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Nattabi J, Bahar OS, Nabayinda J, Nabunya P, Kiyingi J, Kizito S, Namuwonge F, Nsubuga E, Witte SS, Ssewamala FM. Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda. RESEARCH SQUARE 2024:rs.3.rs-4468785. [PMID: 38883774 PMCID: PMC11177997 DOI: 10.21203/rs.3.rs-4468785/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Women Engaged in commercial Sex Work (WESW) are exposed to behavioral, biological, and structural factors that exacerbate their risk to HIV infection and other sexually transmitted infections. While commercial sex work may appear voluntary, WESW are more likely to be constrained to selling sex due to limited viable alternatives. To effectively support this vulnerable group of women, it is critical to understand factors that facilitate and impede their decisions to transition from sex work into other careers or jobs. The current study explored women's decision to transition from sex work into other careers or jobs. Methods Semi-structured in-depth interviews were conducted with 53 WESW aged 20-47 enrolled within a larger study-Kyaterekera study, a randomized clinical trial (N = 542) implemented in 19 HIV hotspots in the Southern region of Uganda. Participants were selected based on their intervention attendance (high/medium/low attendance). The interviews were conducted in Luganda the widely spoken language in the study area to explore the factors influencing women's decisions to from transition from sex work to other jobs or careers. The main interview question used for this study was, "What are some of the factors that may influence whether you would transition from sex work to other jobs or vocations?". All interviews were audio-recorded, transcribed verbatim and translated into English. Thematic analysis in Dedoose software was used to analyze the data. Results Participants reported three primary types of decisions, including considering leaving sex work, deciding to leave, and continuing sex work. The emerging themes from the interviews were categorized into individual and structural level facilitators and barriers to leave sex work. Individual level factors included issues of stigma, discrimination, and aging as factors that facilitated women's decision to leave sex work. At the structural level, factors which include interpersonal stigma and discrimination (from immediate family and community members), physical and sexual violence and income related factors were identified as facilitators and barriers to leaving sex work. Conclusion Our study highlights the complex decision-making processes among WESW as they navigate transitions to alternative jobs or careers. By advocating for multifaceted interventions and policies tailored to the diverse challenges faced by WESW, our study contributes to a more informed approach to supporting their transition out of sex work.
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Birger L, Peled E, Benyamini Y. Stigmatizing and inaccessible: The perspectives of female sex workers on barriers to reproductive healthcare utilization - A scoping review. J Adv Nurs 2024; 80:2273-2289. [PMID: 38069507 DOI: 10.1111/jan.16010] [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: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 05/12/2024]
Abstract
AIM To systematically map the extent, range and nature of qualitative studies that explored female sex workers' own perspectives on barriers to accessing reproductive healthcare services. DESIGN A scoping review of the literature utilizing Arksey and O'Malley's method. DATA SOURCES/REVIEW METHODS A search of the electronic databases MEDLINE/ PubMed, PsycNET, Sociological Abstracts, ProQuest, ScienceDirect, HeinOnline, Scopus, Web of Science and Google Scholar was conducted for items published in English between 2001 and 2021. RESULTS Twenty-one studies were included in the review, the majority of which were conducted in lower-middle-income countries. RHC themes studied were diverse, with a few more studies focusing on STI/HIV, contraceptive use and pregnancy than those focusing on childbirth and postnatal care. The findings indicate barriers in four main domains: socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. Stigma was a major multifaceted barrier. CONCLUSION Female sex workers experience exclusion in utilizing reproductive healthcare services globally. As such, healthcare services are advised to adopt a nonjudgemental approach, to enhance physical accessibility and to train nurses and other healthcare professionals on reproductive health needs of female sex workers. Finally, knowledge production processes on the RHC of FSW should adopt a holistic view of FSW, by exploring their needs and barriers related to childbirth and maternity care and by including the perspectives of FSW in high-income countries. IMPACT The review offered an in-depth understanding of female sex workers' own perspectives regarding needs and barriers in utilizing reproductive healthcare services. Findings indicated socio-legal barriers, health services-related barriers, interpersonal barriers and personal history-related barriers. The review could inform the training of nurses and other healthcare professionals in reproductive healthcare services globally. Researchers should adopt a holistic view of female sex workers, by exploring their family planning needs, including barriers related to childbirth, maternity and postpartum care. REPORTING METHOD We adhered to the EQUATOR guidelines PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.
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Affiliation(s)
- Lior Birger
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Peled
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Benyamini
- The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
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Mukuku O, Kiakuvue YN, Numbi GY, Ruhindiza BM, Kakisingi C, Mwamba CM, Katabwa JK. Assessing high-risk sexual practices associated with human immunodeficiency virus infection among young female sex workers in Lubumbashi, Democratic Republic of the Congo: a cross-sectional study. AIDS Res Ther 2024; 21:16. [PMID: 38504236 PMCID: PMC10949734 DOI: 10.1186/s12981-024-00602-x] [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: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Young female sex workers (YFSWs) face a higher risk of HIV infection compared to older workers, but there is a lack of comprehensive data on their sexual practices and HIV infection risks, which may present unique challenges and vulnerabilities. The study aimed to identify high-risk sexual practices associated with HIV infection among YFSWs in Lubumbashi. METHODS We conducted an analytical cross-sectional study and used a comprehensive sample of all YFSWs who presented to the HIV/Sexually Transmitted Infections Screening and Treatment Center in Lubumbashi between April 2016 and December 2017. We collected data on socio-demographic characteristics and behavioral risk factors of female sex workers were collected using a structured questionnaire. Using STATA version 16, multivariate logistic regression was fitted and the results were presented as adjusted odds ratios (aORs) with their 95% confidence intervals (95% CIs). RESULTS A total of 572 YFSWs were included in the study, 19 of whom were HIV-positive (3.3%; 95% CI: 2.1-5.1%). Participants who were forced to have sex (aOR = 12.2; 95% CI: 3.2-46.4; p < 0.0001), those who did not use condoms systematically (aOR = 4.1; 95% CI: 1.3-13.0; p = 0.018), and those who had anal sex (aOR = 23.8; 95% CI: 6.9-82.4; p < 0.0001) were more likely to be HIV-positive. CONCLUSION The study reveals a concerning trend of higher hospital HIV prevalence among YFSWs compared to the general Congolese population. It also highlights a significant link between high-risk sexual practices and HIV infection, highlighting the need for urgent interventions.
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Affiliation(s)
- Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
| | | | - Georges Yumba Numbi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | | | - Christian Kakisingi
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Claude Mulumba Mwamba
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Joe Kabongo Katabwa
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Kawuma S, Katwesigye R, Walusaga H, Akatukunda P, Nangendo J, Kabugo C, Kamya MR, Semitala FC. Determinants to Continuation on Hiv Pre-exposure Propylaxis Among Female Sex Workers at a Referral Hospital in Uganda: a Mixed Methods Study Using Com-b Model. RESEARCH SQUARE 2024:rs.3.rs-3914483. [PMID: 38405703 PMCID: PMC10889058 DOI: 10.21203/rs.3.rs-3914483/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Female sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre exposure prophylaxis (PrEP) has been recommended as part of the HIV combination prevention strategy, with improved patient initiation, but continuation on the service is low. We evaluated PrEP continuation among FSWs and explored potential determinants of PrEP continuation within a public referral hospital in Urban Uganda. Methods An explanatory sequential mixed method study was conducted at Kiruddu National referral hospital in Uganda. Secondary data on social demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021.We used Kaplan-Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers. Results Of the 292 FSWs initiated on PrEP during this period, 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3-21). The continuation rates on PrEP at six (6) and 12 months were, 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. Conclusion Continuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness on PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.
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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.
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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
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Lyu Y, Choong A, Chow EPF, Seib KL, Marshall HS, Unemo M, de Voux A, Wang B, Miranda AE, Gottlieb SL, Mello MB, Wi T, Baggaley R, Marshall C, Abu-Raddad LJ, Abara WE, Chen XS, Ong JJ. Vaccine value profile for Neisseria gonorrhoeae. Vaccine 2023:S0264-410X(23)00086-5. [PMID: 38123397 PMCID: PMC11169088 DOI: 10.1016/j.vaccine.2023.01.053] [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: 10/21/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 12/23/2023]
Abstract
Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports.
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Affiliation(s)
- Yiming Lyu
- University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Annabelle Choong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Victoria 3053, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria 3053, Australia.
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Helen S Marshall
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Magnus Unemo
- WHO CC for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden; Institute for Global Health, University College London (UCL), London, UK.
| | - Alex de Voux
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town 7700, South Africa.
| | - Bing Wang
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Angelica E Miranda
- Department of Social Medicine, Universidade Federal do Espirito Santo, Av. Fernando Ferrari, 514 - Goiabeiras, Vitória - ES 29075-910, Brazil.
| | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Caroline Marshall
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Laith J Abu-Raddad
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Box 24144, Doha, Qatar.
| | - Winston E Abara
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Xiang-Sheng Chen
- National Center for STD Control of China CDC, 12 Jiangwangmiao Street, Nanjing 210042, China.
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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Langenbach BP, Thieme A, van der Veen R, Reinehr S, Neuendorff NR. Attitudes towards sex workers: a nationwide cross-sectional survey among German healthcare providers. Front Public Health 2023; 11:1228316. [PMID: 37744482 PMCID: PMC10513093 DOI: 10.3389/fpubh.2023.1228316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Worldwide, sex workers face stigmatization and discrimination, also within healthcare. Only few studies on healthcare providers' attitudes towards care of sex workers have been performed. This study assessed attitudes and knowledge of healthcare providers in Germany towards sex workers and their specific health risks. Methods German healthcare professionals and medical students were invited to participate in a nationwide cross-sectional study in 2022. The online survey used a German translation of the "Attitudes towards Prostitutes and Prostitution Scale" by Levin and Peled for assessment of attitudes towards sex work and workers, together with prevalence estimates of common mental and physical disorders. Results A total of 469 questionnaires were included into analysis. Older participants tended to regard sex work as less of a choice (p < 0.004) and sex workers as more victimized (p < 0.001). The frequency of professional contact to sex workers neither affected the perception of sex workers' status as victims vs. independent individuals, nor the perceived moral status. Moreover, healthcare professionals overestimated the prevalence of various disorders which was influenced by participants' attitudes towards sex workers. Discussion A comparison to a recent Allensbach survey demonstrated similar attitudes of healthcare providers and the general population towards sex workers. Our results suggest that German healthcare professionals are not free of prejudices against sex workers, as has been shown for other marginalized groups in society. Instead, they seem to be influenced by personal opinion rather than by objective facts which they should have acquired during their professional education. Future interventions (e.g., better training regarding marginal societal groups) are necessary to encounter these issues in order to improve healthcare for sex workers.
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Affiliation(s)
- Benedikt P. Langenbach
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Thieme
- Department of Psychiatry and Psychotherapy, LVR University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Raquel van der Veen
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sabrina Reinehr
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina R. Neuendorff
- Department of Haematology and Stem Cell Transplantation, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Hufelandstr, Essen, Germany
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Elmi N, Marquez NG, Rucinski K, Lyons C, Turpin G, Ba I, Turpin N, Gouane E, Obodou E, Diouf D, Baral S. Meeting the reproductive health needs of female sex workers in Côte d'Ivoire: protecting the human right to dignified health. Reprod Health 2023; 20:133. [PMID: 37670305 PMCID: PMC10481554 DOI: 10.1186/s12978-023-01659-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: 06/12/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023] Open
Abstract
The sexual and reproductive health needs of female sex workers (FSW) are often understudied and underserved in the context of HIV-related research in countries across Sub-Saharan Africa and West Africa. We assessed the lived experiences of FSW across Côte d'Ivoire to characterize unmet reproductive health needs and opportunities to address them. From February-August, 2020, ENDA Santé, Côte d'Ivoire conducted 75 in-depth interviews and 15 focus group discussions with FSW and community informants in five cities in Côte d'Ivoire. Themes that emerged included the inconsistent use of contraception services, a history of unintended pregnancies, and experiences of stigma at public healthcare facilities. Opportunities to increase the impact of both SRH and HIV services included strengthening existing HIV and family planning service integration for FSW. Taken together, the results highlight the importance of addressing the unmet reproductive health needs of FSW to both optimize the HIV response and increase the delivery of human-rights affirming sexual and reproductive health services for sex workers.
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Affiliation(s)
- Nika Elmi
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Nuria Gallego Marquez
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Katherine Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Carrie Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Gnilane Turpin
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | | | | | - Emile Gouane
- ENDA Santé Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | | | | | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
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Nyariki E, Wanjiru R, Shah P, Kungu M, Babu H, Weiss HA, Seeley J, Kimani J, Beattie TS. Managing motherhood - the experiences of female sex workers in Nairobi, Kenya. CULTURE, HEALTH & SEXUALITY 2023; 25:1230-1243. [PMID: 36519798 DOI: 10.1080/13691058.2022.2153926] [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: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Women selling sex often face challenges in raising their children in the context of significant socio-economic difficulties and the social stigma inherent in sex work. This paper is based on a cross-sectional qualitative study that explored the dual roles of motherhood and sex work among female sex workers enrolled for ongoing HIV prevention and treatment services in the Sex Workers Outreach Programme (SWOP) clinics in Nairobi, Kenya. We examined women's experiences and coping in negotiating and managing the dual roles of motherhood and sex work. In-depth interviews were conducted with 39 women randomly selected from 1,000 women included in a baseline behavioural-biological survey conducted in October-November 2020 as part of the Maisha Fiti study. The analysis focused on themes related to motherhood and making a living: (i) entry into sex work; (ii) childcare arrangements; (iii) ensuring respectability for their children; and (iv) pursuit of safety and security. Findings from the study show women's entry into sex work was necessitated by poverty and a lack of reliable sources of livelihood to support their children. While performing their motherhood roles, the women demonstrate agency in navigating through their stigmatised conflicted sex work role to be able to provide for their children.
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Affiliation(s)
- Emily Nyariki
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jones HS, Hensen B, Musemburi S, Chinyanganya L, Takaruza A, Chabata ST, Matambanadzo P, Platt L, Rice B, Cowan FM, Hargreaves JR. Temporal trends in, and risk factors for, HIV seroconversion among female sex workers accessing Zimbabwe's national sex worker programme, 2009-19: a retrospective cohort analysis of routinely collected HIV testing data. Lancet HIV 2023; 10:e442-e452. [PMID: 37329897 DOI: 10.1016/s2352-3018(23)00110-8] [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: 12/31/2022] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The frequency of new HIV infections among female sex workers in sub-Saharan Africa is poorly understood. We used routinely collected data that enable unique identification of repeat HIV testers to assess temporal trends in seroconversion and identify associated risk factors for female sex workers accessing Sisters with a Voice, Zimbabwe's national sex worker programme. METHODS We pooled HIV testing data gathered between Sept 15, 2009, and Dec 31, 2019, from 36 Sisters programme sites in Zimbabwe. We included female sex workers aged 16 years or older with an HIV-negative test and at least one subsequent programme test. We calculated HIV seroconversion rates (using the midpoint between the HIV-positive test and the last negative test as the seroconversion date) and estimated rate ratios to compare 2-year periods by using Poisson regression, with robust SEs to account for clustering by site and adjusting for age and testing frequency to assess temporal trends. We did sensitivity analyses to explore assumptions about seroconversion dates and the effects of variation in follow-up time on our conclusions. FINDINGS Our analysis included data for 6665 female sex workers, 441 (7%) of whom seroconverted. The overall seroconversion rate was 3·8 (95% CI 3·4-4·2) per 100 person-years at risk. Seroconversion rates fell with time since first negative HIV test. After adjustment, there was evidence of a decrease in seroconversion rates from 2009 to 2019 (p=0·0053). In adjusted analyses, being younger than 25 years, and having a sexually transmitted infection diagnosis at a previous visit, were significantly associated with increased seroconversion rates. Our findings were mostly robust to sensitivity analyses, but when 1 month before an HIV-positive test was used as the seroconversion date, seroconversion rates no longer fell with time. INTERPRETATION We identified high rates of seroconversion shortly after linkage to programme services, which emphasises the need to strengthen HIV prevention programmes from first contact with female sex workers in Zimbabwe. New infections among female sex workers remain challenging to measure, but longitudinal analysis of routine testing data can provide valuable insights into seroconversion rates and associated risk factors. FUNDING UN Population Fund, Deutsche Gesellschaft für Internationale Zusammenarbeit, the Bill & Melinda Gates Foundation, The Global Fund to Fight AIDS, Tuberculosis and Malaria, US President's Emergency Plan for AIDS Relief, US Agency for International Development, and the Elton John AIDS Foundation.
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Affiliation(s)
- Harriet S Jones
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bernadette Hensen
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Sungai T Chabata
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | | | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Brian Rice
- University of Sheffield, School of Health and Related Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe; Faculty of Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James R Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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11
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Rael CT, Sandfort TGM, Gichangi P, Lafort Y, Mantell JE. Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention. J Assoc Nurses AIDS Care 2023; 34:248-258. [PMID: 37129476 PMCID: PMC10754228 DOI: 10.1097/jnc.0000000000000401] [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: 05/03/2023]
Abstract
ABSTRACT Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.
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Affiliation(s)
- Christine Tagliaferri Rael
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Theo G M Sandfort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gichangi
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yves Lafort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne E Mantell
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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12
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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.
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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
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13
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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.
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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
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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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15
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Moore BE, Govaerts L, Kapadia F. Maternal health and maternal health service utilization among female sex workers: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231206303. [PMID: 37899632 PMCID: PMC10617279 DOI: 10.1177/17455057231206303] [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: 03/09/2023] [Revised: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High proportions of female sex workers (FSWs) become pregnant and have children. Many FSWs are at increased risk of maternal health complications due to factors such as poverty, violence, and healthcare barriers. Despite this, FSWs' maternal health and use of maternal health services (MHS) receive limited attention. OBJECTIVES The objectives of this scoping review are to (1) synthesize existing data on FSWs' maternal health and MHS utilization and (2) assess the state of peer-reviewed literature on FSWs' maternal health in regard to methodological approaches and reported outcomes. ELIGIBILITY CRITERIA Included articles were peer-reviewed, published in English, and reported empirical data on FSWs for outcomes related to antenatal care, pregnancy, and labor complications, postnatal and delivery care, and/or barriers to MHS. SOURCES OF EVIDENCE Article searches were conducted in PubMed, Web of Science, Global Health, Sociological Abstracts, Sociological Index, PsychInfo, and CINAHL. CHARTING METHODS Information extracted from eligible articles included publication year, study design, location, sample size, outcome measures, and findings. The "Three Delays" model was used to synthesize findings on barriers to MHS as relevant to phase I, II, or III delays. RESULTS Eighteen publications met the eligibility criteria. Studies were conducted in 11 countries and primarily reported quantitative data from cross-sectional surveys. The most frequently reported outcome was antenatal care utilization (n = 14), whereas few studies reported findings related to postnatal care and breastfeeding counseling (n = 2). Across publications, there was a substantial range in the proportion of FSWs who reported accessing different types of MHS. CONCLUSION Literature on FSWs' maternal health is limited and heterogenous. More research is needed that specifically focuses on measuring outcomes related to FSWs' maternal health and examines associated factors. Such work can inform future research directions and public health interventions for FSWs-a population of marginalized women whose maternal health has been overlooked in existing efforts.
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Affiliation(s)
- Brandi E Moore
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Lauren Govaerts
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Farzana Kapadia
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
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16
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte S, Kiyingi J, Nsubuga E, Schriger S, Nattabi J, Mayo-Wilson LJ, Nakigudde J, Tozan Y, Ssewamala FM. "I decided in my heart I have to complete the sessions": A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda. PLoS One 2023; 18:e0280138. [PMID: 36634037 PMCID: PMC9836279 DOI: 10.1371/journal.pone.0280138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION NCT03583541.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- * E-mail:
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Josephine Nabayinda
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Susan Witte
- Columbia University School of Social Work, New York City, NY, United States of America
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Edward Nsubuga
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Simone Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jennifer Nattabi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, United States of America
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
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17
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Stockton MA, Kraemer J, Oga E, Kimani J, Mbote D, Kemunto C, Njuguna S, Nyblade L. Validation of a Brief Internalized Sex-work Stigma Scale among Female Sex Workers in Kenya. JOURNAL OF SEX RESEARCH 2023; 60:146-152. [PMID: 34622725 PMCID: PMC8989712 DOI: 10.1080/00224499.2021.1983752] [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] [Indexed: 06/13/2023]
Abstract
Female sex workers (FSW) often face severe stigma and discrimination and are extremely vulnerable to HIV and other sexually transmitted infections. In the fields of HIV and mental health, internalized stigma is associated with poor health care engagement. Due to the lack of valid, standardized measures for internalized sex work-related stigma, its dimensions and role are not well-understood. This study aimed to validate the six-item Internalized AIDS-Related Stigma Scale adapted to capture internalized sex work-related stigma by examining the scale's psychometric properties and performance among a cross-sectional, snowball sample of FSW (N = 497) in Kenya. While the original pre-hypothesized six-item model yielded acceptable CFI and SRMR values (CFI = 0.978 and SRMR = 0.038), the RMSEA was higher than desirable (RMSEA = 0.145). Our final four-item model demonstrated improved goodness of fit indices (RMSEA = 0.053; CFI = 0.999; and SRMR = 0.005). Both the pre-hypothesized six-item and reduced final four-item model demonstrated good internal consistency (Cronbach's alphas of 0.8162 and 0.8754, respectively). Higher levels of internalized stigma were associated with depression, riskier sexual behavior, and reduced condom use. This very brief measure will allow for reliable assessment of internalized stigma among FSW. Further investigation of internalized stigma among male sex workers, particularly the intersection of sex work-related and same-sex behavior-related stigmas, is needed.
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Affiliation(s)
- Melissa A. Stockton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - John Kraemer
- Department of Health Systems Administration, Georgetown University, Washington DC, USA
- Global Health Division, International Development Group, RTI International, Washington DC, USA
| | - Emmanuel Oga
- Center for Applied Public Health Research, RTI International, Rockville, MD, USA
| | - Joshua Kimani
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi; Kenya
| | - David Mbote
- Kuria Foundation for Social Enterprise, Nairobi, Kenya
| | | | | | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington DC, USA
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18
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Nabayinda J, Kiyingi J, Kizito S, Nsubuga E, Nabunya P, Bahar OS, Magorokosho N, Nattabi J, Witte S, Fred MS. Does asset ownership influence sexual risk-taking behaviors among women engaged in sex work in Southern Uganda? A mediation analysis. BMC Womens Health 2022; 22:537. [PMID: 36550547 PMCID: PMC9773531 DOI: 10.1186/s12905-022-02129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Economic vulnerability influences women engaged in commercial sex work (WESW) to further engage in sexual risk behaviors, as they often have multiple customers and engage in unprotected sex for financial gains. This study examined asset ownership's direct and indirect impact on sexual risk-taking behaviors among WESW in Southern Uganda, a very vulnerable group of women at high risk for contracting HIV and other STIs. METHODOLOGY We used baseline data from the Kyaterekera study, an NIH-funded study among WESW aged 18-55 across 19 HIV hotspots in Southern Uganda. Structural equation modeling was used to examine the direct, indirect, and total effects of assets-defined as ownership of physical and financial resources-on sexual risk-taking behaviors among WESW. RESULTS Results showed that asset ownership was associated with a decrease in depression (β = - 0.096 [95% CI - 0.191, - 0.001], p = 0.050) and increased access to medical care (β = 0.174 [95% CI 0.072, 0.275], p = 0.001).We also found that an increase in access to medical care was associated with decreased sexual risk-taking behaviors (β = - 0.107 [95% CI - 0.210, - 0.004], p = 0.041). We observed a specific indirect effect between assets and sexual risk-taking behaviors through access to medical care (β = - 0.019 [95% CI - 0.040, - 0.002], p = 0.05). Mediation contributed 31% of the total effects of asset ownership on sexual risk-taking behaviors. CONCLUSION To our knowledge, this is among the few studies to examine the impact of asset ownership on sexual risk-taking behaviors among WESW in Southern Uganda. Findings from this study indicate that increasing access to economic resources may reduce the risk of WESW engaging in unprotected sex for higher income, which limits the spread of HIV among this population. The results also indicate that asset ownership may allow women to access healthcare services.
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Affiliation(s)
- Josephine Nabayinda
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Joshua Kiyingi
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Samuel Kizito
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Edward Nsubuga
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Proscovia Nabunya
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Ozge Sensoy Bahar
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Natasja Magorokosho
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Jennifer Nattabi
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Susan Witte
- grid.21729.3f0000000419368729Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027 USA
| | - M. Ssewamala Fred
- grid.4367.60000 0001 2355 7002International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, St. Louis, MO 63130 USA
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19
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Aantjes C, Muchanga V, Munguambe K. Exposed and unprotected: Sex worker vulnerabilities during the COVID-19 health emergency in Mozambique. Glob Public Health 2022; 17:3568-3582. [PMID: 35748776 DOI: 10.1080/17441692.2022.2092184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Measures to contain the spread of COVID-19 have been shown to disproportionately affect the marginalised groups in our societies. We studied the impacts of national restrictions on young adult sex workers in Mozambique, and actions at individual, governmental and civil society level to mitigate against these impacts. The country case study was part of a multi-country qualitative research, including fifty-four semi-structured interviews with female sex workers (N = 38), outreach workers (N = 10) in Maputo and Quelimane, and informants with key positions in national COVID coordination bodies, the Ministry of Health and civil society organisations (N = 7). While restrictions impacted all sex worker participants, the COVID crisis was found to deepen existing class differences and further incite violence against the most visible and economically vulnerable category of street-based sex workers. Parallel enforcement of morals against this group of 'urban undesirables' resulted in bodily harm and further degradation of the female sex worker under the guise of COVID emergency decrees, while restrictions weakened protection from peers and outreach workers against abuse by the police and other perpetrators. The State needs to act against unlawful police action and include impact mitigation strategies in its public health response to COVID in order to protect the most vulnerable.
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Affiliation(s)
- Carolien Aantjes
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Vasco Muchanga
- Faculty of Medicine, Community Health Department, Sexual and Reproductive Health Unit, Eduardo Mondlane University, Maputo, Mozambique
| | - Khátia Munguambe
- Faculty of Medicine, Community Health Department, Sexual and Reproductive Health Unit, Eduardo Mondlane University, Maputo, Mozambique
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Pandey AK, Seelman K. History of Sex Work Is Associated with Increased Risk of Adverse Mental Health and Substance Use Outcomes in Transgender Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15908. [PMID: 36497981 PMCID: PMC9735961 DOI: 10.3390/ijerph192315908] [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: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Understanding factors influencing mental health and substance use in transgender and gender diverse people is critical to reducing disparities in this population. We sought to investigate whether a history of sex work was associated with increased prevalence of poor mental health, substance use, and a negative experience within drug and alcohol treatment facilities. We conducted a secondary analysis of the data of 25,204 transgender respondents of the 2015 United States Transgender Survey. We estimated multiple logistic regressions to assess the association between a history of sex work and adverse mental health and substance use outcomes. We then estimated mean prevalence of adverse outcomes by type of sex work. Finally, we performed chi-square analysis to explore differences in mistreatment at drug and alcohol treatment facilities. Respondents with a history of sex work were significantly more likely to have poorer psychological health, suicidality, and substance use after adjusting for covariates. Among those who visited drug and alcohol treatment facilities, those with a history of sex work were significantly more likely to report adverse experiences (26.34% vs. 11.63%). Our findings highlight the increased risk of adverse outcomes in transgender sex workers and emphasize the need for interventions targeting this subgroup of transgender people.
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Affiliation(s)
- Ajay Keshav Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Kristie Seelman
- School of Social Work, Georgia State University, Atlanta, GA 30302, USA
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21
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Jaffer M, Christofides N, Hlongwane K, Otwombe K, Milovanovic M, Hopkins KL, Matuludi M, Mbowane V, Abdullah F, Gray G, Jewkes R, Coetzee J. The HIV Cascade of Care and Service Utilisation at Sex Work Programmes Among Female Sex Workers in South Africa. AIDS Behav 2022; 26:2907-2919. [PMID: 35247114 PMCID: PMC8897612 DOI: 10.1007/s10461-022-03616-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Female sex workers (FSWs) in South Africa experience a uniquely high prevalence of HIV. We describe the HIV cascade of care (CoC) in FSWs in South Africa, and explored service utilisation at sex work programmes. A cross-sectional, study enrolled FSWs across 12 sites in South Africa. Participants were recruited using chain-referral method. Inclusion criteria: ≥ 18 years, cis-gender female, sold/transacted in sex, HIV positive. 1862 HIV positive FSWs were enrolled. 92% were known positive, 87% were on antiretroviral treatment (ART). Of those on ART, 74% were virally suppressed. Younger FSWs were significantly less likely to be on ART or virally suppressed. Female sex workers using HIV services from specialised programs were 1.4 times more likely to be virally suppressed than non-program users. The pre-COVID-19 pandemic HIV CoC amongst FSWs in South Africa shows striking improvement from previous estimates, and approaches achievement of 90:90:90 goals.
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Affiliation(s)
- Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- African Potential Management Consultancy, Kyalami, South Africa.
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22
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Tomko C, Nestadt DF, Weicker NP, Rudzinski K, Underwood C, Kaufman MR, Sherman SG. External resilience in the context of drug use and socio-structural vulnerabilities: a qualitative exploration among women who use drugs and sell sex in Baltimore, Maryland. Harm Reduct J 2022; 19:94. [PMID: 36002879 PMCID: PMC9400291 DOI: 10.1186/s12954-022-00678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Resilience is a commonly used construct in substance use and mental health research. Yet it is often narrowly defined by only its internal qualities (e.g., adaptability, hardiness) and overlooks its external qualities (e.g., supportive relationships, navigating one’s environment). Further, substance use is often viewed as antithetical to resilience despite populations like women who use drugs and sell sex (WWUD-SS) surviving significant hardships. This study aims to fill a gap in the literature by characterizing external resilience among WWUD-SS and understanding the ways that socio-structural vulnerabilities (e.g., poverty, stigma) and substance use shape external resilience.
Methods WWUD-SS (N = 18) enrolled in an ongoing cohort study were purposively sampled for age, race, and recruitment location and participated in semi-structured, in-depth interviews aimed to elucidate external resilience (i.e., social support and resource utilization). WWUD-SS were queried about recent difficult experiences with a focus on how they did or did not use social support or formal resources (e.g., clinic, crisis hotline) in response.
Results Participants were a median age of 37 years, 50% identified as Black, and 50% reported currently injecting drugs. Participants described reluctance to ask for support and often felt resigned to address problems alone. Participants also distinguished between transactional relationships (help is contingent upon receiving something in return) versus genuine (non-transactional or altruistic) support, including the role of family members who do and do not use drugs. Resource utilization was rare, and “self-medication” through substance use was common absent other perceived options for help. Conclusions External resilience appears limited among WWUD-SS and shaped by the social and economic contexts of a street-involved life. WWUD-SS’ ability to exercise external resilience may be undercut by experiencing structural vulnerabilities and competition for material resources that create transactional relationships and diminish the perceived value of social support. Internalized stigma, reflecting the larger society’s stigmatized views of drug use, sex work, and poverty, left WWUD-SS eschewing help from outside sources. Focus on internal resilience alone offers an incomplete picture of the construct in drug-using populations. Improving connections to community resources may be a targeted way to strengthen external resilience, as are policies addressing structural vulnerabilities for marginalized communities.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Noelle P Weicker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Katherine Rudzinski
- Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Carol Underwood
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 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
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23
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, Hladik W. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda. BMC Pregnancy Childbirth 2022; 22:646. [PMID: 35978285 PMCID: PMC9382809 DOI: 10.1186/s12884-022-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - Reena H Doshi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
| | - Herbert Kiyingi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Jonathan Standish
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, USA
| | - Wolfgang Hladik
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
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24
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Beckham S, Karver TS, Mantsios A, Shembilu C, Donastorg Y, Perez M, Gomez H, Barrington C, Mwampashi A, Davis W, Likindikoki S, Mbwambo JK, Kerrigan D. Acceptability and perceptions of HIV oral self-testing across settings: A comparative qualitative study among Dominican and Tanzanian female sex workers. Glob Public Health 2022; 17:870-884. [PMID: 33736565 PMCID: PMC8449797 DOI: 10.1080/17441692.2021.1901129] [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: 10/14/2020] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants' interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW's perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach.
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Affiliation(s)
- S.Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Tahilin S. Karver
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Catherine Shembilu
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Maria Perez
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ardi Mwampashi
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K. Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
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25
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Restar AJ, Valente PK, Ogunbajon A, Masvawure TB, Sandfort T, Gichangi P, Lafort Y, Mantell JE. Solidarity, support and competition among communities of female and male sex workers in Mombasa, Kenya. CULTURE, HEALTH & SEXUALITY 2022; 24:627-641. [PMID: 33666535 PMCID: PMC8556737 DOI: 10.1080/13691058.2021.1876248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Female and male sex workers are at elevated risk for HIV infection, psychological distress and other adverse health outcomes. It is therefore important to understand how sex workers' social relationships with one another might inform psychosocial support services for this population. We conducted semi-structured interviews to examine the formation and nature of social networks of 25 female and 25 male sex workers recruited from bars and clubs in Mombasa, Kenya. Relationships between and among female and male participants were often formed based on a mutual understanding of the challenging nature of sex work. Both groups described their relationships in terms of friendship and brotherhood/sisterhood and highlighted the following benefits of sex worker social networks: economic benefits, access to information about HIV/STIs and protection, and support against violence from clients and law enforcement agents. Social networks were often threatened by competition for clients and hence could result in conflict. However, sex workers explained that their sense of solidarity and reliance on one another for health, protection and economic well-being helped minimise conflict. The social networks of sex workers could therefore be used to leverage or optimise access to HIV prevention and care.
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Affiliation(s)
- Arjee J. Restar
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Corresponding Author: Arjee Restar
| | - Pablo K. Valente
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Adedotun Ogunbajon
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tsitsi Beatrice Masvawure
- Health Studies Program, Center for Interdisciplinary Studies, College of the Holy Cross, Worcester, MA, USA
| | - Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Peter Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Department of Anatomy, University of Nairobi, Nairobi, Kenya
| | - Yves Lafort
- KEMRI, Wellcome Trust Research Programme, Kilifi, Kenya
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
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26
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Assessing the Relationship Between HIV Quality of Care and Treatment Literacy on ART Adherence and Viral Suppression Among Female Sex Workers Living in the Dominican Republic. AIDS Behav 2022; 26:3056-3067. [PMID: 35305180 DOI: 10.1007/s10461-022-03647-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/01/2022]
Abstract
This study assessed the relationship between the quality of HIV care and treatment literacy on antiretroviral therapy (ART) adherence and viral suppression among female sex workers (FSWs) living with HIV (n = 211) in Santo Domingo, Dominican Republic. Multivariable logistic regression results indicate better patient-provider communication (AOR 1.04; 95% CI 1.01-1.07) and respectful treatment (AOR 2.17; 95% CI 1.09-4.32) increase the odds of viral suppression, while higher costs reduce both the odds of ART adherence (AOR 0.57, 95% CI 0.34- 0.95) and being virally suppressed (AOR 0.59, 95% CI 0.41-0.85). Greater treatment literacy was associated with an increased odds of ART adherence (AOR 4.15 for understanding of viral load; 95% CI 1.50-11.52) and viral suppression (AOR 2.75 for understanding of CD4 count; 95% CI 1.31-5.80). Findings support investments in treatment education, effective and respectful patient-provider communication, dignified care, and cost-support for associated HIV care costs to facilitate FSWs' pathway towards viral suppression.
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27
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Nakiganda LJ, Bavinton BR, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bell S. Social Influences on Engagement With HIV Testing, Treatment and Care Services Among Men Who Have Sex With Men Living in Rural Uganda. QUALITATIVE HEALTH RESEARCH 2022; 32:635-645. [PMID: 34923882 DOI: 10.1177/10497323211058162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Men who have sex with men in Uganda are a heterogenous, discriminated population, experiencing high HIV burden, limited access to HIV testing, and low treatment adherence. We contribute to the lack of information about men who have sex with men in rural Uganda by using socio-ecological analyses to examine the social influences shaping their engagement with HIV services. Based on in-depth interviews with 16 men, our findings reveal the inhibitive influence of interpersonal relationships with sexual partners, peers and families, and institutional influences within health service and non-governmental organizational settings. Yet men take action to strategize and seek support to enhance engagement with HIV care in heavily criminalized and stigmatized settings. Future HIV prevention, testing, treatment, and care responses could draw on what affected individuals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.
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Affiliation(s)
- Lydia J Nakiganda
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- 561068Rakai Health Sciences Program, Kalisizo, Uganda
- 58589Makerere University School of Public Health, Kampala, Uganda
| | | | - Isobel M Poynten
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- School of Public Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Social Research in Health, 7800UNSW Sydney, Sydney, NSW, Australia
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Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Page KR, Celentano D, Smith KC, Kerrigan D. Exploring peer navigation and support in the quality of HIV care experiences of female sex workers in the Dominican Republic. BMC Health Serv Res 2022; 22:56. [PMID: 35016659 PMCID: PMC8753897 DOI: 10.1186/s12913-021-07439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite evidence on peer navigation’s association with positive HIV outcomes, such as engagement in HIV care and antiretroviral therapy (ART) initiation, the mechanisms through which peer navigation may influence these outcomes have been less explored. The purpose of this study is to describe the role of peer navigation and support on enhancing the quality of HIV treatment and care services experienced by female sex workers (FSWs).
Methods
Survey data was derived from a quantitative cohort (n = 211) of FSWs living with HIV in the Dominican Republic and complemented with data from two rounds of in-depth interviews (IDIs) from a qualitative subsample (n = 20 per round). Descriptive statistics and multivariable logistic regressions were used to explore the association between peer navigation and relational aspects of care and overall satisfaction of the quality of HIV treatment and care. Thematic analysis was employed to code and synthesize textual data from IDIs.
Results
41.2% of the participants reported having had contact with a peer navigator in the last 6 months. Qualitative data revealed that peer navigation and support was instrumental in assisting FSWs linkage to HIV care after diagnosis, elevating FSWs’ ability to access more comprehensive clinical care facilities, and promoting agency by improving FSWs’ skills to more strategically and effectively engage with the clinic environment and health care providers. Peer navigation was positively associated with experiencing more respectful treatment by clinic staff (AOR: 6.65, 95% CI: 2.32–19.02), and greater satisfaction with overall HIV care services (AOR: 2.57, 95% CI: 1.77–3.74).
Conclusion
Promoting the full integration of peer navigation into healthcare structures is a strategic approach to enhance the quality of HIV care experienced by FSWs and improve their HIV-related outcomes.
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Mantsios A, Muraleetharan O, Donastorg Y, Perez M, Gomez H, Shembilu C, Beckham SW, Karver TS, Davis W, Likindikoki S, Mbwambo J, Barrington C, Kerrigan D. "She is the one who knows": A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000981. [PMID: 36712835 PMCID: PMC9880901 DOI: 10.1371/journal.pgph.0000981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite documented interest among female sex workers (FSW), uptake of oral pre-exposure prophylaxis (PrEP) for HIV prevention has been low. Recent trials and regulatory approval of long-acting injectable (LAI) PrEP offer new hope for the potential of this biomedical intervention. We examined FSW's PrEP-related interest and preferences regarding both oral and LAI PrEP situating these dynamics within their specific social and occupational realities. We conducted this work using qualitative methods across two distinct contexts by conducting 40 in-depth interviews with FSW in Tanzania and the Dominican Republic. Textual data was coded using iterative thematic content analysis. Analytic summaries were developed and reviewed to identify recurring themes. We systematically organized themes within each country and then compared across settings. Women in both settings expressed strong interest in PrEP seeing it as an important option to protect themselves in their work. Most participants preferred LAI PrEP due to expectations of reduced stigma and concerns about daily pill adherence and side effects. Occupational factors such as alcohol use, overnight dates with clients, and fear of violence from clients were identified as barriers to daily oral PrEP. LAI PrEP was seen as having the potential to reduce stress related to oral PrEP. Women who preferred pills discussed fear of needles, skepticism about the injections, and others relayed that taking a daily pill would not be challenging for them. There was a pre-dominant sentiment that women know best whether they are better suited for oral or LAI PrEP. Participants stressed the importance of FSW understanding both options to ensure informed decision-making around PrEP and described community-led peer education as key to delivering trusted information. Community empowerment approaches led by FSW which address structural and psychosocial constraints and promote safe work environments may facilitate equitable access and uptake of PrEP among FSW across settings.
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Affiliation(s)
- Andrea Mantsios
- Public Health Innovation & Action, New York, New York, United States of America
- * E-mail:
| | - Ohvia Muraleetharan
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Yeycy Donastorg
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Catherine Shembilu
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States of America
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States of America
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Muhindo R, Mujugira A, Castelnuovo B, Sewankambo NK, Parkes-Ratanshi R, Tumwesigye NM, Nakku-Joloba E, Kiguli J. "I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis": barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda. BMC Public Health 2021; 21:1982. [PMID: 34727898 PMCID: PMC8564957 DOI: 10.1186/s12889-021-12095-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators. Conclusions HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Edith Nakku-Joloba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Kiguli
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Ouma S, Ndejjo R, Abbo C, Tumwesigye NM. Client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda: a cross-sectional study. BMJ Open 2021; 11:e046894. [PMID: 34518251 PMCID: PMC8438829 DOI: 10.1136/bmjopen-2020-046894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE To determine the prevalence and associated factors of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda. DESIGN AND SETTINGS We conducted a cross-sectional study among female sex workers in Gulu district in conflict-affected Northern Uganda. PARTICIPANTS The study participants included 300 female sex workers aged 18+ years. The participants were selected using simple random sampling from a database of female sex workers maintained at a national non-governmental organisation in Gulu. OUTCOME MEASURE The outcome measure was self-reported exposure to client-perpetrated gender-based violence. METHODS We used a pretested semistructured questionnaire to collect data on sociodemographic characteristics, sex work-related characteristics, alcohol use, illicit drug use, HIV status and self-reported exposure to client-perpetrated gender-based violence. Then, data were entered into Epi Info V.7 and analysed using Stata V.14.0. RESULTS Among participants, 61.0% reported client-perpetrated gender-based violence. Economic (58.7%) and emotional (52.0%) violence were the most common forms of client-perpetrated gender-based violence in this population. Independently, being: street-based (adjusted OR=9.66, 95% CI 2.78 to 33.5), mobile (adjusted OR=3.21, 95% CI 1.83 to 5.64), HIV-positive (adjusted OR=1.90, 95% CI 1.09 to 3.31) and a low-income earner (<USh200 000 monthly) (adjusted OR=2.26, 95% CI 1.18 to 4.30) were positively associated with exposure to client-perpetrated gender-based violence. CONCLUSIONS There is a high prevalence of client-perpetrated gender-based violence among female sex workers in conflict-affected Northern Uganda. Furthermore, female sex workers who were street-based, mobile, HIV-positive and low-income earners were more likely to experience client-perpetrated gender-based violence. The ministry of health and the development partners need to provide targeted public health interventions to prevent and manage the rampant gender-based violence among this underserved population.
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Affiliation(s)
- Simple Ouma
- Research Department, The AIDS Support Organization, Kampala, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Malama K, Sagaon Teyssier L, Parker R, Tichacek A, Sharkey T, Kilembe W, Inambao M, Price MA, Spire B, Allen S. Client-Initiated Violence Against Zambian Female Sex Workers: Prevalence and Associations With Behavior, Environment, and Sexual History. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9483-NP9500. [PMID: 31268388 PMCID: PMC8366593 DOI: 10.1177/0886260519860083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Violence against women is a known risk factor for HIV and affects female sex workers (FSW) in sub-Saharan Africa. Little is known about the magnitude and determinants of violence against FSW in Zambia, where HIV and gender-based violence prevalence are high. We conducted a cross-sectional study, using multivariable logistic regression, to determine the prevalence and correlates of client-initiated physical violence among 419 FSW in Lusaka and Ndola. The prevalence of client-initiated physical violence was 39%. The odds of violence were higher for FSW who: lived in Lusaka, recruited clients from the street, serviced clients in the clients' homes, had a physically forced sexual debut, and had a higher client volume. Our results call for safer working spaces for FSW and violence prevention interventions for their male clients.
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Affiliation(s)
- Kalonde Malama
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Luis Sagaon Teyssier
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
| | - Tyronza Sharkey
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - William Kilembe
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
| | - Mubiana Inambao
- Zambia Emory HIV Research Project, Rwanda Zambia HIV Research Group, Emory University, Ndola, Zambia
| | - Matt A Price
- International AIDS Vaccine Initiative (IAVI) New York, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Bruno Spire
- Aix-Marseille Université, APHM, INSERM, IRD, Sciences Économiques & Sociales de la Santé et Traitement de l’Information Médicale (SESSTIM), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Emory University, Pathology & Laboratory Medicine, School of Medicine, Atlanta, GA, United States
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Vélez-Grau C, El-Bassel N, McCrimmon T, Chang M, Terlikbayeva A, Primbetova S, Mergenova G, Witte SS. Suicidal ideation among women who engage in sex work and have a history of drug use in Kazakhstan. MENTAL HEALTH & PREVENTION 2021; 23:200208. [PMID: 38031555 PMCID: PMC10686267 DOI: 10.1016/j.mhp.2021.200208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Suicide rates in Kazakhstan rank fourth worldwide. Suicidal ideation is a strong predictor of death by suicide. Yet there is limited information about factors associated with suicidal ideation among women who engage in sex work (WESW) with a history of drug use. Guided by the Diathesis-Stress Theory of Suicide, this study examined the risk and protective factors associated with suicidal ideation among WESW in Kazakhstan. Data drew from the baseline assessments from a sample of four hundred women who participated in a cluster randomized control trial comparing a treatment arm which received a combination of HIV Risk Reduction (HIVRR) and microfinance intervention, and a control arm which received HIVRR alone. Multiple logistic regression models controlling for sociodemographic characteristics examined the effects of risk and protective factors on suicidal ideation. More than half of the participants (52.5%) reported suicidal ideation in the past seven days. Women with vulnerabilities such as child sexual abuse and harmful alcohol use and stressors such as stigma were more likely to think about suicide compared with those who did not. Keeping income from sex work was associated with a lower risk of suicidal ideation. HIV interventions targeting WESW and use drugs must include a mental health component to decrease the risk of suicidal ideation among this group. Women's ability to keep income from sex work suggests the potential to strengthen women's financial stability as a source of empowerment, which may in turn lessen the detrimental effects of childhood adversities and life stressors experienced by WESW.
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Affiliation(s)
- Carolina Vélez-Grau
- Silver School of Social Work, New York University, USA
- McSilver Institute for Poverty Policy and Research, USA 1 Washington Square N, New York, New York 10003, Unites States
| | - Nabila El-Bassel
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Tara McCrimmon
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Mingway Chang
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Sholpan Primbetova
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Gaukhar Mergenova
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
| | - Susan S Witte
- Columbia University School of Social Work, USA 1255 Amsterdam Ave, New York, NY 10027, United States
- Global Health Research Center of Central Asia 38B, Shashkina Str. 050040, Almaty, Kazakhstan
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Keuroghlian AS, Mujugira A, Mayer KH. Healthcare worker training to improve quality of care for sexual and gender minority people in sub-Saharan Africa: learning from efforts in Uganda. J Int AIDS Soc 2021; 24 Suppl 3:e25728. [PMID: 34189872 PMCID: PMC8242968 DOI: 10.1002/jia2.25728] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Training in care for sexual and gender minority (SGM) populations is critical for ending the HIV epidemic. SGM people, particularly men who have sex with men (MSM) and transgender women, experience disproportionate HIV infection across the globe. The objective of this commentary was to synthesize facilitators of and barriers to SGM health training efforts for healthcare workers in Uganda, in order to help inform potential priorities, strategies and next steps to advance culturally responsive HIV-related care for SGM communities across Uganda and sub-Saharan Africa. DISCUSSION SGM health training often includes education on: foundational concepts and language; stigma, discrimination and SGM health disparities; understanding and addressing implicit bias; sensitive and effective communication and building SGM-inclusive and welcoming healthcare environments. Clinicians' education includes sexual and gender histories, sex-positive HIV counselling, sexually transmitted infections, HIV pre-exposure prophylaxis and gender-affirming hormone therapy. SGM communities in sub-Saharan Africa have often experienced discrimination, persecution, incarceration and physical violence, and they encounter unique barriers to engagement in sexual health services and HIV prevention and treatment. SGM health training efforts in Uganda reveal challenges to and opportunities for advancing equity for SGM communities in sexual health and HIV medical care across the region. In Uganda, SGM community advocacy, as well as policies and programmes of the Ministry of Health and US President's Emergency Plan for AIDS Relief, have increased readiness and need for scaling up training and skills-sharing in SGM-focused HIV and sexual healthcare, including Ugandan-led and international initiatives. CONCLUSIONS Numerous challenges exist to widespread culturally responsive HIV and sexual healthcare for SGM communities in sub-Saharan Africa. Lessons learned from healthcare worker training efforts in Uganda may inform future replication, adaptation and dissemination initiatives to meet the needs of more SGM communities in the region. Evaluation of SGM health training programmes to determine the impact on HIV virological suppression and sexual health outcomes will be critical for identifying best practices and strategies that may support advancing HIV epidemic control for SGM communities in Uganda and across sub-Saharan Africa.
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Andrew Mujugira
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
- Department of Global Health and PopulationHarvard T.C. Chan School of Public HealthBostonMAUSA
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Jin H, Restar A, Beyrer C. Overview of the epidemiological conditions of HIV among key populations in Africa. J Int AIDS Soc 2021; 24 Suppl 3:e25716. [PMID: 34190412 PMCID: PMC8242974 DOI: 10.1002/jia2.25716] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite extraordinary progress in HIV treatment coverage and expanding access to HIV prevention services and that multiple African countries are on track in their efforts to reach 90-90-90 goals, the epidemic continues to persist, with prevalence and incidence rates too high in some parts of the continent to achieve epidemic control. While data sources are improving, and research studies on key populations in specific contexts have improved, work on understanding the HIV burdens and barriers to services for these populations remains sparse, uneven and absent altogether in multiple settings. More data have become available in the last several years, and data published in 2010 or more recently are reviewed here for each key population. This scoping review assesses the current epidemiology of HIV among key populations in Africa and the social and political environments that contribute to the epidemic, both of which suggest that without significant policy reform, these epidemics will likely continue. RESULTS AND DISCUSSION Across Africa, the HIV epidemic is most severe among key populations including women and men who sell or trade sex, men who have sex with men, people who inject drugs, transgender women who have sex with men and prisoners and detainees. These groups account for the majority of new infections in West and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those populations. The HIV literature in Africa emphasizes that despite significant health needs, key populations experience barriers to accessing services within the healthcare and legal justice systems. Current shortcomings of surveillance systems in enumerating key populations impact the way funding mechanisms and resources are allocated and distributed. Adapting more equitable and epidemiologically sound frameworks will be necessary for current and future HIV programming investments. CONCLUSIONS Through this review, the available literature on HIV epidemiology among key populations in Africa brings to light a number of surveillance, programmatic and research gaps. For many communities, interventions targeting the health and security conditions continue to be minimal. Compelling evidence suggests that sweeping policy and programmatic changes are needed to effectively tackle the persistent HIV epidemic in Africa.
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Affiliation(s)
- Harry Jin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
| | - Arjee Restar
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
| | - Chris Beyrer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
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Moyo I, Macherera M. The experiences of sex workers accessing HIV care services in Bulawayo, Zimbabwe. Afr Health Sci 2021; 21:593-602. [PMID: 34795712 PMCID: PMC8568253 DOI: 10.4314/ahs.v21i2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although sub-Saharan African countries have rolled out massive HIV treatment and care programmes, there is little evidence of these having embraced key population groups particularly female sex workers. Due to the criminalisation of sex work in countries like Zimbabwe, research on HIV and its impact on this group is sparse. The absence of an enabling environment has hindered access to HIV care and treatment services for female sex workers. OBJECTIVES To gain an in-depth understanding of the experiences of female sex workers accessing HIV care and treatment services to enhance programming and planning for this key population group. METHODS This study was qualitative and phenomenological. Data saturation determined the sample size of 20 participants. Data was collected using in-depth interviews that were audio recorded, transcribed, and subjected to thematic content analysis. RESULTS Our findings demonstrate varying dynamics between the private and public sector HIV care services for sex workers, with facilitators and barriers to access to care. CONCLUSION Health workers need sensitization and training in the provision of differentiated care. For effective linkage to and retention in care an enabling environment is critical.
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Ayieko J, Petersen ML, Kabami J, Mwangwa F, Opel F, Nyabuti M, Charlebois ED, Peng J, Koss CA, Balzer LB, Chamie G, Bukusi EA, Kamya MR, Havlir DV. Uptake and outcomes of a novel community-based HIV post-exposure prophylaxis (PEP) programme in rural Kenya and Uganda. J Int AIDS Soc 2021; 24:e25670. [PMID: 34152067 PMCID: PMC8215805 DOI: 10.1002/jia2.25670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Antiretroviral-based HIV prevention, including pre-exposure prophylaxis (PrEP), is expanding in generalized epidemic settings, but additional prevention options are needed for individuals with periodic, high-risk sexual exposures. Non-occupational post-exposure prophylaxis (PEP) is recommended in global guidelines. However, in Africa, awareness of and access to PEP for sexual exposures are limited. We assessed feasibility, acceptability, uptake and adherence in a pilot study of a patient-centred PEP programme with options for facility- or community-based service delivery. METHODS After population-level HIV testing with universal access to PrEP for persons at elevated HIV risk (SEARCH Trial:NCT01864603), we conducted a pilot PEP study in five rural communities in Kenya and Uganda between December 2018 and May 2019. We assessed barriers to PEP in the population and implemented an intervention to address these barriers, building on existing in-country PEP protocols. We used community leaders for sensitization. Test kits and medications were acquired through the Ministry of Health supply chain and healthcare providers based at the Ministry of Health clinics were trained on PEP delivery. Additional intervention components were (a)PEP availability seven days/week, (b)PEP hotline staffed by providers and (c)option for out-of-facility medication delivery. We assessed implementation using the Proctor framework and measured seroconversions via repeat HIV testing. Successful "PEP completion" was defined as self-reported adherence over four weeks of therapy with post-PEP HIV testing. RESULTS Community leaders were able to sensitize and mobilize for PEP. The Ministry of Health supplied test kits and PEP medications; after training, healthcare providers delivered the 28-day regimen with high completion rates. Among 124 persons who sought PEP, 66% were female, 24% were ≤25 years and 42% were fisherfolk. Of these, 20% reported exposure with a serodifferent partner, 72% with a new or existing relationship and 7% from transactional sex. 12% of all visits were conducted at out-of-facility community-based sites; 35% of participants had ≥1 out-of-facility visit. No serious adverse events were reported. Overall, 85% met the definition of PEP completion. There were no HIV seroconversions. CONCLUSIONS Among individuals with elevated-risk exposures in rural East African communities, patient-centred PEP was feasible, acceptable and provides a promising addition to the current prevention toolkit.
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Affiliation(s)
- James Ayieko
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Maya L Petersen
- Department of BiostatisticsUniversity of CaliforniaBerkeleyCAUSA
| | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | | | - Fred Opel
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Marilyn Nyabuti
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - James Peng
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Catherine A Koss
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Laura B Balzer
- Department of Biostatistics and EpidemiologyUniversity of MassachusettsAmherstMAUSA
| | - Gabriel Chamie
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Elizabeth A Bukusi
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Moses R Kamya
- Department of MedicineMakerere UniversityKampalaUganda
| | - Diane V Havlir
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
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Gaps in HIV Testing and Treatment Among Female Sex Workers in Lae and Mt. Hagen, Papua New Guinea. AIDS Behav 2021; 25:1573-1582. [PMID: 32761475 DOI: 10.1007/s10461-020-02997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We conducted biobehavioral surveys among female sex workers (FSW) in Lae and Mt. Hagen, Papua New Guinea (January-December 2017). Respondent-driven sampling was used to recruit FSW aged ≥ 12 years, who were assigned female sex at birth, who spoke English or Tok Pisin, and who sold or exchanged sex for money, goods, or services in the last 6 months. When adjusted for viral suppression, 48.9% of FSW Lae and 61.9% in Mt. Hagen were aware of their HIV positive status. Of these women, 95.3% in Lae and 98.9% in Mt. Hagen were on antiretroviral therapy, and of these, 83.5% in Lae and 87.0% in Mt. Hagen had suppressed viral load. Renewed efforts are needed to increase HIV testing among FSW and provide support to FSW on treatment in both cities to attain viral suppression.
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Blumer N, Pfadenhauer LM, Burns J. Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: Coverage, barriers and facilitators. PLoS One 2021; 16:e0250024. [PMID: 33861784 PMCID: PMC8051789 DOI: 10.1371/journal.pone.0250024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
The provision of comprehensive prevention services is vital for reducing the high burden of HIV amongst Ukrainian female sex workers (FSWs). To identify barriers and facilitators that influence access to HIV prevention amongst this population between 2009 and 2017, we developed a literature-informed conceptual framework and conducted a document analysis to identify the components of the Ukrainian prevention package (PP). Using the Integrated Bio Behavioural Surveillance Surveys, we then conducted descriptive analyses to explore PP coverage from 2009 to 2017 and the influence of factors, identified by our conceptual framework. After increasing over four years, a drop in PP coverage was observed from 2013 onwards. Being a client of a non-governmental organisation, street and highway solicitation, non-condom use, and knowledge of HIV may influence access to HIV prevention in the Ukrainian context. Future interventions should consider barriers and facilitators to HIV prevention and the multiple structural levels on which they operate.
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Affiliation(s)
- Natasha Blumer
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
- * E-mail:
| | - Lisa M. Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology – IBE, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health Munich, Munich, Germany
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40
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Nabunya P, Byansi W, Damulira C, Bahar OS, Jennings Mayo-Wilson L, Tozan Y, Kiyingi J, Nabayinda J, Braithwaite R, Witte SS, Ssewamala FM. Predictors of Depressive Symptoms and Post Traumatic Stress Disorder Among Women Engaged in Commercial Sex Work in Southern Uganda. Psychiatry Res 2021; 298:113817. [PMID: 33636517 PMCID: PMC8005481 DOI: 10.1016/j.psychres.2021.113817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023]
Abstract
This study examined the factors associated with depressive symptoms and post traumatic depressive disorder (PTSD) among economically vulnerable women engaged in commercial sex work (WESW) in southern Uganda. Baseline data from a longitudinal cluster randomized study involving 542 self-identified WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. Hierarchical linear regression modelling was utilized to estimate individual, family-level and economic-level predictors of depressive symptoms and PTSD. Family cohesion, sex work stigma, HIV status, financial distress, household assets, number of children and number of household income earners, were associated with PTSD. Similarly, family cohesion, number of people in the household, HIV status, sex work stigma, financial distress, and household assets, were associated with depressive symptoms. Women engaged in commercial sex work are at a higher risk of HIV and poor mental health outcomes. Sex work stigma and financial distress elevate levels of depressive symptoms and PTSD, over and above an individual's HIV status. Family and economic-level factors have the potential to mitigate the risk of poor mental health outcomes. As such, integrating stigma reduction and economic strengthening components in the programming targeting WESW-a key population, may be critical to address their mental health outcomes.
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Affiliation(s)
- Proscovia Nabunya
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - William Byansi
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Christopher Damulira
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Ozge Sensoy Bahar
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Science, 1025 E. 7(TH) Street, Bloomington, IN 47405, USA.
| | - Yesim Tozan
- New York University College of Global Public Health, 14 East 4(th) street, 3(rd) floor. New York, NY 10003, USA.
| | - Joshua Kiyingi
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Josephine Nabayinda
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Rachel Braithwaite
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
| | - Susan S Witte
- Columbia University School of Social Work1255 Amsterdam Avenue, New York, NY 10027, USA.
| | - Fred M Ssewamala
- Washington University in St. Louis Brown School, International Center for Child Health and Development (ICHAD), 1 Brookings Drive, St. Louis, MO 63130, USA.
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41
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Wilson A, Musyoki H, Avery L, Cheuk E, Gichangi P, Bhattacharjee P, Musimbe J, Leung S, Blanchard J, Moses S, Mishra S, Becker M. Sexual and reproductive health among adolescent girls and young women in Mombasa, Kenya. Sex Reprod Health Matters 2021; 28:1749341. [PMID: 32425108 PMCID: PMC7888015 DOI: 10.1080/26410397.2020.1749341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This secondary data analysis of a cross-sectional survey conducted in Mombasa, Kenya characterises sexual and reproductive health (SRH) indicators among adolescent girls and young women (AGYW) engaged in casual and transactional sexual relationships as well as sex work. It describes the association between awareness of local HIV programmes and SRH services uptake for AGYW engaged in sex work. Thirty-eight percent of the participants reported a history of pregnancy. Among participants not trying to get pregnant, 27% stated that they were not currently using any form of contraception. Of the participants who had an abortion, 59% were completed under unsafe conditions. For AGYW engaged in sex work, awareness of local HIV prevention programmes was associated with increased STI testing within the last year (29%) as well as at least one HIV test (99%) compared to those who were not aware of local programming (18% and 92%, respectively); however, only 26% of participants engaged in sex work had heard of local HIV prevention programmes. There were no associations between awareness of local HIV programming and rates of dual contraception use, safe abortion, most recent birth attended by a skilled health professional or testing for HIV during pregnancy. Our study found high need for SRH services, particularly, access to contraception and safe abortion. Continued efforts are required to improve access to the full spectrum of SRH interventions, including family planning services and access to safe abortion in addition to HIV prevention to promote health equity.
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Affiliation(s)
- Andrea Wilson
- Research Associate, Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Helgar Musyoki
- Program Manager, Key Populations Programme, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Lisa Avery
- Associate Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Eve Cheuk
- Research Associate, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Gichangi
- Senior Adviser, International Centre for Reproductive Health, Mombasa, Kenya
| | - Parinita Bhattacharjee
- Senior Technical Advisor, Africa Programs, Centre for Global Public Health, University of Manitoba, Nairobi, Kenya
| | - Janet Musimbe
- Technical Manager, Partnership for Health and Development in Africa, Nairobi, Kenya
| | - Stella Leung
- Senior Technical Advisor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - James Blanchard
- Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen Moses
- Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmistha Mishra
- Assistant Professor, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Marissa Becker
- Associate Professor, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada. Correspondence:
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42
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Ortega-Williams A, Beltrán R, Schultz K, Ru-Glo Henderson Z, Colón L, Teyra C. An Integrated Historical Trauma and Posttraumatic Growth Framework: a Cross-Cultural Exploration. J Trauma Dissociation 2021; 22:220-240. [PMID: 33480826 DOI: 10.1080/15299732.2020.1869106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Trauma recovery for racial and ethnic groups experiencing ongoing systemic violence and discrimination requires a framework that simultaneously addresses harms and strengths. Historical trauma (HT) is a social determinant of health emanating from targeted mass group-level harm. Posttraumatic growth (PTG) focuses on positive shifts in individuals coping with trauma. This article highlights the unique contributions of these two distinct bodies of literature to inform trauma recovery. We explore areas of overlap, gaps, and tensions between the concepts to present an HT-PTG conceptual framework. The HT-PTG framework combines HT's focus on socio-structural-historical experiences in racial and ethnic groups targeted for oppression with PTG's descriptions of characteristics of growth. Specifically, five mass group-level domains of growth, centering healing, creativity, growth, and transformation are described. The ancestral legacies of the authors, including American Indian, Indigenous Mexican, African American, Puerto Rican, and Indigenous Taiwanese, inform the HT-PTG framework. This paper presents implications for trauma-recovery research and practice.
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Affiliation(s)
- Anna Ortega-Williams
- Silberman School of Social Work, Hunter College of the City University of New York, NY, USA
| | - Ramona Beltrán
- University of Denver Graduate School of Social Work, Denver, Colorado, USA
| | - Katie Schultz
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lisa Colón
- University of Denver Graduate School of Social Work, Denver, Colorado, USA
| | - Ciwang Teyra
- Department of Social Work, National Taiwan University, Taipei, Taiwan
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Doshi RH, Hoff NA, Bratcher A, Mukadi P, Gadoth A, Nicholson BP, Williams R, Mukadi D, Mossoko M, Wasiswa J, Mwanza A, Sinai C, Alfonso VH, Shah R, Bramble MS, Ilunga-Kebela B, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Risk factors for Ebola exposure in healthcare workers in Boende, Tshuapa Province, Democratic Republic of the Congo. J Infect Dis 2020; 226:608-615. [PMID: 33269402 PMCID: PMC9441197 DOI: 10.1093/infdis/jiaa747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Healthcare workers (HCW) are more likely to be exposed to Ebola virus (EBOV) during an outbreak compared to people in the general population due to close physical contact with patients and potential exposure to infectious fluids. However, not all will fall ill. Despite evidence of subclinical and paucisymptomatic Ebola Virus Disease (EVD), the prevalence and associated risk factors remains unknown. We conducted a serosurvey among healthcare workers in the town of Boende in Tshuapa Province, Democratic Republic of Congo (DRC). Human anti-EBOV Glycoprotein (GP) IgG titers were measured using a commercially available ELISA kit. We assessed associations between anti-EBOV IgG seroreactivity, defined as ≥2.5 units/mL and risk factors using univariable and multivariable logistic regression. Sensitivity analyses explored a more conservative cutoff >5 units/mL. Overall, 22.5% of HCWs were seroreactive for EBOV. In multivariable analyses, using any form of personal protective equipment (PPE) when interacting with a confirmed, probable, or suspect EVD case was negatively associated with seroreactivity [0.23 (95% CI: 0.07, 0.73)]. Our results suggest high exposure to EBOV among HCWs and provide additional evidence for asymptomatic or minimally symptomatic EVD. Further studies should be conducted to determine the probability of onward transmission and if seroreactivity is associated with immunity.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Anna Bratcher
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Adva Gadoth
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | | | | | - Daniel Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Matthias Mossoko
- Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | - Joseph Wasiswa
- UCLA-DRC Research Program, Kinshasa, DRC.,Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | | | - Cyrus Sinai
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Vivian H Alfonso
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Rupal Shah
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Matthew S Bramble
- Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, D.C. USA
| | | | | | | | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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45
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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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McMahon SA, Musoke DK, Wachinger J, Nakitende A, Amongin J, Nanyiri E, Turcotte-Tremblay AM, Oldenburg CE, Barnighausen T, Ortblad KF. Unintended uses, meanings, and consequences: HIV self-testing among female sex workers in urban Uganda. AIDS Care 2020; 33:1278-1285. [PMID: 33138623 DOI: 10.1080/09540121.2020.1837722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACTFemale sex workers (FSWs) are at increased risk of HIV and face significant barriers to clinic-based HIV testing, including provider stigma and privacy constraints. HIV self-testing (HIVST) has been proven to significantly increase HIV testing among FSWs. Less is known, however, about how FSWs make meaning of oral-fluid HIV self-tests, and the unintended ways they use and understand this novel technology. From October 2016 to March 2017, we conducted 61 in-depth interviews with FSWs (n = 31) in Kampala, Uganda. Eligible participants were: female, ≥18 years, exchanged sex for money or goods, and had not recently tested for HIV. We used inductive coding to identify emerging themes and re-arranged these into an adapted framework. Unintended desirable ways FSWs described self-testing included as a means to test others, to bolster their reputation as a health-conscious sex worker, and to avoid bearing witness to suffering at health facilities. Unintended undesirable meanings ascribed to self-testing included misunderstandings about how HIV is transmitted (via saliva versus blood) and whether self-tests also test for other infections. HIVST can increase FSWs' knowledge of their own HIV status and that of their sexual partners, but messaging and intervention design must address misunderstandings and misuses of self-testing.Trial registration: ClinicalTrials.gov identifier: NCT02846402.
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Affiliation(s)
- Shannon A McMahon
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jonas Wachinger
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | | | | | | | - Anne-Marie Turcotte-Tremblay
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Canada.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Till Barnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, 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
| | - Katrina F Ortblad
- Department of Global Health, University of Washington, Seattle WA, USA
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47
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Hakim AJ, Bolo A, Werner M, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Wesson J, Okiria AG. High HIV and syphilis prevalence among female sex workers in Juba, South Sudan. PLoS One 2020; 15:e0239543. [PMID: 32986767 PMCID: PMC7521730 DOI: 10.1371/journal.pone.0239543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country’s epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7–6.1) or Kenya (aOR: 4.3, 95% CI: 1.5–13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan’s HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.
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Affiliation(s)
- Avi J. Hakim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Alex Bolo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Werner
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Joel Katoro
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Golda Caesar
- South Sudan Ministry of Health, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
| | | | - Jennifer Wesson
- IntraHealth International, Chapel Hill, NC, United States of America
| | - Alfred G. Okiria
- IntraHealth International, Chapel Hill, NC, United States of America
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Cange CW, Wirtz AL, Ky-Zerbo O, Lougue M, Kouanda S, Baral S. Effects of traumatic events on sex workers' mental health and suicide intentions in Burkina Faso: a trauma-informed approach. Sex Health 2020; 16:348-357. [PMID: 31295417 DOI: 10.1071/sh17213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022]
Abstract
Background Data from other settings suggest that female sex workers (FSWs) are regularly exposed to violence and risks of psychological and physical trauma, although less is known about the effects of this violence. The objective of this study was to understand the experiences of violence and relationships with mental health symptomatology among FSWs. METHODS A mixed-methods design was used to explore the contexts and social perceptions of violence and mental health effects among FSW in Burkina Faso in 2013. RESULTS In all, 696 FSWs were recruited via respondent-driven sampling and enrolled in the study in Ouagadougou and Bobo-Dioulasso, Burkina Faso. Seventy participants were also recruited into qualitative research. Nearly two-thirds of quantitative respondents (61.7%) reported experiencing lifetime physical violence, of whom 77.4% reported experiencing violence after initiating sex work. Further, 40.9% of participants reported forced non-consensual sex, most of which occurred after they had started sex work (73.0%). In some cases, the male perpetrator used physical force to force non-consensual sex. Forced non-consensual sex was often without condoms. Among quantitative participants, 41.8% reported ever having feelings of depression; there was also a high prevalence of suicide ideation in this group. Qualitative participants also described feelings of depression, alienation, and suicide ideation. Some qualitative participants described using protective methods to avoid violence and to promote social protection among FSWs. CONCLUSIONS The findings suggest that stigma and physical and sexual abuse are prevalent among FSWs. Within this context of sex work, lifetime experiences of physical and sexual violence were highly correlated with self-reported mental health symptoms.
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Affiliation(s)
- Charles W Cange
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; and Department of Health Sciences, Lehman College, The City University of New York, 250 Bedford Park Boulevard, New York, NY 10468, USA; and Corresponding author.
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Odette Ky-Zerbo
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Marcel Lougue
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Program d'Appui au Monde Associatif et Communautaire, 11 BP 1023 CMS Ouagadougou, Burkina Faso
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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50
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Tokar A, Osborne J, Hengeveld R, Lazarus JV, Broerse JEW. 'I don't want anyone to know': Experiences of obtaining access to HIV testing by Eastern European, non-European Union sex workers in Amsterdam, the Netherlands. PLoS One 2020; 15:e0234551. [PMID: 32634136 PMCID: PMC7340317 DOI: 10.1371/journal.pone.0234551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Historically, the Netherlands has hosted a large number of migrant sex workers. Since sex work is considered a legal profession it might serve as an example of better access to health services, including HIV testing, at least for those working within the legal framework. However, migrant sex workers, especially non-European Union (EU) nationals, might not be eligible to register for official employment and thus face obstacles in obtaining access to health services, becoming essentially invisible. This study examined context-specific vulnerabilities of migrant female sex workers (FSWs) from Belarus, Moldova, Russia and Ukraine, whether and how they have access to HIV testing compared to other EE, non-EU migrant FSWs in Amsterdam in the Netherlands. We conducted a multi-stakeholder perspective study from November 2015 to September 2017 in Amsterdam. The study comprised 1) semi-structured interviews with key stakeholders (N = 19); 2) in-depth interviews with Eastern European, non-EU migrant FSWs (N = 5) and field observations of the escort agency working with them; and 3) in-depth interviews with key stakeholders (N = 12). We found six key barriers to HIV testing: 1) migration and sex-work policies; 2) stigma, including self-stigmatization; 3) lack of trust in healthcare providers or social workers; 4) low levels of Dutch or English languages; 5) negative experience in accessing healthcare services in the home country; and 6) low perceived risk and HIV-related knowledge. Having a family and children, social support and working at the licensed sex-work venues might facilitate HIV testing. However, Internet-based sex workers remain invisible in the sex-work industry. Our findings indicate the importance of addressing women’s diverse experiences, shaped by intrapersonal, interpersonal, community, network and policy-level factors, with stigma being at the core. We call for the scaling up of outreach interventions focusing on FSWs and, in particular, migrant FSWs working online.
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Affiliation(s)
- Anna Tokar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic–University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Jacob Osborne
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Robbert Hengeveld
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic–University of Barcelona, Barcelona, Spain
| | - Jacqueline E. W. Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
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