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Mokinu RA, Yonge SA, Lafort Y, Sandfort TGM, Mantell JE, Gichangi PB. Sexual practices, their influencers, and utilization of HIV services among female sex workers in Mombasa County, Kenya. Pan Afr Med J 2024; 47:209. [PMID: 39247770 PMCID: PMC11380618 DOI: 10.11604/pamj.2024.47.209.41775] [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: 09/20/2023] [Accepted: 01/13/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction female sex workers (FSWs) are vulnerable to acquiring HIV and other sexually transmitted infections due to unprotected sex. Understanding and addressing the gaps in safer sex among FSWs can help to reduce HIV acquisition and transmission. This study described sexual practices, their correlates and use of HIV services among FSWs in Mombasa County, Kenya. Methods participants were recruited for a baseline survey by a time-location cluster randomized design at predetermined intervals from five bars and five clubs in Mombasa County until a sample size of 160 was reached. Descriptive statistics and inferential analysis using R were conducted, and p<0.05 was regarded as statistically significant. Results nearly all (99%) of the participants were unmarried, and 11% had tertiary education. Ninety-eight percent (98%) reported vaginal intercourse, 51% reported using alcohol/drugs before sex, and 28% practiced unprotected intercourse. About 64% had tested for HIV within three months, 14% believed that it is safe to reuse condoms, and 10% that it is safe to engage in unprotected sex. In bi-variate analysis, FSWs were more likely to engage in unprotected intercourse if they reported more frequent sex, more frequent sex with regular clients, poor HIV knowledge, alcohol/drug use, and violence. In multivariate analysis, risky sexual practices were associated with frequency of sexual intercourse, alcohol/drug use, and poor HIV knowledge. Conclusion female sex workers engage in unprotected sex while under the influence of substances, belief in re-using condoms and have high frequency of sexual intercourse. Inadequate knowledge of HIV and substance use significantly correlated with unprotected sex. Interventions to address these modifiable factors are needed to mitigate the risk of HIV among FSWs.
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Affiliation(s)
- Robert Abuga Mokinu
- County Government of Mombasa, Mombasa, Kenya
- Department of Environment and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Shadrack Ayieko Yonge
- Department of Environment and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Yves Lafort
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium
| | - Theodorus Gustavus Maria Sandfort
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Joanne Ellen Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Peter Bundi Gichangi
- Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Amogne MD, Sanders EJ, Belihu WB, Sundewall J, Agardh A. Condom failure and pre-exposure prophylaxis use experience among female sex workers in Ethiopia: a qualitative study. BMC Public Health 2022; 22:1079. [PMID: 35641959 PMCID: PMC9158269 DOI: 10.1186/s12889-022-13468-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake. METHOD A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes. RESULT Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence. CONCLUSION The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake.
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Affiliation(s)
- Minilik Demissie Amogne
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden. .,Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Eduard J Sanders
- KEMRI/Wellcome Trust Research Programme Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Headington, UK.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Kenya Medical Research Institute, Kilifi, Kenya
| | - Wudinesh Belete Belihu
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden.,Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jesper Sundewall
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden.,HEARD, University of KwaZulu-Natal, Durban, South Africa
| | - Anette Agardh
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
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Hamill MM, Hu F, Kokogho A, Shoyemi E, Ekeh C, Charurat ME, Robb ML, Adebajo S, Baral SD, Nowak RG, Crowell TA. Factors Associated With Condom Failure in a Longitudinal Cohort of Men Who Have Sex With Men and Transgender Women in Abuja and Lagos, Nigeria. J Acquir Immune Defic Syndr 2021; 86:329-338. [PMID: 33234806 PMCID: PMC7878282 DOI: 10.1097/qai.0000000000002559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective condom use is a critical intervention to limit the spread of HIV and other sexually transmitted infections, particularly among individuals in high-risk networks who practice anal sex. We characterized condom failures in cisgender men who have sex with men and transgender women in Nigeria. SETTING The TRUST/RV368 cohort provided condoms, compatible lubricants, and safer sex education to men who have sex with men and transgender women at community-engaged health centers in Abuja and Lagos, Nigeria. METHODS Participants completed structured interview questions about condom usage and failure every 3-6 months. Robust Poisson regression models with generalized estimating equations were used to estimate relative risks and 95% confidence intervals for prespecified factors potentially associated with condom failure in the previous month. RESULTS From September 2013 to September 2019, 2221 of 2737 participants (81.1%) reported condom use for anal sex with a male partner in the last month, and 305 (13.7%) reported condom failure during this time. Multivariate analyses demonstrated an increased risk of condom failure at postenrollment visits, as well as in participants who reported frequent Internet use, 2 or more casual sexual partners, and 2-4 main sexual partners. Those who cohabited with a woman had reduced risk. CONCLUSIONS Condom failure was common in this population despite freely available condoms, compatible lubrication, and education. Increased risk of condom failure over time could reflect message fatigue a ceiling for effective condom use, or new uptake of condoms by inexperienced users.
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Affiliation(s)
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- HJF Medical Research International, Abuja, Nigeria;
| | | | | | | | - Merlin L. Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, Abuja, Nigeria; and
| | - Stefan D. Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland, Baltimore, MD
| | - Trevor A. Crowell
- Johns Hopkins University School of Medicine, Baltimore, MD
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
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Tan PP, Fauzi HM, Bahar R, Chang CT, Rahim NAA. Knowledge and Perceptions of Blood Safety among Blood Donors in Kelantan, Malaysia. Malays J Med Sci 2020; 26:127-136. [PMID: 31908594 PMCID: PMC6939727 DOI: 10.21315/mjms2019.26.6.13] [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: 08/22/2019] [Accepted: 11/11/2019] [Indexed: 11/12/2022] Open
Abstract
Background Unsafe blood products may cause transfusion-transmissible infections. This study aimed to evaluate the knowledge and perceptions of blood donors regarding blood safety. Methods This was a cross-sectional study conducted in the Kelantan state of Malaysia. The questionnaire comprised 39 questions that covered areas such as donors’ social demographic information, knowledge of transfusion-transmitted diseases, blood screening and donor eligibility and perceptions towards blood safety. The knowledge score was categorised as good or poor. Results Of the 450 distributed questionnaires, 389 were suitable for analysis. Only 18.5% of the donors had good knowledge, with 81.5% having poor knowledge. Less than 30% were aware that people with multiple sexual partners, bisexual people and male homosexual people are permanently deferred from blood donation. Only 29.4% agreed that donors are responsible if their blood causes infection. Furthermore, 39.3% assumed that they could check their HIV status through blood donation, and 10.3% and 5.4% of the respondents believed that donors are free from infection if they wear a condom during sex or only have oral sex when involved in prostitution, respectively. Conclusion Poor knowledge and notable misperceptions concerning safe blood donation were found among blood donors. The Ministry of Health should incorporate safe blood education in future public awareness programmes.
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Affiliation(s)
- Pei Pei Tan
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Hafizuddin Mohamed Fauzi
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Rosnah Bahar
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia
| | - Nur Arzuar Abdul Rahim
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
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