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Macias-Konstantopoulos WL, Perttu E, Weerasinghe S, Dlamini D, Willis B. Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation. J Glob Health 2024; 14:04052. [PMID: 38454881 PMCID: PMC10921126 DOI: 10.7189/jogh.14.04052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. Methods The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Results Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. Conclusions The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.
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Affiliation(s)
- Wendy L Macias-Konstantopoulos
- Global Health Promise, Portland, Oregon, USA
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Swarna Weerasinghe
- Global Health Promise, Portland, Oregon, USA
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Duduzile Dlamini
- Global Health Promise, Portland, Oregon, USA
- Mothers for the Future, Cape Town, Republic of South Africa
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Abrahams N, Mhlongo S, Chirwa E, Dekel B, Ketelo A, Lombard C, Shai N, Ramsoomar L, Mathews S, Labuschagne G, Matzopoulos R, Prinsloo M, Martin LJ, Jewkes R. Femicide, intimate partner femicide, and non-intimate partner femicide in South Africa: An analysis of 3 national surveys, 1999-2017. PLoS Med 2024; 21:e1004330. [PMID: 38236895 PMCID: PMC10796052 DOI: 10.1371/journal.pmed.1004330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In most countries, reliable national statistics on femicide, intimate partner femicide (IPF), and non-intimate partner femicide (NIPF) are not available. Surveys are required to collect robust data on this most extreme consequence of intimate partner violence (IPV). We analysed 3 national surveys to compare femicide, IPF, and NIPF from 1999 to 2017 using age-standardised rates (ASRs) and incidence rate ratios (IRRs). METHODS AND FINDINGS We conducted 3 national mortuary-based retrospective surveys using weighted cluster designs from proportionate random samples of medicolegal laboratories. We included females 14 years and older who were identified as having been murdered in South Africa in 1999 (n = 3,793), 2009 (n = 2,363), and 2017 (n = 2,407). Further information on the murdered cases were collected from crime dockets during interviews with police investigating officers. Our findings show that South Africa had an IPF rate of 4.9/100,000 female population in 2017. All forms of femicide among women 14 years and older declined from 1999 to 2017. For IPF, the ASR was 9.5/100,000 in 1999. Between 1999 and 2009, the decline for NIPF was greater than for IPF (IRR for NIPF 0.47 (95% confidence interval (CI) 0.42 to 0.53) compared to IRR for IPF 0.69 (95% CI 0.63 to 0.77). Rates declined from 2009 to 2017 and did not differ by femicide type. The decline in IPF was initially larger for women aged 14 to 29, and after 2009, it was more pronounced for those aged 30 to 44 years. Study limitations include missing data from the police and having to use imputation to account for missing perpetrator data. CONCLUSIONS In this study, we observed a reduction in femicide overall and different patterns of change in IPF compared to NIPF. The explanation for the reductions may be due to social and policy interventions aimed at reducing IPV overall, coupled with increased social and economic stability. Our study shows that gender-based violence is preventable even in high-prevalence settings, and evidence-based prevention efforts must be intensified globally. We also show the value of dedicated surveys in the absence of functional information systems.
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Affiliation(s)
- Naeemah Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine: Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shibe Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esnat Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Bianca Dekel
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
| | - Asiphe Ketelo
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nwabisa Shai
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Leane Ramsoomar
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Shanaaz Mathews
- Children’s Institute, University of Cape Town, Cape Town, South Africa
| | - Gérard Labuschagne
- Department Forensic Medicine & Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lorna J. Martin
- Forensic Medicine & Toxicology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
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Giang HT, Khue PM, Sterk CE, Evans DP, Miedema SS, Yount KM. Prevalence of violence victimisation and poly-victimisation among female sex workers in Haiphong, Viet Nam: A cross-sectional study. Glob Public Health 2024; 19:2308709. [PMID: 38295852 PMCID: PMC11246117 DOI: 10.1080/17441692.2024.2308709] [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: 09/07/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting.
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Affiliation(s)
- Hoang Thi Giang
- Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | - Pham Minh Khue
- Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
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Shah P, Kabuti R, Beksinska A, Nyariki E, Babu H, Kungu M, Jama Z, Ngurukiri P, Kaul R, Kyegombe N, Medley GF, Devries K, Seeley J, Weiss HA, Beattie TS, Kimani J. Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya. BMJ Open 2023; 13:e078618. [PMID: 38114279 DOI: 10.1136/bmjopen-2023-078618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya. BACKGROUND Younger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation. DESIGN Building on previous qualitative research with this cohort, analysis of behavioural-biological cross-sectional data using hierarchical logistic regression. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural-biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling. RESULTS Of the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66). CONCLUSIONS Lower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nambusi Kyegombe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Graham F Medley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karen Devries
- Department of Population Health, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Helen Anne Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Jewkes R, Milovanovic M, Otwombe K, Hlongwane K, Hill N, Mbowane V, Gray G, Coetzee J. Understanding drivers of female sex workers' experiences of external/enacted and internalised stigma: findings from a cross-sectional community-centric national study in South Africa. CULTURE, HEALTH & SEXUALITY 2023; 25:1433-1448. [PMID: 36592099 DOI: 10.1080/13691058.2022.2160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
To deepen our understanding of sex work stigma, and to its drivers and their interrelation, we conducted an analysis using structural equation modelling of the South African National Sex Worker Survey. We enrolled 3005 women in sex work using multi-stage sampling across all South Africa's provinces. Experience of external/enacted and internalised stigma was widespread. Non-partner rape, intimate partner violence and partner controlling behaviour (often expressions of external/enacted stigma) compounded internalised stigma. These experiences of violence, other manifestations of external/enacted stigma and food insecurity, were key drivers of internalised stigma, and often had an impact on mental health. We found that considerable protection against stigma emanated from viewing sex work positively. This resistance to stigma provided opportunities to shift the narrative. Reducing sex workers' exposure to external/enacted stigmatising behaviour, including by enabling more to work indoors, and providing greater protection from partner violence and rape, are critical for better health and well-being. Ending the criminalisation of sex work is foundational for safer working conditions and better health outcomes for sex workers, similarly providing adequately funded mental and physical health and social care through sex work specific programmes.
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Affiliation(s)
- Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Naomi Hill
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
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Beattie TS, Kabuti R, Beksinska A, Babu H, Kung’u M, Shah P, Nyariki E, Nyamweya C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J. Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6046. [PMID: 37297650 PMCID: PMC10253020 DOI: 10.3390/ijerph20116046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
We examined violence experiences among Female Sex Workers (FSWs) in Nairobi, Kenya, and how these relate to HIV risk using a life course perspective. Baseline behavioural-biological surveys were conducted with 1003 FSWs June-December 2019. Multivariable logistic regression models were used to estimate the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for associations of life course factors with reported experience of physical or sexual violence in the past 6 months. We found substantial overlap between violence in childhood, and recent intimate and non-intimate partner violence in adulthood, with 86.9% reporting one or more types of violence and 18.7% reporting all three. Recent physical or sexual violence (64.9%) was independently associated with life course factors, including a high WHO Adverse Childhood Experiences (ACE) score (AOR = 7.92; 95% CI:4.93-12.74) and forced sexual debut (AOR = 1.97; 95% CI:1.18-3.29), as well as having an intimate partner (AOR = 1.67; 95% CI:1.25-2.23), not having an additional income to sex work (AOR = 1.54; 95% CI:1.15-2.05), having four or more dependents (AOR = 1.52; 95% CI:0.98-2.34), recent hunger (AOR = 1.39; 95% CI:1.01-1.92), police arrest in the past 6 months (AOR = 2.40; 95% CI:1.71-3.39), condomless last sex (AOR = 1.46; 95% CI:1.02-2.09), and harmful alcohol use (AOR = 3.34; 95% CI:1.74-6.42). Interventions that focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including violence experience and HIV acquisition.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | | | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Chrispo Nyamweya
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi P.O. Box 3737-00506, Kenya
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Sitonga N, Nomatshila SC, Phalane M, Chitha WW, Mabunda SA. Knowledge, Attitudes, and Practices of Sex Workers of Three South African Towns towards Female Condom Use and Contraceptives. Healthcare (Basel) 2023; 11:healthcare11091271. [PMID: 37174812 PMCID: PMC10178106 DOI: 10.3390/healthcare11091271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Female sex workers are a marginalized and highly vulnerable population who are at risk of HIV and other sexually transmitted diseases, harassment, and unplanned pregnancies. Various female condoms are available to mitigate the severity of the consequences of their work. However, little is known about the acceptability and usage of female condoms and contraceptives among sex workers in small South African towns. This descriptive cross-sectional study of conveniently selected sex workers explored the acceptability and usage of female condoms and contraceptives among sex workers in South Africa using validated questionnaires. The data were analyzed using STATA 14.1. The 95% confidence interval is used for precision, and a p-value ≤ 0.05 is considered significant. Out of 69 female-only participants, 49.3% were unemployed, 53.6% were cohabiting, and 30.4% were HIV positive. The median age of entry into sex work was 16 years old. Participants reported use of condoms in their last 3 sexual encounters (62.3%), preference of Implanon for contraception (52.2%), barriers to condom use (81.2%), condoms not being accepted by clients (63.8%), being difficult to insert (37.7%), and being unattractive (18.8%). Participants who reported barriers to condom use were 90% more likely to have adequate knowledge than those who did not (PR = 1.9; p-value < 0.0001). Knowledge of condom use was an important factor in determining knowledge of barriers to their use. Reasons for sex work, sex workers' perceptions, and clients' preferences negatively affect the rate of condom use. Sex worker empowerment, community education, and effective marketing of female condoms require strengthening.
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Affiliation(s)
- Noluvuyo Sitonga
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
| | | | - Mahlane Phalane
- Mpumalanga Department of Health, Witbank Hospital, Emalahleni 1035, South Africa
| | - Wezile W Chitha
- Health Systems Enablement and Innovation Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sikhumbuzo A Mabunda
- Department of Public Health, Walter Sisulu University, Mthatha 5117, South Africa
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- The George Institute for Global Health and Research, University of New South Wales, Sydney 2042, Australia
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Shah P, Beattie TS, Kabuti R, Liku J, Kung'u M, Babu H, Jama Z, Kaul R, Weiss HA, Kyegombe N, Medley GF, Devries K, Gafos M, Nyariki E, Kimani J, Seeley J. Syndemic of factors that shape the early lives of women who enter into sex work: a qualitative methods study from Nairobi, Kenya. BMJ Open 2023; 13:e068886. [PMID: 37045579 PMCID: PMC10106030 DOI: 10.1136/bmjopen-2022-068886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To explore the structural and social co-factors that shape the early lives of women who enter sex work in Nairobi, Kenya. DESIGN Thematic analysis of qualitative data collected as part of the Maisha Fiti study among female sex workers (FSWs) in Nairobi. PARTICIPANTS AND MEASURES FSWs aged 18-45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi and participated in baseline behavioural-biological surveys. Participants in this qualitative study were randomly selected from the Maisha Fiti study cohort and were interviewed between October 2019 and July 2020. Women described their lives from childhood, covering topics including sex work, violence and financial management. RESULTS 48 out of 1003 Maisha Fiti participants participated in the in-depth qualitative interviews. FSWs described how physical and sexual violence, poverty and incomplete education in their childhood and adolescence intertwined with early pregnancy, marriage, intimate partner violence and relationship breakdown in their adolescence and early adulthood. The data analysis found clear syndemic relationships between these risk factors, particularly childhood violence, poverty and incomplete education and highlighted pathways leading to financial desperation and caring for dependents, and subsequent entry into sex work. Women perceived sex work as risky and most would prefer alternative work if possible, but it provided them with some financial independence and agency. CONCLUSIONS This is the first study in Kenya to qualitatively explore the early lives of sex workers from a syndemic perspective. This method identified the pivotal points of (1) leaving school early due to poverty or pregnancy, (2) breakdown of early intimate relationships and (3) women caring for dependents on their own. Complex, multi-component structural interventions before these points could help increase school retention, reduce teenage pregnancy, tackle violence, support young mothers and reduce entry into sex work and the risk that it entails by expanding livelihood options.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Jennifer Liku
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Mary Kung'u
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Anne Weiss
- MRC International and Statistics Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Graham F Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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9
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Ngo A, Nguyen VT, Phan H, Pham V, Ngo C, Nguyen L, Ha T. Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam. Mhealth 2023; 9:3. [PMID: 36760784 PMCID: PMC9902234 DOI: 10.21037/mhealth-22-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) has been used to promote sexual and reproductive health (SRH) education and services; however, little is known about the use of mHealth to improve safe abortion knowledge and access to safe abortion services among female sex workers (FSWs). This study evaluated the feasibility and effectiveness of iConnect intervention through changes in knowledge on safe abortion and changes in perceived barriers to safe abortion services among FSWs in Vietnam. METHODS iConnect mobile app was developed as an interactive platform to deliver safe abortion education and referral to safe abortion services through short messaging services (SMS) enhanced by tele-counseling for 512 FSWs in Hanoi, Vietnam. A pretest-posttest evaluation was conducted using questionnaire-based phone interviews administered to 251 participants at baseline and 3 months following the intervention. Non-parametric tests evaluated the change in abortion knowledge, behaviors, and perceived barriers to safe abortion. RESULTS There were significant improvements in the knowledge on safe abortion among the study participants. Specifically, FSWs' knowledge of correct gestational ages (≤22 weeks) for medical abortion increased from 78.9% at baseline to 96.8% (P=0.001). Knowledge of correct gestational ages for medical abortion at the private clinic increased from 45.3% to 63.1% (P=0.001). Knowledge on the consequences of unsafe abortion increased from 75.2% to 92.1% (P=0.001). In addition, perceived stigma and discrimination when seeking safe abortion decreased from 36.5% to 27.8% (P=0.036) and worry about the lack of confidentiality decreased from 23.3% to 15.5% (P=0.035). CONCLUSIONS The evaluation results showed the initial effectiveness of a mobile app-based intervention in improving access to safe abortion information and services among FSWs. A future study is needed to establish the efficacy of the intervention for scaling up in Vietnam and elsewhere.
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Affiliation(s)
- Anh Ngo
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Thi Nguyen
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Ha Phan
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Van Pham
- Center for Promotion of Advance of Society, Hanoi, Vietnam
| | - Cuong Ngo
- US News and World Report, Washington, DC, USA
| | | | - Toan Ha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
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10
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Kassanjee R, Welte A, Otwombe K, Jaffer M, Milovanovic M, Hlongwane K, Puren AJ, Hill N, Mbowane V, Dunkle K, Gray G, Abdullah F, Jewkes R, Coetzee J. HIV incidence estimation among female sex workers in South Africa: a multiple methods analysis of cross-sectional survey data. Lancet HIV 2022; 9:e781-e790. [PMID: 36075252 PMCID: PMC9626386 DOI: 10.1016/s2352-3018(22)00201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although numerous studies have investigated HIV risk factors and shown high HIV prevalence among female sex workers in South Africa, no national HIV incidence estimate exists for this potentially important group for HIV transmission. We aimed to estimate HIV incidence among female sex workers in South Africa who could be accessed through sex worker programmes, and to refine and describe the methods that enabled analysis. METHODS This study was embedded in a cross-sectional national survey of female sex workers who were linked to sex worker programmes. We aimed to enrol 3000 female sex workers aged at least 18 years who had sold or transacted in sex in the preceding 6 months in 12 randomly selected districts of the 22 districts with sex worker programmes, ensuring coverage of all provinces of South Africa. Women who self-reported as current victims of human trafficking were excluded from enrolment. We used a multistep process to sample districts and then hotspots, and a chain referral method to recruit participants. We collected cross-sectional data for self-reported HIV status, demographic characteristics, and exposure to violence. Two rapid tests were used to ascertain diagnostic markers, a viral load assay was used to ascertain clinical markers, and the Maxim Limiting Antigen Avidity EIA was used to ascertain infection-staging HIV markers. Given the challenges of estimating HIV incidence, especially cross-sectionally, multiple methods of estimation were adapted to our setting, leveraging the age structure of HIV prevalence, recency-of -infection biomarker results (ie, where recent infection is classified as ≤1·5 normalised optical density [ODn] on the avidity assay and viral load of ≥1000 copies per mL), and reported testing histories. FINDINGS Of 3005 female sex workers who were enrolled and interviewed between Feb 4 and June 26, 2019, 2999 who had HIV test results were included in this analysis. The median age of participants was 32 years (IQR 27-38). 1714 (57·2%) of 2999 participants self-reported as being HIV positive, and 1447 (48·3%) of 2993 participants reported client sexual violence in the past year. The measured HIV prevalence was 62·1% (95% CI 60·3-65·7) and peaked at approximately age 40 years. Using recency-of-infection biomarker results, we obtained a base case estimate of HIV incidence of 4·60 cases per 100 person-years (95% CI 1·53-8·45) for the population. Estimates were generally consistent by method, and outlying incidence estimates calculated by self-reported testing histories were considered unreliable. Various sensitivity analyses produced estimates up to 11 cases per 100 person-years, and we did not detect differences by age and region. INTERPRETATION We found that female sex workers have extraordinarily high HIV incidence of approximately 5 cases per 100 person-years, emphasising the need to sustain and strengthen efforts to mitigate risk and provide adequate care. The notable role that sex work has in HIV transmission demands substantial investment in ongoing epidemiological monitoring. FUNDING South African Medical Research Council, South African National Treasury, Global Fund, South African Department of Science and Innovation, Wellcome Trust.
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Affiliation(s)
- Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa; The South African Department of Science and Innovation-National Research Foundation, Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.
| | - Alex Welte
- The South African Department of Science and Innovation-National Research Foundation, Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, 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
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian J Puren
- South African National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Naomi Hill
- Wits Reproductive Health Institute, 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
| | - Kristin Dunkle
- South African Medical Research Council, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Fareed Abdullah
- South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 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; South African Medical Research Council, Cape Town, South Africa
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11
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Willis B, Perttu E, Fitzgerald M, Thompson H, Weerasinghe S, Macias-Konstantopoulos W. Causes of mortality among female sex workers: Results of a multi-country study. EClinicalMedicine 2022; 52:101658. [PMID: 36313149 PMCID: PMC9596307 DOI: 10.1016/j.eclinm.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The vast majority of studies on female sex workers (FSW) focus on causes of morbidity while data on causes of mortality are scarce. In low- and middle-income countries, where civil registry and vital statistics data are often incomplete and FSW may not be identified as such in official registries, identifying causes of mortality among FSW has proven challenging. METHODS As part of a larger investigation on the maternal health of FSW, the current study used the Community Knowledge Approach (CKA) to identify causes of mortality among FSW in LMIC across three global regions in 2019. The CKA, validated to identify maternal, neonatal, and jaundice-associated deaths among women living in a community, was employed to identify deaths of any cause among communities of FSW. Study participants, recruited by in-country partner non-governmental organizations (NGOs) working with local FSW, provided detailed information about FSW deaths in their communities. FINDINGS 1280 FSW participated in 165 group meetings through which 2112 FSW deaths were identified. Of these reported deaths, 57·9% occurred in 2019 and 57·2% were among women aged 20-29. Causes of death included abortion (35·5%), other maternal causes (16·6%), suicide (13·6%), murder (12·5%), unclassified causes (11·6%), HIV/AIDS (7·9%), and accidents (3·2%). A total of 3659 children lost their mothers. INTERPRETATION Maternal death comprised the leading cause of FSW mortality in our sample. This methodology can be used by local governments and NGOs to identify unrecognized patterns and clusters of FSW deaths in near-real time and urgently steer targeted preventative strategies. FUNDING New Venture Fund.
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Affiliation(s)
- Brian Willis
- Global Health Promise, Portland, OR, United States
- Corresponding author.
| | - Emily Perttu
- Global Health Promise, Portland, OR, United States
| | - Meghan Fitzgerald
- Global Health Promise, Portland, OR, United States
- U.S. Overseas Cooperative Development Council, Washington DC, United States
| | - Heather Thompson
- Global Health Promise, Portland, OR, United States
- Schulich School of Medicine, McMaster Faculty of Medicine, Grey Bruce Health Services, Hamilton, Ontario, Canada
| | - Swarna Weerasinghe
- Global Health Promise, Portland, OR, United States
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Wendy Macias-Konstantopoulos
- Global Health Promise, Portland, OR, United States
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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12
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Okumu M, Orwenyo E, Nyoni T, Mengo C, Steiner JJ, Tonui BC. Socioeconomic Factors and Patterns of Intimate Partner Violence among Ever-Married Women in Uganda: Pathways and Actions for Multicomponent Violence Prevention Strategies. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16397-NP16420. [PMID: 34388957 DOI: 10.1177/08862605211021976] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intimate partner violence (IPV) is a severe public health problem in sub-Saharan Africa (SSA) with harmful effects on the physical, psychological, and socioeconomic wellbeing of survivors and their families. In SSA, IPV is associated with mental health disorders, high-risk behaviors, and HIV vulnerability, especially among women. In Uganda, poor socioeconomic status increases women's vulnerability to IPV. Yet there is limited evidence on the association between socioeconomic factors and IPV severity in Uganda. Our study used population-based data to (a) establish different patterns describing the severity of IPV experiences, (b) explore associations between socioeconomic factors and severity of IPV experiences among Ugandan ever-married women, and (c) examine direct and indirect pathways from socioeconomic factors to severity of IPV experiences. Data were drawn from the 2016 Uganda Demographic and Health Survey's sample of 7,536 ever-married women aged 15-49 years. A latent class analysis examined distinct patterns of IPV severity among this sample, yielding a four-class solution: low violence (n = 5,059; 67.1%); high physical violence, low sexual violence (n = 1,501; 19.9%); high sexual violence, moderate physical violence (n = 535; 7.1%); and high sexual and severe physical violence (n = 441; 5.9%). Using the low violence group as the reference category, we conducted a multinomial logistic regression that found significant associations between secondary education (aOR 2.35, 95% CI: [1.06, 5.24]), poorest on the wealth index (aOR 2.00, 95% CI: [1.13, 3.54]), and severe IPV experiences. Decision-making (aOR 0.81, 95% CI: [0.68, 0.96]) played a protective role against membership in the high sexual and physical violence class compared to the reference category. Using path analysis, we found that labor force participation partially mediated the path from wealth index and education to IPV severity. Findings indicate the need for interventions that aim to keep girls in school and target schools, communities, and media platforms to address gender norms, economic vulnerability, and comprehensive screening for multiple forms of violence.
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Affiliation(s)
- Moses Okumu
- School of Social Work, the University of Illinois at Urbana-Champaign, IL, USA
| | - Evalyne Orwenyo
- The Catholic University of America National Catholic School of Social Service, Washington, DC, USA
| | - Thabani Nyoni
- Brown School, Washington University in St. Louis, MO, USA
| | - Cecilia Mengo
- College of Social Work, The Ohio State University, Ohio, USA
| | - Jordan J Steiner
- The Catholic University of America National Catholic School of Social Service, Washington, DC, USA
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13
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Elmes J, Stuart R, Grenfell P, Walker J, Hill K, Hernandez P, Henham C, Rutsito S, Sarker MD, Creighton S, Browne C, Boily MC, Vickerman P, Platt L. Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK. Sex Transm Infect 2022; 98:323-331. [PMID: 34702782 PMCID: PMC9340007 DOI: 10.1136/sextrans-2021-055088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine legal and social determinants of violence, anxiety/depression among sex workers. METHODS A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). RESULTS 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. CONCLUSIONS Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.
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Affiliation(s)
- Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Carolyn Henham
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - M D Sarker
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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14
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Ikuteyijo OO, Akinyemi AI, Merten S. Exposure to job-related violence among young female sex workers in urban slums of Southwest Nigeria. BMC Public Health 2022; 22:1021. [PMID: 35597935 PMCID: PMC9123769 DOI: 10.1186/s12889-022-13440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background In Nigeria, many young girls are engaged in commercial sex work as a means of livelihood and support of dependent relatives. Although studies have documented some of the violence related issues among commercial sex workers, the plight of adolescent and young sex workers particularly in urban slums may be different in context and depth. Objective This study explored the lived experiences of violence and health related harm among vulnerable young female sex workers in urban slums in Ibadan and Lagos, Southwest Nigeria. It also analyzed their coping strategies and survival mechanisms. Design The study is cross-sectional and applied an interpretive phenomenological approach to this qualitative study through in-depth interviews. Participants Young female sex workers ages (15–24 years) who reported having experienced violence were recruited for the study. Twelve participants completed the interviews out the 20 initially contacted. Data collection and analysis Primary data were collected using in-depth interviews (IDIs). Data were transcribed using a phenomenological framework analysis. Participants’ reports based on life experiences were identified: lived experience “daily brothel life experience”; sources of violence such as law enforcement agents’ intermittent raids; violence experience with clients who often demanded sexual acts beyond the agreed scope; and coping strategies employed to mitigate the challenges. Settings The study was conducted in brothels of two selected slum areas in Ibadan and Lagos, Southwest Nigeria. Results The results showed that the major motivation for engaging in commercial sex work was for economic reasons. However, there are inherent risks involved particularly for the vulnerable young people. Stigmatization from the community, clients’ uncontrolled-aggressive behavior and harassment from law enforcement agents are some of the frequent violence experiences reported. Self-help coping strategies are usually employed to prevent or mitigate the challenges. Conclusion The plight of this young people required policy and program attention towards alternative economic empowerment to rehabilitate those willing to leave the profession. Also the need to develop arm reduction interventions towards protection of young sex workers against violence. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-13440-1.
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Affiliation(s)
- Olutoyin Opeyemi Ikuteyijo
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Akanni Ibukun Akinyemi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Sonja Merten
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Kreuzstrasse 2, Allschwil, 4123, Basel, Switzerland.,University of Basel, Basel, Switzerland
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15
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Coetzee J, Mbowane V, Mlambo F, Ndlovu P, Rasego B, Milovanovic M. Whose role is it anyways: Knowledge generation within the scope of sex work. Glob Public Health 2022; 17:2268-2279. [PMID: 35544457 DOI: 10.1080/17441692.2022.2063921] [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: 11/04/2022]
Abstract
Research within the context of sex work is challenging. The nature of the subject matter and stigma that surrounds sex work has often privileged a homogenous, academic practice of generating knowledge. Based on the lessons and experiences of an existing sex work programme and a recently completed national public health study with female sex workers (FSWs) in South Africa, we aim to highlight the significance and successes of privileging a bottom-up, community centric approach to the design, data collection, and knowledge generation. A FSW programme provided extensive peer educator skills training and learning opportunities. Lessons were applied to the implementation of a national study on FSW across South Africa. Planning workshops with community members and sites and pre- implementation training of all site staff was undertaken. 3005 FSWs were successfully enrolled and surveyed by their peers, over 6-months. Researchers have a lot to learn from community members and should remain vigilant to the power dynamics that their privilege creates throughout the research process. Those seeking to generate knowledge should practice meaningfully engagement and include population members on the study team in roles that allow them to proactively contribute to the process and create knowledge.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,South African Medical Research Council, Cape Town, South Africa.,African Potential Management Consultancy, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fikile Mlambo
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Ndlovu
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bontle Rasego
- Perinatal HIV Research Unit, Faculty of Health Sciences, 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, Johannesburg, South Africa
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16
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Milovanovic M, Jewkes R, Matuludi M, Dunkle K, Hlongwane K, Vanleeuw L, Slingers N, Jaffer M, Mbowane V, Abdullah F, Otwombe K, Gray G, Coetzee J. Sex work and young women: a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa. AIDS Care 2022; 35:555-563. [PMID: 35373670 DOI: 10.1080/09540121.2022.2057908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescent girls and young women (AGYW) engaging in sex-for-money transactions are at risk of HIV infection. A better understanding of the demographic, socio-economic factors and risks of HIV acquisition is required to guide appropriate public health interventions targeting young sex workers in South Africa. A cross-sectional survey of Female Sex Workers (FSWs), using a chain referral sampling method, was conducted across 12 sites in South Africa in 2019. Three thousand and five participants were enrolled and interviewed assessing demographic characteristics, sexual behaviour, substance use and HIV testing and treatment. Of 3005 women, 13.3% were ≤24 years old (young FSWs); of these, 60.0% entered sex work aged ≤19 years. Economic factors were the primary drivers of entry into sex work. HIV prevalence amongst young FSWs was 40.4%, with 12.4% recently infected. Younger FSWs were significantly less likely to know they were HIV positive (87.6% versus 92.1%), to report any ART exposure (75.2% versus 87.6%) and to be virally suppressed (58.1% versus 75.2%) compared to older FSWs. Our findings highlight that many FSWs enter sex work at a young age. It is essential to develop tailored services and interventions that improve access to HIV prevention and treatment services addressing specific needs.
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Affiliation(s)
- Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Kristin Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Lieve Vanleeuw
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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17
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Yeo EJ, Hlongwane K, Otwombe K, Hopkins KL, Variava E, Martinson N, Strathdee SA, Coetzee J, Milovanovic M. Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study. PLoS One 2022; 17:e0261855. [PMID: 35061728 PMCID: PMC8782394 DOI: 10.1371/journal.pone.0261855] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sex workers in South Africa experience high levels of trauma and mental health issues, but little is known about their drug and alcohol use. This study assessed the prevalence of substance use and its key risk factors amongst female sex workers (FSWs) at two sites in South Africa. METHODS Two cross-sectional studies were conducted, in Soweto and Klerksdorp, South Africa. Using respondent-driven sampling (RDS) 508 FSWs in Soweto and 156 in Klerksdorp were enrolled. A study-specific survey was used to collect social and demographic information, substance use, mental ill-health, and HIV status. Raw and RDS-adjusted data were analyzed using Chi-squared tests of association. Weighted and unweighted Poisson regression models were used to assess key risk factors for alcohol and drug use at both univariate and multivariate levels. RESULTS Of the 664 FSWs, 56.2% were binge drinkers and 29.4% reported using drugs within the last year. Living in a home with regular food (RR: 1.2597, 95% CI: 1.1009-1.4413) and being HIV positive (RR: 1.1678, 95% CI: 1.0227-1.3334) were associated with a higher risk of binge drinking. Having symptoms suggestive of post-traumatic stress disorder (RR: 1.1803, 95% CI: 1.0025-1.3895) and past year physical/sexual abuse from either intimate (RR: 1.3648, 95% CI: 1.1522-1.6167) or non-intimate partners (RR: 1.3910, 95% CI: 1.1793-1.6407) were associated with a higher risk of drug use. DISCUSSION In conclusion, our findings demonstrate a high prevalence of alcohol and drug use among FSWs in Soweto and Klerksdorp with site-specific contextual dynamics driving substance use. Site differences highlight the importance of tailoring site-specific substance use harm mitigation for this key population.
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Affiliation(s)
- Ellis Jaewon Yeo
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, United States of America
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | | | - Ebrahim Variava
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, University of The Witwatersrand, Matlosana, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jenny Coetzee
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- South African Medical Research Council, Cape Town, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
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18
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Ith S, Yi S, Tuot S, Yem S, Chhoun P, Jimba M, Shibanuma A. Gender-based violence and depressive symptoms among female entertainment workers in Cambodia: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000873. [PMID: 36962460 PMCID: PMC10021637 DOI: 10.1371/journal.pgph.0000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022]
Abstract
Female entertainment workers (FEWs) are at higher risk of gender-based violence (GBV) than the general population. The prolonged stress and fear caused by GBV increase the likelihood of depression, a major mental health problem among FEWs. However, their mental health issue has received limited attention and remains poorly researched in the context of GBV. We examined the association between GBV and depressive symptoms among FEWs in Cambodia. We conducted this cross-sectional study in 2017. We used a two-stage cluster random sampling method to select FEWs from the municipality and six provinces for face-to-face interviews. We used the Centre for Epidemiologic Studies Depression Scale (CES-D) to measure depressive symptoms. We conducted a multivariable logistic regression analysis to identify factors associated with depressive symptoms. We included a total of 645 FEWs in data analyses. The proportions of FEWs experiencing emotional, physical, and sexual violence were 36.1%, 11.6%, and 17.2%, respectively. Of the total participants, 65.9% had high levels of depressive symptoms. The adjusted odds of having high levels of depressive symptoms were higher among FEWs who engaged in transactional sex (AOR 1.79, 95% CI 1.09-2.94), experienced emotional abuse (AOR 3.15, 95% CI 1.90-5.23), and experienced two (AOR 7.89, 95% CI 3.28-18.99) and three overlapping types of GBV (AOR 12.12, 95% CI 2.47-59.25) than those who did not. FEWs in this study experienced high levels and overlapping types of GBV associated with high levels of depressive symptoms. Policy interventions and services should be designed to prevent GBV and support the victims of GBV to mitigate depressive symptoms among FEWs in Cambodia.
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Affiliation(s)
- Sophearen Ith
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, California, The United States of America
| | - Sovannary Tuot
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sokunthea Yem
- National Institute for Public Health, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sexual IPV and non-partner rape of female sex workers: Findings of a cross-sectional community-centric national study in South Africa. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957423 PMCID: PMC8654680 DOI: 10.1016/j.ssmmh.2021.100012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/05/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Globally female sex workers (FSWs) are vulnerable to violence from intimate partners, police and clients due to stigma and criminalisation. In this paper we describe South African FSWs' exposure to violence and factors associated with having been raped in the past year. Methods We conducted a multi-stage, community-centric, cross-sectional survey of 3005 FSWs linked to sex worker programmes in 12 sites across all nine provinces that had a SW programme. Adult women who sold sex in the preceding six months were recruited for interviews via sex worker networks. Survey tools were developed in consultation with peer educators and FSWs. Results In the past year, 70.4% of FSWs experienced physical violence and 57.9% were raped: by policemen (14.0%), clients (48.3%), other men (30.2%) and/or and intimate partner (31.9%). Sexual IPV was associated with food insecurity, entering sex work as a child, childhood trauma exposure, post-traumatic stress disorder (PTSD), drinking alcohol to cope with sex work, working more days, partner controlling behaviour, having an ex-client partner, and having no current partner to protect from ex-partners. Rape by a client, other men or policemen was associated with food insecurity, childhood trauma, PTSD, depression, using alcohol and drugs, being homeless or staying in a sex work venue, selling sex on the streets, working more days and having entered sex work as a child and been in sex work for longer. Conclusion South African FSWs are very vulnerable to rape. Within the social climate of gender inequality, sex work stigma, criminalisation, and repeated victimisation, the key drivers are structural factors, childhood and other trauma exposure, mental ill-health, circumstances of sex work and, for SIPV, partner characteristics. Mostly these are amenable to intervention, with legislative change being foundational for ending abuse by policemen, enhancing safety of indoor venues and providing greater economic options for women.
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Motsoeneng M. South African female sex workers’ interactions with law enforcement: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.2001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Molefi Motsoeneng
- Scholarship of Teaching and Learning, Central University of Technology, Free State, Bloemfontein, South Africa
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21
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Saleem HT, Zhang L, Silberg C, Latkin C, Likindikoki S. Structural, everyday, and symbolic violence and the heightened vulnerability to HIV of women who use drugs in Tanzania. SSM - QUALITATIVE RESEARCH IN HEALTH 2021; 1. [PMID: 35174337 PMCID: PMC8846603 DOI: 10.1016/j.ssmqr.2021.100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Women who use drugs shoulder a disproportionate burden of the HIV epidemic in Tanzania. The mechanisms through which violence contributes to their excessively high rates of HIV have not been explored. In this paper, we use concepts of everyday, symbolic, and structural violence to critically examine the relationship between violence and heightened HIV vulnerability of women who use drugs in Dar es Salaam, Tanzania. We conducted cross-sectional surveys with 200 women who use drugs and follow-up, in-depth interviews with 30 survey participants who identified as living with HIV between November 2018 and March 2019. We drew from grounded theory methods to analyze qualitative data and complemented qualitative findings with survey results. Structural violence perpetuated constraints on women's economic opportunities and reduced their agency in sexual encounters manifesting in their disproportionately high rates of HIV. Nearly all women in our study engaged in sex work to meet basic needs and to support their drug use. Their involvement in overlapping drug use and sex work scenes exposed them to physical and sexual violence. Despite the pervasiveness of structural and everyday violence, some women reenacted agency by adopting strategies to maintain control and safety, and to exercise harm reduction. A multi-pronged, structural harm reduction strategy is critical to reducing violence experienced by women who use drugs and their ability to protect themselves from HIV.
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22
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Intersections of Sex Work, Mental Ill-Health, IPV and Other Violence Experienced by Female Sex Workers: Findings from a Cross-Sectional Community-Centric National Study in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211971. [PMID: 34831727 PMCID: PMC8620578 DOI: 10.3390/ijerph182211971] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
Abstract
Female sex workers (FSWs) are at increased risk of mental health problems, including mood disorders and substance abuse, and we need to understand the origins of these to treat and prevent them, and particularly understand how the context in which they sell sex impacts their mental health. We conducted a multi-stage, community-centric, cross-sectional survey of 3005 FSWs linked to SW programmes in twelve sites across all nine provinces of South Africa. We interviewed adult women who had sold sex in the preceding six months, who were recruited via SW networks. We found that FSWs have very poor mental health as 52.7% had depression and 53.6% has post-traumatic stress disorder (PTSD). The structural equation model showed direct pathways from childhood trauma and having HIV+ status to mental ill-health. Indirect pathways were mediated by food insecurity, controlling partners, non-partner rape, harmful alcohol use, substance use to cope with SW, indicators of the circumstances of SW, i.e., selling location (on streets, in taverns and brothels), frequency of selling and experiencing SW stigma. All paths from childhood trauma had final common pathways from exposure to gender-based violence (non-partner rape or intimate partner violence) to mental ill-health, except for one that was mediated by food insecurity. Thus, FSWs’ poor mental health risk was often mediated by their work location and vulnerability to violence, substance abuse and stigma. The potential contribution of legal reform to mitigate the risks of violence and mental ill-health are inescapable. Treatment of mental ill-health and substance abuse should be an essential element of FSW programmes.
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Beksinska A, Jama Z, Kabuti R, Kungu M, Babu H, Nyariki E, Shah P, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Beattie TS, Weiss HA, Kimani J. Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya. BMC Psychiatry 2021; 21:503. [PMID: 34649544 PMCID: PMC8518166 DOI: 10.1186/s12888-021-03515-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance use are associated with poor mental health outcomes, but few studies have examined these risks among Female Sex Workers (FSWs). We examine the prevalence and correlates of common mental health problems including suicidal thoughts and behaviours among FSWs in Kenya. METHODS Maisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline behavioural-biological survey (n = 1003) data were collected June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD) and a two-item tool to measure recent suicidal thoughts/behaviours. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Descriptive statistics and multivariable logistic regression were conducted using a hierarchical modelling approach. RESULTS Of 1039 eligible FSWs, 1003 FSWs participated in the study (response rate: 96%) with mean age 33.7 years. The prevalence of moderate/severe depression was 23.2%, moderate/severe anxiety 11.0%, PTSD 14.0% and recent suicidal thoughts/behaviours 10.2% (2.6% suicide attempt, 10.0% suicidal thoughts). Depression, anxiety, PTSD and recent suicidal thoughts/behaviours were all independently associated with higher ACE scores, recent hunger (missed a meal in last week due to financial difficulties), recent sexual/physical violence and increased harmful alcohol/substance. PTSD was additionally associated with increased chlamydia prevalence and recent suicidal thoughts/behaviours with low education and low socio-economic status. Mental health problems were less prevalent among women reporting social support. CONCLUSIONS The high burden of mental health problems indicates a need for accessible services tailored for FSWs alongside structural interventions addressing poverty, harmful alcohol/substance use and violence. Given the high rates of ACEs, early childhood and family interventions should be considered to prevent poor mental health outcomes.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Zaina Jama
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Rhoda Kabuti
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Mary Kungu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Hellen Babu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Emily Nyariki
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Pooja Shah
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Chrispo Nyabuto
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Monica Okumu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Anne Mahero
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Pauline Ngurukiri
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Erastus Irungu
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Wendy Adhiambo
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Peter Muthoga
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
| | - Rupert Kaul
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada
| | - Janet Seeley
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara S. Beattie
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A. Weiss
- grid.8991.90000 0004 0425 469XMRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Kimani
- grid.10604.330000 0001 2019 0495UK Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi, Kenya
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Sikhosana N, Mokgatle MM. A qualitative exploration on accounts of condom-use negotiation with clients: challenges and predicaments related to sex work among street-based female sex workers in Ekurhuleni District, South Africa. Pan Afr Med J 2021; 40:54. [PMID: 35059100 PMCID: PMC8724014 DOI: 10.11604/pamj.2021.40.54.29918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION female sex workers (FSWs) are the key vulnerable populations since they carry the high burden of HIV and sexually transmitted infections (STIs). However, the vulnerability of street-based FSWs to HIV/STIs is much higher than that of the establishment-based FSWs. The study aimed to explore street-based FSWs' condom negotiation skills, barriers to condom use as well as the challenges and predicaments they face on a daily basis. METHODS an exploratory qualitative approach using focus group discussions was conducted among FSWs working in a major provincial road in a district of Gauteng Province. Thematic content analysis using NVivo version 10 software was conducted. RESULTS the age range of the FSWs was 19 to 44 years. The themes that emerged from the data on challenges to negotiation and condom use among FSWs revealed the ways condoms are used in early sex work and over time, ways of enforcing condom used, preferred types of condoms and the predicaments to working in the sex trade. FSWs gained experience of negotiating condom use over time in their work. Both female and male condoms were available and accurate insertion of condoms was reported. Male condom was preferred. Condom use strategies included direct request; using health-information messages; charging more for condomless sex; and refusing condomless sex. The FSW reported the risks of violent attacks of unregulated street-based environment. CONCLUSION condom negotiation strategies illustrated that peer-education and sharing experiences among themselves were beneficial for protective sexual behaviours. Peer-education benefits and peer-interactions yielded assertive attitudes and behaviours of demanding and/or enforcing condom use.
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Affiliation(s)
- Nokuthula Sikhosana
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud
| | - Mathildah Mpata Mokgatle
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud,Corresponding author: Mathildah Mpata Mokgatle, Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, Afrique du Sud.
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25
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Milovanovic M, Jewkes R, Otwombe K, Jaffer M, Hopkins K, Hlongwe K, Mathaludi M, Mbowane V, Gray G, Dunkle K, Hunt G, Welte A, Kassanjee R, Slingers N, Vanleeuw L, Puren A, Kinghorn A, Martinson N, Abdullah F, Coetzee J. Community-led cross-sectional study of social and employment circumstances, HIV and associated factors amongst female sex workers in South Africa: study protocol. Glob Health Action 2021; 14:1953243. [PMID: 34338167 PMCID: PMC8330713 DOI: 10.1080/16549716.2021.1953243] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In South Africa, female sex workers (FSWs) are perceived to play a pivotal role in the country’s HIV epidemic. Understanding their health status and risk factors for adverse health outcomes is foundational for developing evidence-based health care for this population. Objective Describe the methodology used to successfully implement a community-led study of social and employment circumstances, HIV and associated factors amongst FSWs in South Africa. Method A community-centric, cross-sectional, survey of 3,005 adult FSWs was conducted (January–July 2019) on 12 Sex Work (SW) programme sites across nine provinces of South Africa. Sites had existing SW networks and support programmes providing peer education and HIV services. FSWs were involved in the study design, questionnaire development, and data collection. Questions included: demographic, sexual behaviour, HIV testing and treatment/PrEP history, and violence exposure. HIV rapid testing, viral load, CD4 count, HIV recency, and HIV drug resistance genotypic testing were undertaken. Partner organisations provided follow-up services. Results HIV Prevalence was 61.96%, the median length of selling sex was 6 years, and inconsistent condom use was reported by 81.6% of participants, 88.4% reported childhood trauma, 46.2% reported physical or sexual abuse by an intimate partner and 57.4% by a client. More than half of participants had depression and post-traumatic stress disorder (52.7% and 54.1%, respectively). Conclusion This is the first national survey of HIV prevalence amongst FSWs in programmes in South Africa. The data highlight the vulnerability of this population to HIV, violence and mental ill health, suggesting the need for urgent law reform. Based on the unique methodology and the successful implementation alongside study partners, the outcomes will inform tailored interventions. Our rapid rate of enrolment, low rate of screening failure and low proportion of missing data showed the feasibility and importance of community-centric research with marginalised, highly vulnerable populations.
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Affiliation(s)
- Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy, Kyalami, South Africa
| | - Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Kathryn Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Mokgadi Mathaludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Kristin Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gillian Hunt
- National Institute of Communicable Diseases (NICD), Johannesburg, South Africa
| | - Alex Welte
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,South African National Department of Science and Innovation - National Research Foundation (DSI-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Lieve Vanleeuw
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Adrian Puren
- National Institute of Communicable Diseases (NICD), Johannesburg, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy, Kyalami, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Peitzmeier SM, Wirtz AL, Beyrer C, Peryshkina A, Sherman SG, Colantuoni E, Decker MR. Polyvictimization Among Russian Sex Workers: Intimate Partner, Police, and Pimp Violence Cluster With Client Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8056-NP8081. [PMID: 30966847 PMCID: PMC9476162 DOI: 10.1177/0886260519839431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Female sex workers (FSW) are a key population in the HIV epidemic and face high levels of violence. While women globally are predominantly at risk of intimate partner violence (IPV), FSW are additionally vulnerable to violence from clients, police, and pimps associated with their occupation. FSW are therefore at risk of cumulative trauma from polyvictimization, or violence from multiple types of perpetrators. Polyvictimization is a driver of morbidity and mortality in numerous populations, but there has been little research on how multiple types of victimization are related to one another in FSW. A cross-sectional survey was conducted among 754 FSW from three cities in the Russian Federation. Surveys assessed lifetime experiences of client, police, intimate partner, and pimp violence. Multivariate log-binomial and Poisson regression were used to test associations between these types of violence. Forty-five percent experienced any type of violence, including 31.7% from clients, 16.0% from police, 15.7% from intimate partners, and 11.4% from pimps. One fifth (20.4%) experienced polyvictimization. Client violence was central to polyvictimization: Only 5.9% of polyvictimization occurs without client violence. When client violence was not present, police, pimp, or IPV co-occurred significantly less than would be expected under an assumption that these types of violence occur independently (p < .001). However, they co-occurred more than would be expected when client violence is present. After adjusting for other types of violence experienced and demographic factors, experiencing client violence was independently associated with police violence (adjusted relative risk [ARR] = 2.77, 95% confidence interval [CI] [1.67, 4.59]), IPV (ARR = 3.67, 95% CI [1.95, 6.89]), and pimp violence (ARR = 5.26, 95% CI [2.80, 9.86]). Client violence may drive exposure to other types of violence and enable polyvictimization in a way that other types of violence do not in this setting. Violence prevention interventions may achieve maximal effect in reducing multiple types of violence by focusing on client violence.
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Affiliation(s)
- Sarah M Peitzmeier
- University of Michigan, Ann Arbor, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michele R Decker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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de Gruchy T, Vearey J, Opiti C, Mlotshwa L, Manji K, Hanefeld J. Research on the move: exploring WhatsApp as a tool for understanding the intersections between migration, mobility, health and gender in South Africa. Global Health 2021; 17:71. [PMID: 34210311 PMCID: PMC8248753 DOI: 10.1186/s12992-021-00727-y] [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: 08/24/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagement with the process of migration; (2) exclusion of internal migrants; and (3) lack of methodologies that are able to capture 'real-time' data about health needs and healthcare seeking experiences over both time and place. In this paper, we reflect on a four-month pilot project which explored the use of WhatsApp Messenger - a popular mobile phone application used widely in sub-Saharan Africa - and assessed its feasibility as a research tool with migrant and mobile populations in order to inform a larger study that would address these challenges. METHOD A four-month pilot was undertaken with eleven participants between October 2019 and January 2020. Using Survey Node, an online platform that allows for the automatic administration of surveys through WhatsApp, monthly surveys were administered. The GPS coordinates of participants were also obtained. Recruited through civil society partners in Gauteng, participants were over the age of 18, comfortable engaging in English, and owned WhatsApp compatible cell phones. Enrolment involved an administered survey and training participants in the study protocol. Participants received reimbursement for their travel costs and monthly cell phone data. RESULTS Out of a possible eighty eight survey and location responses, sixty one were received. In general, participants responded consistently to the monthly surveys and shared their location when prompted. Survey Node proved an efficient and effective way to administer surveys through WhatsApp. Location sharing via WhatsApp proved cumbersome and led to the development of a secure platform through which participants could share their location. Ethical concerns about data sharing over WhatsApp were addressed. CONCLUSIONS The success of the pilot indicates that WhatsApp can be used as a tool for data collection with migrant and mobile populations, and has informed the finalisation of the main study. Key lessons learnt included the importance of research design and processes for participant enrolment, and ensuring that the ethical concerns associated with WhatsApp are addressed.
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Affiliation(s)
- Thea de Gruchy
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa.
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa.,School of Social and Political Studies, University of Edinburgh, Edinburgh, Scotland
| | - Calvin Opiti
- Opiti Consulting, Pretoria, South Africa.,Department of Geography, University of the Witwatersrand, Johannesburg, South Africa
| | - Langelihle Mlotshwa
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa
| | - Karima Manji
- London School of Hygiene & Tropical Medicine (LSHTM), London, England
| | - Johanna Hanefeld
- London School of Hygiene & Tropical Medicine (LSHTM), London, England
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Nabunya P, Kiyingi J, Witte SS, Sensoy Bahar O, Jennings Mayo-Wilson L, Tozan Y, Nabayinda J, Mwebembezi A, Tumwesige W, Mukasa B, Namirembe R, Kagaayi J, Nakigudde J, McKay MM, Ssewamala FM. Working with economically vulnerable women engaged in sex work: Collaborating with community stakeholders in Southern Uganda. Glob Public Health 2021; 17:1215-1231. [PMID: 33881949 DOI: 10.1080/17441692.2021.1916054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03583541.
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Affiliation(s)
- Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Susan S Witte
- School of Social Work, Columbia University, New York, NY, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Yesim Tozan
- School of Global Public Health, New York University, New York, NY, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | - Abel Mwebembezi
- International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA.,Reach the Youth (RTY) Uganda, Kampala, Uganda
| | - Wilberforce Tumwesige
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Rashida Namirembe
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Janet Nakigudde
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.,International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA
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Motsoeneng M. Violence and HIV among female street sex workers in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2020.1871219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Molefi Motsoeneng
- Scholarship of Teaching and Learning, Central University of Technology, Free Sate, Bloemfontein, South Africa
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30
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Mbote DK, Nyblade L, Kemunto C, Giger K, Kimani J, Mingkwan P, Njuguna S, Oga E, Kraemer JD. Police Discrimination, Misconduct, and Stigmatization of Female Sex Workers in Kenya: Associations with Delayed and Avoided Health Care Utilization and Lower Consistent Condom Use. Health Hum Rights 2020; 22:199-212. [PMID: 33390707 PMCID: PMC7762893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Discrimination and violence against sex workers by police are common in many populations and are associated with negative health outcomes, as well as being per se violations of human rights laws and norms. There is a close and mutually reinforcing nexus between legally actionable rights violations and stigma, and reducing human rights violations against sex workers likely requires both legal and societal interventions that address both. In this paper, we first aim to estimate levels of discrimination, violence, and stigma against women sex workers by police in Kenya. Second, we aim to estimate the association between manifestations of discrimination and stigma, on the one hand, and general health care utilization and consistent condom use, on the other. Using data from a survey of Kenyan sex workers, we document widespread discrimination and stigma. Through regression analyses, participants with the highest levels of all three categories of manifestations of discrimination and stigma reported significant lower consistent condom use. Those with the highest levels of witnessed/heard manifestations were significantly more likely to delay or avoid needed health care, and the highest level of experienced manifestations were associated with a marginally significant increase in delay or avoidance. Our findings document a plethora of violations of human rights obligations under Kenyan and international law.
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Affiliation(s)
- David Kuria Mbote
- Independent researcher and Director at the Kuria Foundation for Social Enterprise, Nairobi, Kenya
| | - Laura Nyblade
- Fellow and Senior Technical Advisor, Stigma and Discrimination, RTI International, Washington, DC, USA
| | | | - Kayla Giger
- Public Health Analyst at RTI International, Washington, DC, USA
| | - Joshua Kimani
- Clinical Director at Partners for Health and Development in Africa and Lecturer at the Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Pia Mingkwan
- Research Associate at RTI International, Washington, DC, USA
| | - Stella Njuguna
- Research Officer at the Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Oga
- Senior Epidemiologist at RTI International, Rockville, MD, USA
| | - John D. Kraemer
- Associate Professor in the Department of Health Systems Administration at Georgetown University and Visiting Scholar at RTI International, Washington, DC, USA
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Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030903. [PMID: 32024080 PMCID: PMC7037605 DOI: 10.3390/ijerph17030903] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to systematically review studies that examined the prevalence of gender based violence (GBV) that included intimate partner violence (IPV) and non-IPV among women in sub-Saharan Africa (SSA). This evidence is an important aspect to work towards achieving the Sustainable Development Goals (SDG’s) target of eliminating all forms of violence in SSA. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. Studies on GBV in SSA countries that were published in English from 2008 to 2019 were included. A random effect meta-analysis was used. Fifty-eight studies met the inclusion criteria. The pooled prevalence of IPV among women was 44%, the past year-pooled prevalence of IPV was 35.5% and non-IPV pooled prevalence was 14%. The highest prevalence rates of IPV that were reported included emotional (29.40%), physical (25.87%) and sexual (18.75%) violence. The sub-regional analysis found that women residing in Western (30%) and Eastern (25%) African regions experienced higher levels of emotional violence. Integrated mitigation measures to reduce GBV in SSA should focus mainly on IPV in order to achieve the SDG’s that will lead to sustainable changes in women’s health.
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Huschke S, Coetzee J. Sex work and condom use in Soweto, South Africa: a call for community-based interventions with clients. CULTURE, HEALTH & SEXUALITY 2020; 22:1-15. [PMID: 30794091 DOI: 10.1080/13691058.2019.1568575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/08/2019] [Indexed: 05/22/2023]
Abstract
Despite public health interventions targeting sex workers in an attempt to increase condom use, HIV still remains a significant health issue for those involved in the sex industry in many countries. In this paper, we analyse data collected as part of an ethnographic study of sex work in Soweto, South Africa. We show that the main problems with consistent condom use are clients who threaten violence if sex workers insist on condoms, clients who are 'rough' and refuse to stop intercourse when the condom breaks, and clients who offer to pay more money for unprotected sex. These issues relate to unequal gender norms that disempower female sex workers and dismiss the importance of consent in sexual relationships. The criminalisation of sex work increases vulnerability and reduces sex workers' agency as sex workers are reluctant to report crimes committed against them. Persistent 'whore stigma' adds to this dynamic by dehumanising sex workers. In conclusion, we advocate for decriminalisation and posit that public health interventions aimed at increasing condom use and reducing HIV rates need to specifically engage clients, address unequal gender norms and involve local communities to tackle stigma directed against sex workers.
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Affiliation(s)
- Susann Huschke
- African Centre for Migration & Society and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, New Nurses Home, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
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Abelson A, Lyons C, Decker M, Ketende S, Mfochive Njindam I, Fouda G, Ndonko F, Levitt D, Tamoufe U, Billong S, Bissek ACZK, Baral SD. Lifetime experiences of gender-based violence, depression and condom use among female sex workers in Cameroon. Int J Soc Psychiatry 2019; 65:445-457. [PMID: 31234685 DOI: 10.1177/0020764019858646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In general populations, consistent data highlight the relationships among violence, HIV risk behavior and depression; however, these patterns are not well understood among female sex workers (FSWs). We examined the relationship between FSWs' experiences with sexual violence and consistent condom use as a key HIV risk behavior and explored mental health as a potential mediator. METHODS In total, 2,165 FSWs were recruited via respondent-driven sampling in Cameroon in 2016. The women answered questions about violence, condom use and mental health. RESULTS Inconsistent condom use with clients was reported by 23.5% of participants (508/2,165). Lifetime sexual violence was prevalent with 33.0% (713/2,163) of participants. Almost 50% (1,067/2,143) of respondents had some level of depression. Sexual violence was significantly associated with inconsistent condom use (adjusted risk ratio (aRR) 1.4, 95% confidence interval (CI) (1.2-1.6)). Of FSWs with no depression, 24.9% (267/1,071) reported sexual violence, versus 56.1% (32/57) of respondents with severe depression (p < .01). Severe depression significantly increased risk of condomless sex (aRR 1.8, 95% CI (1.3-2.6)); in mediation analysis, both sexual violence and severe depression remained significant predictors of condomless sex (aRR 1.4, 95% CI (1.2, 1.6) and aRR 1.7, 95% CI (1.2-2.4), respectively). Depression did not mediate the relationship between sexual violence and condom use. CONCLUSION Sexual violence and depression are prevalent and independently associated with condom nonuse with clients among FSWs in Cameroon. Results highlight the need for interventions to address mental health as well as gender-based violence for FSWs.
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Affiliation(s)
- Anna Abelson
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele Decker
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sosthenes Ketende
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Serge Billong
- 6 Groupe Technique Central du Comité National de Lutte contre le SIDA, Yaoundc, Cameroon
| | | | - Stefan D Baral
- 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ngale K, Cummings B, Horth R. Unseen, unheard and unprotected: prevalence and correlates of violence among female sex workers in Mozambique. CULTURE, HEALTH & SEXUALITY 2019; 21:898-913. [PMID: 30451098 DOI: 10.1080/13691058.2018.1524512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/09/2023]
Abstract
Violence against women, including female sex workers, is a public health concern worldwide. This is the first study in Mozambique to estimate the prevalence of and factors associated with physical and sexual violence against female sex workers. We used data collected from 1,250 women recruited using respondent-driven sampling in the cities of Maputo, Beira and Nampula in 2011-12. Participants were 15 years of age and reported having had sex for money in the preceding six months. Prevalence of physical or sexual violence (defined as being hit or battered or raped or forced to have sex within the last 6 months) ranged from 10.0% to 25.6%. Strangers (37.0%) and acquaintances (31.2%) were reported to be the most frequent perpetrators of sexual violence. Among participants who experienced sexual violence, 65.9% and 87.0% did not seek medical care and police assistance, respectively. Physical or sexual violence was associated with city (adjusted odds ratio [AOR] 2.6 and 2.0 Nampula and Beira vs Maputo), age (AOR 1.9, aged 15-24 years vs aged 25 and older), unprotected sex with last client (AOR 1.6) and self-reported sexually transmitted infections (AOR 2.1). The high prevalence of violence found confirms the need for interventions to mitigate this problem.
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Affiliation(s)
- Kátia Ngale
- a Pathfinder International , Maputo , Mozambique
| | - Beverley Cummings
- b US Centers for Disease Control and Prevention , Maputo , Mozambique
| | - Roberta Horth
- c Global Health Sciences , University of California San Francisco , Maputo , Mozambique
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35
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Parmley L, Rao A, Young K, Kose Z, Phaswana-Mafuya N, Mcingana M, Lambert A, Hausler H, Baral S, Schwartz S. Female Sex Workers' Experiences Selling Sex during Pregnancy and Post-Delivery in South Africa. Stud Fam Plann 2019; 50:201-217. [PMID: 30997677 DOI: 10.1111/sifp.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in-depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post-delivery in a high-HIV-prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post-delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.
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36
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Beksinska A, Prakash R, Isac S, Mohan HL, Platt L, Blanchard J, Moses S, Beattie TS. Violence experience by perpetrator and associations with HIV/STI risk and infection: a cross-sectional study among female sex workers in Karnataka, south India. BMJ Open 2018; 8:e021389. [PMID: 30206080 PMCID: PMC6144389 DOI: 10.1136/bmjopen-2017-021389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) experience violence from a range of perpetrators, but little is known about how violence experience across multiple settings (workplace, community, domestic) impacts on HIV/sexually transmitted infection (STI) risk. We examined whether HIV/STI risk differs by the perpetrator of violence. METHODS An Integrated Biological and Behavioural Assessment survey was conducted among random samples of FSWs in two districts (Bangalore and Shimoga) in Karnataka state, south India, in 2011. Physical and sexual violence in the past six months, by workplace (client, police, coworker, pimp) or community (stranger, rowdy, neighbour, auto-driver) perpetrators was assessed, as was physical and sexual intimate partner violence in the past 12 months. Weighted, bivariate and multivariate analyses were used to examine associations between violence by perpetrator and HIV/STI risk. RESULTS 1111 FSWs were included (Bangalore=718, Shimoga=393). Overall, 34.9% reported recent physical and/or sexual violence. Violence was experienced from domestic (27.1%), workplace (11.1%) and community (4.2%) perpetrators, with 6.2% of participants reporting recent violence from both domestic and non-domestic (workplace/community) perpetrators. Adjusted analysis suggests that experience of violence by workplace/community perpetrators is more important in increasing HIV/STI risk during sex work (lower condom use with clients; client or FSW under the influence of alcohol at last sex) than domestic violence. However, women who reported recent violence by domestic and workplace/community perpetrators had the highest odds of high-titre syphilis infection, recent STI symptoms and condom breakage at last sex, and the lowest odds of condom use at last sex with regular clients compared with women who reported violence by domestic or workplace/community perpetrators only. CONCLUSION HIV/STI risk differs by the perpetrator of violence and is highest among FSWs experiencing violence in the workplace/community and at home. Effective HIV/STI prevention programmes with FSWs need to include violence interventions that address violence across both their personal and working lives.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Shajy Isac
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - H L Mohan
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
| | - Lucy Platt
- Department of Social and Environmental Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Coetzee J, Buckley J, Otwombe K, Milovanovic M, Gray GE, Jewkes R. Depression and Post Traumatic Stress amongst female sex workers in Soweto, South Africa: A cross sectional, respondent driven sample. PLoS One 2018; 13:e0196759. [PMID: 29975685 PMCID: PMC6033380 DOI: 10.1371/journal.pone.0196759] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers in South Africa are exposed to high levels of violence, yet little is known about their mental health needs. This study aims to understanding the prevalence of depression and post-traumatic stress disorder (PTSD) and their risk factors amongst female sex worker (FSWs) in Soweto, South Africa. METHODS A cross-sectional, respondent-driven sampling (RDS) survey enrolled 508 FSWs. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multinomial regression for risk factors associated with depression and PTSD. FINDINGS Symptoms of severe depression were prevalent amongst 68.7%, PTSD was 39.6%, and 32.7% suffered from comorbid PTSD and depression. Experiencing ≥3 kinds of violence increased the likelihood of comorbidity (RRR4.11, 95% CI 1.52-11.12,p = 0.005). Internalised stigma increased the likelihood of one mental health condition (RRR1.25, 95% CI 1.10-1.42,p = 0.001), higher self-esteem was associated with independent (RRR1.14, 95% CI 1.05-1.25,p = 0.002) and comorbid conditions (RRR1.17, 95% CI 1.07-1.27,p = 0.001). CONCLUSION Our findings highlight the sizable burden of treatable mental health conditions among FSWs in Soweto. This was driven by multiple exposures to violence, sex work related discrimination and overall moderate levels of self-esteem masking defence mechanisms. This suggests the urgent need to design and integrate services geared to the mental health needs for this population.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Buckley
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Department of Psychiatry, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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38
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Coetzee J, Hunt G, Jaffer M, Otwombe K, Scott L, Bongwe A, Ledwaba J, Molema S, Jewkes R, Gray GE. HIV-1 viraemia and drug resistance amongst female sex workers in Soweto, South Africa: A cross sectional study. PLoS One 2017; 12:e0188606. [PMID: 29244809 PMCID: PMC5731765 DOI: 10.1371/journal.pone.0188606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022] Open
Abstract
Background HIV drug resistance (HIVDR) poses a threat to future antiretroviral therapy success. Monitoring HIVDR patterns is of particular importance in populations such as sex workers (SWs), where documented HIV prevalence is between 34–89%, and in countries with limited therapeutic options. Currently in South Africa, there is a dearth in evidence and no ongoing surveillance of HIVDR amongst sex work populations. This study aims to describe the prevalence of HIVDR amongst a sample of female sex workers (FSWs) from Soweto, South Africa. Methodology A cross-sectional, respondent driven sampling (RDS) recruitment methodology was used to enrol FSWs based in Soweto. Participants were tested for HIV and undertook a survey that included HIV knowledge and treatment status. Whole blood specimens were collected from HIV positive FSWs to measure for CD4 counts, viral load (VL) and perform HIVDR genotyping. Frequencies were determined for categorical variables and medians and interquartile ranges (IQR) for the continuous. Results Of the 508 enrolled participants, 55% (n = 280) were HIV positive and of median age 32 (IQR: 20–51) years. Among the HIV positive, 51.8% (132/269) were defined as virologically suppressed (VL < 400 copies/ml). Of the 119 individuals with unsuppressed viral loads who were successfully genotyped for resistance testing 37.8% (45/119) had detectable drug resistance. In this group, HIVDR mutations were found amongst 73.7% (14/19) of individuals on treatment, 27.4% (26/95) of individuals who were treatment naïve, and 100% (5/5) of defaulters. One phylogenetic cluster was found amongst treatment naïve FSWs. The K103N mutation was detected most commonly in 68.9% (31/45) individuals with HIVDR mutations, with 20/26 (76.9%) of treatment naïve FSW with detectable resistance having this mutation. The M184V mutation was found in both FSWs on treatment (12/14, 85.7%) and those defaulting (1/5, 20.0%). Discussion More than one third (45/119) of the genotyped sample had HIVDR, with resistance to the NNRTI class being the most common. Almost half of HIV positive FSWs had unsuppressed viral loads, increasing the likelihood for onward transmission of HIV. Disturbingly, more than 1:4 treatment naïve women with unsuppressed viral loads had HIVDR suggesting that possible sexual transmission of drug resistance is occurring in this high-risk population. Given the high burden of HIVDR in a population with a high background prevalence of HIV, it is imperative that routine monitoring of HIVDR be implemented. Understanding transmission dynamics of HIVDR in FSW and its impact on treatment success should be urgently elucidated.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Gillian Hunt
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, Faculty of Health Science, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Asiashu Bongwe
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Johanna Ledwaba
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Sephonono Molema
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
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