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Chebet JJ, Akyoo WO, Goymann H, Harling G, Barnhart DA, Mosha IH, Kamori DD, Gandhi M, Mbunda T, Kipeleka J, Sando D, Spiegelman D, Mpembeni R, Bärnighausen T. Demonstrating service delivery models for effective initiation and retention on pre-exposure prophylaxis (PrEP) among female bar workers in Dar es Salaam, Tanzania: A double randomized intervention study protocol. PLoS One 2024; 19:e0304077. [PMID: 38935796 PMCID: PMC11210872 DOI: 10.1371/journal.pone.0304077] [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: 08/20/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pre-Exposure Prophylaxis (PrEP) has demonstrated efficacy in preventing HIV infection. Female Bar Workers (FBWs) often act as informal sex workers, placing them at risk of HIV infection. Despite expressing interest in PrEP, FBWs face barriers to accessing public-sector clinics where PrEP is delivered. We developed a study to compare the effectiveness of workplace-based PrEP provision to standard-of-care facility-based provision for PrEP initiation, retention and adherence among FBWs. METHODS In this double-randomized intervention study, FBWs aged 15 years and above will be screened, consented and initiated on PrEP (emtricitabine/tenofovir disoproxil), and followed for six months. Participants will be randomized at the bar level and offered PrEP at their workplace or at a health facility. Those who are initiated will be independently individually randomized to either receive or not receive an omni-channel PrEP champion intervention (support from an experienced PrEP user) to improve PrEP adherence. We expect to screen 1,205 FBWs to enroll at least 160 HIV negative women in the study. Follow-up visits will be scheduled monthly. HIV testing will be performed at baseline, month 1, 4 and 6; and TDF testing at months 2 and 6. Primary outcomes for this trial are: (1) initiation on PrEP (proportion of those offered PrEP directly observed to initiate PrEP); and (2) adherence to PrEP (detectable urine TDF drug level at 6-months post-enrollment). The primary outcomes will be analyzed using Intention-to-Treat (ITT) analyses. DISCUSSION Using a randomized trial design, we will evaluate two interventions aiming to reduce barriers to uptake and retention on PrEP among FBWs, a vulnerable population at risk of HIV acquisition and onward transmission. If these interventions prove effective in promoting PrEP among FBWs, they could assist in abating the HIV epidemic in Africa. TRIAL REGISTRATION Registered with German Clinical Trials Register (www.drks.de) on 29 April 2020; Registration number DRKS00018101.
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Affiliation(s)
- Joy J. Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | - Winfrida Onesmo Akyoo
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Hannah Goymann
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts, United States of America
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Dale A. Barnhart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Idda H. Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Doreen Donald Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Theodora Mbunda
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Judith Kipeleka
- Management and Development for Health, Dar es Salaam, Tanzania
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Donna Spiegelman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Management and Development for Health, Dar es Salaam, Tanzania
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Popoola VO, Kagaayi J, Ssekasanvu J, Ssekubugu R, Kigozi G, Ndyanabo A, Nalugoda F, Chang LW, Lutalo T, Tobian AAR, Kabatesi D, Alamo S, Mills LA, Kigozi G, Wawer MJ, Santelli J, Gray RH, Reynolds SJ, Serwadda D, Lessler J, Grabowski MK. HIV epidemiologic trends among occupational groups in Rakai, Uganda: A population-based longitudinal study, 1999-2016. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002891. [PMID: 38377078 PMCID: PMC10878534 DOI: 10.1371/journal.pgph.0002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23-0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18-0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.
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Affiliation(s)
- Victor O. Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | - Larry W. Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Aaron A. R. Tobian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Donna Kabatesi
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Stella Alamo
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Lisa A. Mills
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | | | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - John Santelli
- Department of Population and Family Health and Pediatrics, Columbia University, New York, New York, United States of America
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J. Reynolds
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - M. Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Yang LS, Nattabi J, Magorokosho N, Ssewamala FM. Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav 2023; 27:969-977. [PMID: 36112259 PMCID: PMC9974574 DOI: 10.1007/s10461-022-03833-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] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
We examined the factors associated with consistent condom use among women engaged in sex work in the Southern parts of Uganda. We used baseline data from a longitudinal study involving WESW from 19 hotspots in Southern Uganda. We conducted hierarchical models to determine the individual, economic, behavioral, and health-related factors associated with consistent condom use. We found that, alcohol use (b=-0.48, 95% CI=-0.77, -0.19), accepting money for condomless sex (b=-0.33, 95% CI=-0.38, -0.28), multiple customers (b=-0.01, 95% CI=-0.01, -0.005), being married (b = 0.50, 95% CI = 0.01, 0.99), owning more assets (b = 0.08, 95% CI = 0.05, 0.13), having another income earner in the household (b = 0.55, 95% CI = 0.27, 0.83), condom use self-efficacy (b = 0.11, 95% CI = 0.03, 0.19), condom use communication (b = 0.06, 95% CI = 0.001, 0.12), and being knowledgeable about HIV/STIs transmission (b = 0.08, 95% CI = 0.01, 0.15) were associated with consistent condom use. Additionally, 29% of the women were consistent condom users. Hence, there is need to implement interventions that promote consistent condom use among WESW.
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Affiliation(s)
- 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
| | - 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
| | - Susan Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Proscovia Nabunnya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - 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
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, 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
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB7400, 27599, Chapel Hill, NC, USA
| | - Lyla Sunyoung Yang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - 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
| | - 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.
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HIV Prevalence among Injury Patients Compared to Other High-Risk Groups in Tanzania. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sixty-eight percent of persons infected with HIV live in Africa, but as few as 67% of those know their infection status. The emergency department (ED) might be a critical access point to HIV testing. This study sought to measure and compare HIV prevalence in an ED injury population with other clinical and nonclinical populations across Tanzania. Adults (≥18 years) presenting to Kilimanjaro Christian Medical Center ED with acute injury of any severity were enrolled in a trauma registry. A systematic review and meta-analysis was conducted to compare HIV prevalence in the trauma registry with other population groups. Further, 759 injury patients were enrolled in the registry; 78.6% were men and 68.2% consented to HIV counseling and testing. The HIV prevalence was 5.02% (tested), 6.25% (self-report), and 5.31% (both). The systematic review identified 79 eligible studies reporting HIV prevalence (tested) in 33 clinical and 12 nonclinical population groups. Notable groups included ED injury patients (3.53%, 95% CI), multiple injury patients (10.67%, 95% CI), and people who inject drugs (17.43%, 95% CI). These findings suggest that ED injury patients might be at higher HIV risk compared to the general population, and the ED is a potential avenue to increasing HIV testing among young adults, particularly men.
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Beltrán LF, Davis DA, Barrington C, Castro M, Pérez D. 'I did not get this disease on the street; it was brought home as a gift': Gender, violence and HIV vulnerability among Cuban women. CULTURE, HEALTH & SEXUALITY 2022; 24:1107-1121. [PMID: 34254895 DOI: 10.1080/13691058.2021.1925744] [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: 10/14/2020] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Abstract
While gay, bisexual and other men who have sex with men are most affected by HIV in Cuba, infections among women have increased over time, but there has been little research to contextualise their vulnerability to HIV. The purpose of this study was to explore the role of gender and violence in shaping vulnerability to HIV among Cuban women. Qualitative in-depth interviews were conducted with women living with HIV at an outpatient HIV clinic in Havana. Narrative and thematic technique were used to systematically analyse the data. Participants described negotiating sexual relationships in a context where traditional gender norms merge with the paradox of increasing professional opportunities for women alongside growing economic precarity. Interconnected economic and emotional dependence along with violence influenced the acceptance of certain behaviours that heightened vulnerability to HIV, including inconsistent condom use and infidelity. Gender transformative approaches that recognise the complex interplay between gender norms, economic precarity and violence are needed to address women's vulnerability to HIV in the Cuban context. Such efforts can reinforce existing strategies to promote behaviourally focused prevention while creating an enabling environment for the integration and expansion of biomedical innovation in HIV prevention.
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Affiliation(s)
- Lisandra Fuentes Beltrán
- Department of Epidemiology, Centre of Research, Diagnosis and Reference, Pedro Kourí Tropical Medicine Institute, Havana, Cuba
| | - Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marta Castro
- Teaching Department, Pedro Kourí Tropical Medicine Institute, Havana, Cuba
| | - Dennis Pérez
- Department of Epidemiology, Centre of Research, Diagnosis and Reference, Pedro Kourí Tropical Medicine Institute, Havana, Cuba
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Differences in Access to HIV Services and Risky Sexual Behaviors Among Malawian Women at Social Venues Who Do and Do Not Engage in Sex Work. AIDS Behav 2021; 25:2920-2928. [PMID: 33987782 DOI: 10.1007/s10461-021-03289-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
In the high HIV-burden country of Malawi, female sex workers (FSW) are one of the populations most profoundly affected by HIV. The Malawi Priorities for Local AIDS Control Efforts (PLACE) surveyed 1,004 self-identified FSW, 213 other FSW (OFSW), and 130 other high risk women (OHRW) at social venues. Analyses compared the three groups using survey-weighted log binomial regression models. Each group had a distinct pattern of usage and access to services: OFSW and FSW had greater access to condoms, while using a condom ever was greatest among FSW. Nearly all women knew where to get tested for HIV but very few used FSW drop-in centers. HIV prevalence was high in all three groups (35% FSW, 20% OFSW, 20% OHRW). Given these results, HIV services should be targeted to all women at social venues in Malawi, regardless of sex worker status to improve health outcomes and limit onward transmission of HIV.
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Beattie TS, Smilenova B, Krishnaratne S, Mazzuca A. Mental health problems among female sex workers in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003297. [PMID: 32931504 PMCID: PMC7491736 DOI: 10.1371/journal.pmed.1003297] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Shari Krishnaratne
- Department of Global Health and Development, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - April Mazzuca
- School of Population and Public Health, University of British Columbia, Canada
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Dambach P, Mahenge B, Mashasi I, Muya A, Barnhart DA, Bärnighausen TW, Spiegelman D, Harling G. Socio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review. BMC Public Health 2020; 20:697. [PMID: 32414352 PMCID: PMC7227324 DOI: 10.1186/s12889-020-08838-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although sex workers are considered a key population in the HIV epidemic in sub-Saharan Africa (SSA), less consideration has been given to female bar workers (FBW), whose primary occupation is not sex work but who often engage in transactional sex. Understanding FBWs’ risk profiles is central to designing targeted HIV prevention interventions for them. This systematic review describes the socio-demographic characteristics and risk factors for HIV transmission among FBWs in SSA. Methods We searched six databases: PubMed, Google Scholar, Web of Science, Popline, Embase and additionally the World Health Organization’s WHOLIS database for grey literature between July and September 2017. Inclusion criteria were reporting (1) primary socio-demographic or behavioral data; on (2) women who sold or delivered drinks to clients; (3) in establishments serving alcohol; (4) in SSA. We excluded studies not presenting separate data on FBWs. We extracted quantitative and qualitative data from the selected studies and conducted a qualitative synthesis of findings. Results We found 4565 potentially eligible articles, including duplicates. After applying inclusion and exclusion criteria, we retained 19 articles. FBWs often migrated from rural to urban areas due to economic need or social marginalization. They began bar-based transactional sex due to low wages, peer pressure and to increase financial independence. FBWs had high HIV risk awareness but low agency to negotiate condom use, particularly with regular partners or when offered higher prices for condomless sex. FBWs were also vulnerable to violence and stigmatization. Conclusions FBWs are a vulnerable population for HIV infection. Despite social stigmatization and elevated risk of contracting STIs, bar work remains attractive because it enables unskilled women to both, make a living and maintain some independence. FBWs face HIV-related risk factors at the individual, community and societal level and may benefit from biomedical, behavioral and structural interventions.
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Affiliation(s)
- Peter Dambach
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | | | - Irene Mashasi
- Management and Development for Health (MDH), Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Aisa Muya
- Management and Development for Health (MDH), Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Dale A Barnhart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Till W Bärnighausen
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics and Nutrition Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Methods of Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.,Department of Biostatistics and Center for Methods on Implementation and Prevention Science, Yale University, New Haven, USA
| | - Guy Harling
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Institute for Global Health, University College London, London, UK.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
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