valentine Becquet
- INED (French Institute for Demographic Studies), Paris, France
- CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France
| | | | - Mélanie Plazy
- ISPED, Inserm Research Center 1219 (Bordeaux Population Health), Université de Bordeaux, Bordeaux, France
| | | | | | | | | | | | - Joseph Larmarange
- CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France
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Matos B, Haze L. Bottoms up: a whorelistic literature review and commentary on sex workers’ romantic relationships. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2019.1636958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Bella Matos
- Department of Psychology, The American University of Paris, Paris, France
| | - Lola Haze
- The University of Lived Experience, New York City, USA
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8
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Long JE, Waruguru G, Yuhas K, Wilson KS, Masese LN, Wanje G, Kinuthia J, Jaoko W, Mandaliya KN, McClelland RS. Prevalence and predictors of unmet contraceptive need in HIV-positive female sex workers in Mombasa, Kenya. PLoS One 2019; 14:e0218291. [PMID: 31216298 PMCID: PMC6583985 DOI: 10.1371/journal.pone.0218291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs. STUDY DESIGN This cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need. RESULTS Among 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8-68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0-1.5), desire for (more) children (PR 1.3, 95%CI 1.1-1.5), and having 2-3 previous pregnancies compared to 0-1 prior pregnancies (PR 0.8, 95%CI 0.6-0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need. CONCLUSIONS Unmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0-1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.
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Affiliation(s)
- Jessica E. Long
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | | | - Krista Yuhas
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kate S. Wilson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Linnet N. Masese
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - George Wanje
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, GPO, Nairobi, Kenya
| | | | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
- * E-mail:
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9
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Bhattacharjee P, Campbell L, Thalinja R, Nair S, Doddamane M, Ramanaik S, Isac S, Beattie TS. Understanding the Relationship Between Female Sex Workers and Their Intimate Partners: Lessons and Initial Findings From Participatory Research in North Karnataka, South India. HEALTH EDUCATION & BEHAVIOR 2018; 45:824-835. [PMID: 29618240 PMCID: PMC6139989 DOI: 10.1177/1090198118763934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While traditional HIV prevention programs with female sex workers (FSWs) in Karnataka, India, have focused on reducing HIV transmission between FSWs and clients through increased condom use, these programs have not fully addressed the transmission risk between FSWs and their nonpaying intimate partners (IPs). Condom use is infrequent and violence is recurrent in these relationships: Furthermore, there is little evidence on the precise nature of FSW–IP relationships. Our study addresses this knowledge gap to inform HIV programs targeted at FSWs. A series of workshops, using participatory tools, was held to explore FSW-IP relationships; 31 FSWs and 37 IPs participated. Three aspects of FSW–IP relationships were examined: how FSWs and IPs understand and interpret their relationships, factors influencing condom use, and the role of violence and its consequences. FSWs wish to be perceived as their IPs’ wives, while IPs expect their FSW partners to accept their dominance in the relationship. Nonuse of condoms signals fidelity and elevates the status of the relationship almost to that of marriage, which helps FSWs enter the category of “good” (married) women. Tolerating and accepting violence in these relationships is normative, as in other marital relationships; IPs justify violence as necessary to establish and maintain their power within the relationship. Both FSWs and IPs value their relationships despite the high degree of risk posed by low condom use and high levels of violence. Implications for program design include addressing current norms around masculinity and gender roles, and improving communication within relationships.
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Affiliation(s)
- Parinita Bhattacharjee
- 1 Karnataka Health Promotion Trust, Bangalore, India.,2 University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Sapna Nair
- 1 Karnataka Health Promotion Trust, Bangalore, India.,4 Institute for Financial Management and Research, Chennai, India
| | | | | | - Shajy Isac
- 1 Karnataka Health Promotion Trust, Bangalore, India.,2 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- 5 London School of Hygiene and Tropical Medicine, London, UK
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10
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Peltzer K, Sifunda S, Mandell LN, Rodriguez VJ, Lee TK, Cook R, Weiss SM, Jones DL. Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:9-17. [PMID: 29497335 PMCID: PMC5818871 DOI: 10.2147/hiv.s153212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction This study aimed to assess fertility intentions (planning to have more children in the future) and associated factors among pregnant and postpartum HIV positive women in rural South Africa. Methods In a longitudinal study, as part of a prevention of mother to child transmission (PMTCT) intervention trial, 699 HIV positive prenatal women, were systematically recruited and followed up at 6 months and 12 months postpartum (retention rate = 59.5%). Results At baseline, 32.9% of the women indicated fertility intentions and at 12 months postnatal, 120 (28.0%) reported fertility intentions. In longitudinal analyses, which included time-invariant baseline characteristics predicting fertility intention over time, not having children, having a partner with unknown/HIV-negative status, and having disclosed their HIV status to their partner, were associated with fertility intentions. In a model with time-varying covariates, decreased family planning knowledge, talking to a provider about a future pregnancy, and increased male involvement were associated with fertility intentions. Conclusion Results support ongoing perinatal family planning and PMTCT education.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.,Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
| | - Sibusiso Sifunda
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Cook
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Ippoliti NB, Nanda G, Wilcher R. Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence. Stud Fam Plann 2017; 48:121-151. [PMID: 28422301 DOI: 10.1111/sifp.12020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.
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Blanc A, Rojas AJ, Sayans-Jiménez P. Erotofobia-erotofilia, asertividad sexual y deseo sexual de las mujeres inmigrantes que ejercen la prostitución. Rev Int Androl 2017. [DOI: 10.1016/j.androl.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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