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Perrault Sullivan G, Guédou FA, Tounkara FK, Béhanzin L, Camara N, Aza-Gnandji M, Keita BD, Azonnadou O, Thera I, Avery L, Alary M. Longitudinal study of pregnancy intention and its association with pregnancy occurrence among female sex workers in Benin and Mali. Reprod Health 2023; 20:25. [PMID: 36717914 PMCID: PMC9887776 DOI: 10.1186/s12978-023-01565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The intention of becoming pregnant has an evident impact on the prenatal and postnatal period. For female sex workers (FSWs) in West Africa, among whom pregnancies are frequent as are HIV and sexually transmitted infections, a better understanding of their pregnancy intention and its influence on pregnancy occurrence could help prevent unwanted pregnancies and adverse effects on wanted pregnancies. METHODS We recruited 330 FSWs in Benin and 322 in Mali and followed them for 12 months. We evaluated their pregnancy intention at recruitment and 6-month follow-up, using a multidimensional prospective measure that we developed. We assessed pregnancy occurrence with a pregnancy test and a retrospective questionnaire at 6 and 12 months. A Cox proportional hazard model was used to estimate the association between intention and pregnancy. We carried out an analysis to take losses to follow-up into account using the inverse of probability of censoring weights and a cluster analysis to corroborate that the multidimensional measure of pregnancy intention fitted the data. RESULTS 407 FSWs were included in the first 6-month analysis and 284 at 12 months. Mean age was 30.9 years. The pregnancy intention distribution was similar between the two periods: 15.2% in the first period and 16.3% in the second had a positive intention. One out of four were ambivalent and almost 60% (57.7% and 56.3%) had a negative intention. For 38.2% of the FSWs, the intention changed between the two periods. The global incidence rate (to first event) was 19.1 pregnancies per 100 person-years. There was a borderline significant trend (p = 0.0529) of decreased pregnancy incidence with decreasing intention. Compared to positive intention, the adjusted hazard ratio (aHR) for ambivalent and negative intentions were 0.71 [95% confidence interval (95% CI) 0.32-1.60] and 0.46 (95% CI 0.21-1.01), respectively. CONCLUSION The level of pregnancy intention influences its occurrence among FSWs and nearly one out of six wants a baby despite working in the sex trade. Programmatically, early identification of these women could facilitate provision of quality antenatal and postnatal care. Given other health risks associated with sex work this care may decrease potential risks of adverse maternal, fetal and neonatal outcomes.
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Affiliation(s)
- Gentiane Perrault Sullivan
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada ,grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,grid.434819.30000 0000 8929 2775Institut National de Santé Publique, Québec, Canada
| | - Fernand Aimé Guédou
- grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | - Fatoumata Korika Tounkara
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Luc Béhanzin
- grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin ,grid.440525.20000 0004 0457 5047École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Benin
| | | | | | | | - Odette Azonnadou
- Dispensaire IST, Centre de Santé Communal de Cotonou 1, Cotonou, Benin
| | | | - Lisa Avery
- grid.21613.370000 0004 1936 9609Institute for Global Public Health, Dept. Obstetrics, Gynecology and Reproductive Sciences, Max Rady Medical College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michel Alary
- grid.23856.3a0000 0004 1936 8390Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada ,grid.23856.3a0000 0004 1936 8390Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du Chu de Québec – Université Laval, Québec, Canada ,grid.434819.30000 0000 8929 2775Institut National de Santé Publique, Québec, Canada
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Moradi G, Gouya MM, Ezzati Amini E, Ghorbani SS, Akbarpour S, Zareie B, Izadi N, Kashefi F, Moradi Y. Intentional abortion and its associated factors among female sex workers in Iran: Results from national bio-behavioral surveillance-2020. PLoS One 2022; 17:e0273732. [PMID: 36037196 PMCID: PMC9423624 DOI: 10.1371/journal.pone.0273732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
In addition to estimating the prevalence of intentional abortion in Iranian female sex workers (FSWs), this study identified related factors using the data of a national study.
Methods
This cross-sectional study utilizes the third round of integrated bio-behavioral surveillance-III data in Iranian FSWs in December 2019 and August 2020, and 1515 Participants were selected in 8 geographically diverse cities in Iran. Logistic regression was performed using unweighted analysis to identify factors associated with intentional abortion. Stata software (version 14), respondent-driven sampling analyses, and R (version 4.1.2) was used for data analysis.
Results
From 1390 participants with valid responses to the abortion question, 598 (37.3%; 95% CI: 32.43, 42.11%) reported intentional abortion during their life. According to the age groups, the highest prevalence of abortion was in the age group of 31 to 40 years (42.60%). In the multivariate logistic regression model, the marital status (divorced women (AOR = 2.05, 95% CI: 1.29, 3.27), concubines (AOR = 1.78, 95% CI: 1.02, 3.11)), work experience in brothels (AOR = 1.39, 95% CI: 1.04, 1.84), the type of sex (AOR = 2.75, 95% CI: 1.35, 5.58), the history of sexual violence (AOR = 1.54, 95% CI: 1.19, 2.01), and alcohol consumption (AOR = 1.53, 95% CI: 1.18, 2.01) were significantly associated with a history of intentional abortion.
Conclusion
Intentional abortion’s prevalence among Iranian FSWs has been much higher than that of the general female population in Iran, which is an alarming issue in the public health of this group and needs more effective interventions. In addition, alcohol consumption, working in a brothel, and being divorced are essential factors in increasing abortions among sex workers.
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Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Elnaz Ezzati Amini
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Bushra Zareie
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Izadi
- Department of Epidemiology School of Public health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Kashefi
- Reproductive health, Population, Family and School Health Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- * E-mail:
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Nestadt DF, Park JN, Galai N, Beckham SW, Decker MR, Zemlak J, Sherman SG. Sex workers as mothers: Correlates of engagement in sex work to support children. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:251-261. [PMID: 36935888 PMCID: PMC10019358 DOI: 10.1007/s40609-021-00213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Globally, most female sex workers (FSW) are mothers but are rarely considered as such in public health and social service programs and research. We aimed to quantitatively describe FSW who are mothers and to examine correlates of current engagement in sex work to support children among a cohort of FSW in Baltimore, Maryland, United States (U.S.). METHODS The study utilized baseline survey and HIV/STI testing data from the Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study of women engaged in street-based sex work in Baltimore, Maryland. Variable selection and interpretation were guided by Connell's theory of Gender and Power. We used bivariate and multivariate logistic regression analyses to examine correlates of engagement in sex work to support children among FSW mothers. RESULTS Our sample included 214 FSW with children, of whom 27% reported supporting children as a reason for the current engagement in sex work. Median age was 36 years, and mean number of children was 2.88. 20.6% were currently living with any of their minor aged children, and this was significantly more common among mothers engaged in sex work to support children (57.9% vs. 7%; p<0.001). 38.7% had ever lost legal custody of children, which was significantly less common among those supporting children through sex work (26.8% vs. 42.9%; p=0.033). In multivariate analyses, the following were independently associated with engaging in sex work to support children: African-American versus white race (aOR=2.62; 95% CI:1.18-5.82; p=0.018); less housing instability (aOR=0.42; 95% CI:0.20-0.89; p=0.024); initiating sex work at age <23 (aOR=2.59; 95% CI:1.23-5.46; p=0.012); less frequent intoxication during sex with clients (aOR=0.31; 95% CI:0.14-0.67; p=0.003); and reporting mental health as most important health concern (aOR=2.37; 95% CI:1.09-5.17; p=0.029). CONCLUSIONS FSW mothers who report engagement in sex work to support children are distinct from their counterparts in key areas related to HIV and other health outcomes. Neglecting to account for this important social role may lead to missed opportunities to meaningfully promote physical and mental health and to engage women on their own terms. Future research and interventions should seek to address FSW as whole social beings and center their experiences and needs as mothers.
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Affiliation(s)
- Danielle Friedman Nestadt
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Mount Carmel, Israel
| | - S. W. Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Zemlak
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Faini D, Munseri P, Bakari M, Sandström E, Faxelid E, Hanson C. "I did not plan to have a baby. This is the outcome of our work": a qualitative study exploring unintended pregnancy among female sex workers. BMC Womens Health 2020; 20:267. [PMID: 33261591 PMCID: PMC7709442 DOI: 10.1186/s12905-020-01137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.
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Affiliation(s)
- Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), 9 United Nations Road, Dar es Salaam, Tanzania.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Muhammad Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Eric Sandström
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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5
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Perrault Sullivan G, Guédou FA, Batona G, Kintin F, Béhanzin L, Avery L, Bédard E, Gagnon MP, Zannou DM, Kpatchavi A, Alary M. Overview and factors associated with pregnancies and abortions occurring in sex workers in Benin. BMC WOMENS HEALTH 2020; 20:248. [PMID: 33167931 PMCID: PMC7650197 DOI: 10.1186/s12905-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/27/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. Methods Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. Results Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. Conclusion One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.
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Affiliation(s)
- Gentiane Perrault Sullivan
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Fernand Aimé Guédou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Georges Batona
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Frédéric Kintin
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | - Luc Béhanzin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin.,École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Parakou, Bénin
| | - Lisa Avery
- Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emmanuelle Bédard
- Département des sciences infirmières, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Marie-Pierre Gagnon
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.,Département des sciences infirmières, Université Laval, Québec, Canada
| | - Djimon Marcel Zannou
- Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin.,Centre national hospitalier universitaire HMK de Cotonou, Cotonou, Bénin
| | - Adolphe Kpatchavi
- Département de Sociologie - Anthropologie, Faculté des Lettres, Arts et Sciences Humaines, Université d'Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada. .,Département de médecine sociale et préventive, Université Laval, Québec, Canada.
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Yang F, Ketende S, Jennings Mayo-Wilson L, Lyons CE, Liestman B, Diouf D, Drame FM, Coly K, Turpin G, Mboup S, Toure-Kane C, Castor D, Cheng A, Diop-Ndiaye H, Leye-Diouf N, Kennedy C, Baral S. Associations Between Economic Factors and Condom Use Behavior Among Female Sex Workers in Dakar and Mbour, Senegal. AIDS Behav 2020; 24:2829-2841. [PMID: 32180091 DOI: 10.1007/s10461-020-02832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Condom use remains a mainstay of HIV prevention programs around the world. However, data characterizing economic determinants of condom use among female sex workers (FSW) are limited, including in Senegal. We recruited 718 FSWs via respondent-driven sampling. Bivariate and multivariable regressions were conducted to assess the associations between economic variables and condom use at last sex. Paying rent (aRR: 1.07, 95%CI 1.01-1.13) was positively associated with condom use at last sex with new clients. No statistically significant associations were found between condom use and financial responsibility for dependent children, having additional source of income, sharing sex work earnings, or the ability to borrow from other FSWs, regardless of sexual partner types. The relationship between economic marginalization and consistent condom use among sex workers is complex reinforcing the need for behavioral economic research and prevention to be integrated into HIV prevention and treatment research and programs.
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Affiliation(s)
- Fan Yang
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA.
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA.
- School of Medicine, University of North Carolina, Project-China, Guangzhou, China.
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | | | - Carrie E Lyons
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Benjamin Liestman
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | | | - Fatou M Drame
- Enda Santé, Dakar, Senegal
- Gaston Berger University, Saint-Louis, Senegal
| | - Karleen Coly
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Souleymane Mboup
- Institut de Recherche en Santé, de Surveillance Epidemiologique Et de Formations, Dakar, Senegal
- Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Laboratoire de Bacteriologie-Virologie, CHU Aristide Le Dantec, Dakar, Senegal
| | - Delivette Castor
- USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, VA, USA
| | - Alison Cheng
- USAID, Office of HIV/AIDS, Bureau for Global Health, Arlington, VA, USA
| | | | - Nafissatou Leye-Diouf
- Institut de Recherche en Santé, de Surveillance Epidemiologique Et de Formations, Dakar, Senegal
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, USA
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Hakim AJ, Callahan T, Benech I, Patel M, Adler M, Modi S, Bateganya M, Parris KA, Bingham T. Addressing Vulnerable Population Needs in the Last Mile to the elimination of mother to child transmission of HIV: (Re)Claiming the HIV Response for Female Sex Workers and Their Children. BMC Public Health 2020; 20:1015. [PMID: 32590975 PMCID: PMC7320569 DOI: 10.1186/s12889-020-09114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
As countries strive to eliminate mother-to-child transmission of HIV, female sex workers (FSW) and their children still face barriers to accessing these essential services. Data on FSW uptake of HIV and reproductive health services before, during, and after pregnancy reveal inadequate service utilization. Stigma encountered by FSW in healthcare settings may contribute to low uptake of HIV testing, antiretroviral therapy (ART), and other prevention of mother-to-child HIV transmission (PMTCT) services. Coordination between community-based FSW and facility-based PMTCT programs can facilitate successful linkage of pregnant FSW to antenatal services to support PMTCT efforts. We offer a way forward to reach 90-90-90 targets for FSW and their families and eliminate mother-to-child transmission of HIV.
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Affiliation(s)
- Avi J Hakim
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA.
| | - Tegan Callahan
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Irene Benech
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Monita Patel
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Michelle Adler
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Surbhi Modi
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Moses Bateganya
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Kae Anne Parris
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
| | - Trista Bingham
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, 1600 Clifton Rd, NE, US2-1, Atlanta, GA, 30329, USA
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8
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Twizelimana D, Muula AS. Correlates of pregnancy among Female Sex Workers (FSWs) in semi urban Blantyre, Malawi. BMC Pregnancy Childbirth 2020; 20:337. [PMID: 32487138 PMCID: PMC7268236 DOI: 10.1186/s12884-020-03018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/15/2020] [Indexed: 11/28/2022] Open
Abstract
Background Little is known about female sex workers’ (FSWs) reproductive health apart from their being at higher than usual risk of sexually transmitted infections (STIs), including HIV. The aim of this study was therefore to investigate the correlates of pregnancy among FSWs in semi – urban Blantyre in Malawi. Methods We used systematic sampling to recruit a total of 200 FSWs in four different study sites in Blantyre. Data were collected through questionnaire interviews. We calculated the mean and standard deviation for continuous covariates and proportions for categorical variables to describe the data. Logistic regression analysis was used to examine the correlates between the outcome variable (pregnancy) and independent variables. Results Ninety one (45, 5%) FSWs were between 18 and 24 years. The prevalence of pregnancy was 61% for FSWs born in rural place as compared to 37% for those who were born in town. In multivariate analysis FSWs who reported to value being respected as mothers had 12 times the risk of pregnancy comparing to the ones who did not (AOR: 11.8, 95% CI: [4.56, 30.72] p-value < 0.001). FSWs who reported using condoms inconsistently had five times the risk of pregnancy compared to the ones who did not, (AOR: 5.26, 95% CI: [2.29, 12.08], p-value < 0.001). FSWs who had a request to bear children from steady partners had 5 times the risk of pregnancy comparing to the ones who did not (AOR: 5.07, 95% CI: [2.14, 11.99]). FSWs who reported forgetfulness of contraceptives’ use had 3 times more risk of pregnancy comparing to the ones who did not (AOR: 3.49 CI: [1.29, 9.37], p-value < 0.013). Conclusion The study documents a wide range of correlates of pregnancies among FSWs in the study sites. It is important to recognize the child bearing desires and circumstances of FSWs in order to inform health programs responsive to their needs.
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Affiliation(s)
- Donatien Twizelimana
- Mlambe Mission Hospital, P.O. Box: 45 Lunzu, Blantyre, Malawi. .,Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. .,The Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi.
| | - Adamson S Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,The Africa Center of Excellence in Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi
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9
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Quaife M, Lépine A, Deering K, Terris-Prestholt F, Beattie T, Isac S, Paranjape RS, Vickerman P. The cost of safe sex: estimating the price premium for unprotected sex during the Avahan HIV prevention programme in India. Health Policy Plan 2020; 34:784-791. [PMID: 31603470 PMCID: PMC6913694 DOI: 10.1093/heapol/czz100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/26/2022] Open
Abstract
There is some evidence that female sex workers (FSWs) receive greater earnings for providing unprotected sex. In 2003, the landscape of the fight against HIV/AIDS dramatically changed in India with the introduction of Avahan, the largest HIV prevention programme implemented globally. Using a unique, cross-sectional bio-behavioural dataset from 3591 FSWs located in the four Indian states where Avahan was implemented, we estimate the economic loss faced by FSWs who always use condoms. We estimate the causal effect of condom use on the price charged during the last paid sexual intercourse using the random targeting of Avahan as an instrumental variable. Results indicate that FSWs who always use condoms face an income loss of 65% (INR125, US$2.60) per sex act compared to peers providing unprotected sex, consistent with our expectations. The main finding confirms that clients have a preference for unprotected sex and that policies aiming at changing clients’ preferences and at improving the bargaining power of FSWs are required to limit the spread of HIV.
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Affiliation(s)
- Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurélia Lépine
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Deering
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Tara Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Shajy Isac
- Monitoring and Evaluation, Research and Special Studies, Karnataka Health Promotion Trust, Rajajinagar, Bangalore, India.,Department of Community Health Sciences, Center for Global Public Health, University of Manitoba, Canada
| | | | - Peter Vickerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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10
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Neary M, Owen A, Olagunju A. Pharmacokinetics of HIV therapies in pregnant patients: an update. Expert Opin Drug Metab Toxicol 2020; 16:449-461. [PMID: 32271621 DOI: 10.1080/17425255.2020.1754792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Mother-to-child transmission (MTCT) of HIV is thought to account for over 90% of new pediatric infections, and is associated with poor maternal and fetal outcomes. As such ensuring further reduction in MTCT is a priority in HIV treatment and prevention programs. AREAS COVERED This review aims to provide a comprehensive update on the pharmacokinetics of recently approved antiretroviral drugs and novel drug formulations and delivery systems. Alongside recent recommendations for dose adjustments, and an overview of the implications of co-infections on the pharmacokinetics of antiretrovirals relevant to pregnant HIV positive patients. Additionally, potential opportunities to progress pharmacokinetic research of new treatments in this population are highlighted. EXPERT OPINION In order to improve our understanding of how to provide safe and effective treatment to HIV positive pregnant women, further work is required to enable their inclusion in early stages of clinical trials. Incentives must be created for this research, in the form of additional investment by key stakeholders and regulatory agencies. Furthermore, as the incidence of MTCT is reduced globally there is a need to conduct long-term pharmacovigilance studies in uninfected children exposed to HIV and antiretrovirals in utero, in order to determine the safest and most effective antiretroviral therapies.
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Affiliation(s)
- Megan Neary
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool, UK
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool, UK
| | - Adeniyi Olagunju
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool, UK.,Faculty of Pharmacy, Obafemi Awolowo University , Ile-Ife, Nigeria
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11
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Bowring AL, Schwartz S, Lyons C, Rao A, Olawore O, Njindam IM, Nzau J, Fouda G, Fako GH, Turpin G, Levitt D, Georges S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi AC, Baral S. Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:82-99. [PMID: 32234842 PMCID: PMC7108938 DOI: 10.9745/ghsp-d-19-00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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Affiliation(s)
- Anna L Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Burnet Institute, Melbourne, Australia
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Metabiota, Yaounde, Cameroon
| | | | | | | | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Serge C Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Anne-Cécile Zoung-Kanyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.,Division of Operations Research, Ministry of Health, Yaounde, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Bowring AL, Ampt FH, Schwartz S, Stoové MA, Luchters S, Baral S, Hellard M. HIV pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind. J Int AIDS Soc 2020; 23:e25442. [PMID: 32064765 PMCID: PMC7025091 DOI: 10.1002/jia2.25442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. DISCUSSION FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. CONCLUSIONS As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights.
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Affiliation(s)
- Anna L Bowring
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
- Burnet InstituteMelbourneVictoriaAustralia
| | - Frances H Ampt
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Mark A Stoové
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stanley Luchters
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Population HealthAga Khan UniversityNairobiKenya
- International Centre for Reproductive HealthDepartment of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Margaret Hellard
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneVictoriaAustralia
- Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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13
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Kilembe W, Inambao M, Sharkey T, Wall KM, Parker R, Himukumbwa C, Tichacek A, Malama K, Visoiu AM, Price M, Chomba E, Allen S. Single Mothers and Female Sex Workers in Zambia Have Similar Risk Profiles. AIDS Res Hum Retroviruses 2019; 35:814-825. [PMID: 31204869 DOI: 10.1089/aid.2019.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to compare reproductive health and high-risk behaviors in female sex workers (FSWs) and single mothers (SMs) in Zambia's two largest cities, Lusaka and Ndola. FSWs were invited from known community hot spots, and sexually active HIV- SMs were referred from infant vaccination services for free and anonymous screening and treatment for HIV and other sexually transmitted infections (STIs) and long acting reversible contraception. A subset completed an interviewer-administered survey. From 2012 to 2016, 1,893 women (1,377 FSWs and 516 HIV- SMs) responded to referrals. HIV prevalence was 50% in Lusaka and 33% in Ndola FSWs. Positive syphilis serology (rapid plasmin reagin) was found in 29%-31% of HIV+ FSWs and 9%-12% of HIV- FSWs and SMs. Trichomonas was more common in Ndola (11%-12%), compared with Lusaka (3%-7%). Antiretroviral therapy (ART) use among HIV+ FSWs was 9%-15%. In all groups, consistent condom use (8%-11%) and modern contraceptive use (35%-65%) were low. Low literacy and reported coercion at first sexual intercourse were common in both FSWs and SMs, as was alcohol use during sex among FSWs. Zambian FSWs and SMs have low condom use and high HIV/STI and unplanned pregnancy risk. Many FSWs and half of SMs are ≥25 years of age, and thus too old for HIV prevention services targeting "adolescent girls and young women" (aged 15-24). Tailored and targeted reproductive health services are needed to reduce HIV, STI, and unplanned pregnancy in these vulnerable women.
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Affiliation(s)
| | | | | | - Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, New York
| | - Elwyn Chomba
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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14
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Semple SJ, Pines HA, Vera AH, Pitpitan EV, Martinez G, Rangel MG, Strathdee SA, Patterson TL. Maternal role strain and depressive symptoms among female sex workers in Mexico: the moderating role of sex work venue. Women Health 2019; 60:284-299. [PMID: 31195898 DOI: 10.1080/03630242.2019.1626792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Stressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016-2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.
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Affiliation(s)
- Shirley J Semple
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Heather A Pines
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alicia Harvey Vera
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eileen V Pitpitan
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gustavo Martinez
- Department of Patient Care, Federación Méxicana de Asociaciones Privadas, A.C. (FEMAP), Ciudad Juarez, Mexico
| | - M Gudelia Rangel
- Department of Migrant Health, US-Mexico Border Health Commission, Tijuana, Mexico
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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15
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Yam EA, Sultana N, Hossain T, Zieman B, Roy S, Yasmin R, Sadiq N, Hossain SMI. Reproductive health and desire for children among young female sex workers in Bangladesh brothels. Health Care Women Int 2019; 40:981-994. [PMID: 31161893 DOI: 10.1080/07399332.2019.1623801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Globally, reproductive health research among female sex workers (FSWs) often focuses on pregnancy prevention, but many women who sell sex aspire to have children in the future. In Bangladesh, where early marriage and parenthood is the norm, we examine reproductive histories and childbearing desires of young women who sell sex in brothels. We interviewed 1061 FSWs aged 18 to 24 in eight brothels in three Bangladesh divisions. Interviewers elicited information on sociodemographic characteristics, contraceptive use, pregnancy history, and childbearing desire. Bivariate and multivariate analyses were conducted to examine correlates of wanting to have a child within 24 months.
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Affiliation(s)
- Eileen A Yam
- Population Council , Washington , District of Columbia , USA
| | | | | | - Brady Zieman
- Population Council , Washington , District of Columbia , USA
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16
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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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17
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Grosso AL, Ketende SC, Stahlman S, Ky-Zerbo O, Ouedraogo HG, Kouanda S, Samadoulougou C, Lougue M, Tchalla J, Anato S, Dometo S, Nadedjo FD, Pitche V, Baral SD. Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infect Dis 2019; 19:208. [PMID: 30832604 PMCID: PMC6399877 DOI: 10.1186/s12879-019-3693-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. Methods This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. Results One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. Conclusions Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
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Affiliation(s)
- Ashley L Grosso
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA. .,Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.
| | - Sosthenes C Ketende
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Shauna Stahlman
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Henri Gautier Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Cesaire Samadoulougou
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Vincent Pitche
- Conseil National de Lutte contre le SIDA et les IST, 01 BP 2237, Lomé, 01, Togo
| | - Stefan D Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
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18
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The time is now: closing the pediatric treatment gap and building resilience among female sex workers and their children. AIDS 2018; 32:1913-1915. [PMID: 30005005 DOI: 10.1097/qad.0000000000001952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Motherhood is common among female sex workers (FSWs) and many have at least one biological child. Preventable mother-to-child transmission of HIV can occur given poor uptake of contraception coupled with high rates of unintended pregnancies among FSWs. Globally, there are 2.1 million children living with HIV, and antiretroviral treatment coverage is dismally low at 43%. Without timely diagnosis and treatment, half of all children born with HIV will die by the age of 2 years. By integrating services for key populations and their children, prevention of mother-to-child transmission of HIV uptake among FSW mothers and early infant diagnosis can improve and therefore reduce transmission of HIV. This field note addresses the needs of FSWs and their children, and advocates for programs to develop and scale up comprehensive, integrated, stigma-free services for this vulnerable population. Sensitive, confidential, child-friendly, tailored services that protect FSWs while addressing their children are essential to saving these young lives and breaking the transmission cycle of the virus. By siloing programs that neglect children of FSWs, we are missing opportunities and existing entry points to take an innovative, holistic, family approach to care, support, and treatment services that could improve outcomes. Given the high prevalence of HIV in FSWs and other stigmatizing factors which affect access to services, children of FSWs can no longer afford to be left behind and the time is now to prioritize them in current and future HIV programming.
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19
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Ma PHX, Chan ZCY, Loke AY. Conflicting identities between sex workers and motherhood: A systematic review. Women Health 2018; 59:534-557. [PMID: 30040603 DOI: 10.1080/03630242.2018.1500417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.
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Affiliation(s)
- Polly H X Ma
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Zenobia C Y Chan
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
| | - Alice Yuen Loke
- a School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong , China
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Vrazo AC, Sullivan D, Ryan Phelps B. Eliminating Mother-to-Child Transmission of HIV by 2030: 5 Strategies to Ensure Continued Progress. GLOBAL HEALTH, SCIENCE AND PRACTICE 2018; 6:249-256. [PMID: 29959270 PMCID: PMC6024627 DOI: 10.9745/ghsp-d-17-00097] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/04/2018] [Indexed: 01/26/2023]
Abstract
To keep up momentum in preventing mother-to-child transmission we propose: (1) advocating for greater political and financial commitment; (2) targeting high-risk populations such as adolescent girls and young women; (3) implementing novel service delivery models such as community treatment groups; (4) performing regular viral load monitoring during pregnancy and postpartum to ensure suppression before delivery and during breastfeeding; and (5) harnessing technology in monitoring and evaluation and HIV diagnostics.
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Affiliation(s)
- Alexandra C Vrazo
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA.
| | - David Sullivan
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Benjamin Ryan Phelps
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
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Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region. Sex Transm Dis 2018; 44:477-482. [PMID: 28703726 DOI: 10.1097/olq.0000000000000634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women's vulnerability to HIV and STIs among FSWs. METHODS From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments. RESULTS Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27-2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19-2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10-2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26-0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43-0.91). CONCLUSIONS These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman's decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.
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Kim HY, Grosso A, Ky-Zerbo O, Lougue M, Stahlman S, Samadoulougou C, Ouedraogo G, Kouanda S, Liestman B, Baral S. Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso. Ann Epidemiol 2017; 28:13-19. [PMID: 29425532 DOI: 10.1016/j.annepidem.2017.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/07/2017] [Accepted: 11/27/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities. METHODS FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression. RESULTS The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio [aOR] = 3.59, 95% confidence interval [CI] 1.48-8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14-4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27-5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09-3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47-5.86) were associated with perceived health care stigma. CONCLUSIONS In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma.
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Affiliation(s)
- Hae-Young Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ashley Grosso
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
| | - Shauna Stahlman
- Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
| | | | - Gautier Ouedraogo
- Institute de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institute de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Benjamin Liestman
- Programme d'Appui au Monde Associatif et Communautaire, Ouagadougou, Burkina Faso
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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Mazeingia YT, Olijjira L, Dessie Y. Anal sexual experience and HIV risk awareness among female sex workers in Dire Dawa, eastern Ethiopia. Glob Health Res Policy 2017; 2:27. [PMID: 29202095 PMCID: PMC5683548 DOI: 10.1186/s41256-017-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/20/2017] [Indexed: 11/15/2022] Open
Abstract
Background Female sex workers have been disproportionately affected with HIV and anal sexual experience elevate their vulnerability. Anal intercourse has more risk of HIV transmission than vaginal intercourse for receptors that coupled with low condom and proper lubricant use behavior during anal sex. Besides majority of them did not understand HIV transmission risk of anal intercourse. In Ethiopia, studies on anal sexual experience is almost none existent, so the purpose of this study is to explored anal sexual experience and HIV transmission risk awareness among female sex worker in Dire Dawa, Eastern Ethiopia. Method Qualitative study with thematic analysis approach was conducted among 18 female sex workers and recruitment of study participants performed until saturation of information. The principal investigator conducted in-depth interviews using local language (Amharic) and it was recorded on audio recorder. Tape recorded data was transcribed and translated to English and entered into open code version 3.4 for coding and theme identification. Data collection conducted simultaneously with data analysis. Result Female sex workers practiced anal sex for different themes like financial influence, coercion, intentionally, peer pressure and as a sign of intimacy and love. Coercion, negative attitudes, poor awareness about HIV transmission risks of anal sex and protection capacity of condom and proper lubricants are the identified themes for not using condom and proper lubricants during anal sex by female sex workers. Inaccessibility and unavailability of health services for issues related to anal sex was the core reason for female sex workers’ misperception and risk anal sexual experience. Conclusion Female sex workers practiced anal sex without risk reduction approaches and they did not understand exacerbated risk of anal sex to HIV transmission. Stakeholders including ministry of health need to incorporate potential awareness raising tasks and programs about risk of anal sex and methods of risk reduction for female sex workers. Electronic supplementary material The online version of this article (doi:10.1186/s41256-017-0047-6) contains supplementary material, which is available to authorized users.
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Yam EA, Kidanu A, Burnett-Zieman B, Pilgrim N, Okal J, Bekele A, Gudeta D, Caswell G. Pregnancy Experiences of Female Sex Workers in Adama City, Ethiopia: Complexity of Partner Relationships and Pregnancy Intentions. Stud Fam Plann 2017; 48:107-119. [PMID: 28263396 PMCID: PMC5516190 DOI: 10.1111/sifp.12019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research and programs for female sex workers (FSWs) tend to focus exclusively on HIV prevention, with little attention paid to how pregnancy affects their lives. We examine the circumstances surrounding pregnancy and childbirth among women selling sex in Ethiopia. In Adama City, researchers asked 30 FSWs aged 18 and older who had ever been pregnant to participate in in-depth interviews. The women reported on pregnancies experienced both before and after they had begun selling sex. They identified some of the fathers as clients, former partners, and current partners, but they did not know the identities of the other fathers. Missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy. Abortion was common, typically with a medication regimen at a facility. Comprehensive sexual and reproductive health services should be provided to women who sell sex, in recognition and support of their need for family planning and their desire to plan whether and when to have children.
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Affiliation(s)
- Eileen A Yam
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Aklilu Kidanu
- Director, Miz-Hasab Research Center, Addis Ababa, Ethiopia
| | - Brady Burnett-Zieman
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Nanlesta Pilgrim
- Associate, Brady Burnett-Zieman is Staff Associate, and Nanlesta Pilgrim is Associate, Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008
| | - Jerry Okal
- Associate, Population Council, Nairobi, Kenya
| | - Assefa Bekele
- Adama Branch Manager and Daniel Gudeta is Project Coordinator, Link Up, Organization for Social Services, Health and Development, Addis Ababa, Ethiopia
| | - Daniel Gudeta
- Link Up, Organization for Social Services, Health and Development, Addis Ababa, Ethiopia
| | - Georgina Caswell
- Regional Advisor, Link Up, International HIV/AIDS Alliance, Cape Town, South Africa
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Ippoliti NB, Nanda G, Wilcher R. Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence. Stud Fam Plann 2017; 48:121-151. [PMID: 28422301 DOI: 10.1111/sifp.12020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.
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Karamouzian M, Mirzazadeh A, Shokoohi M, Khajehkazemi R, Sedaghat A, Haghdoost AA, Sharifi H. Lifetime Abortion of Female Sex Workers in Iran: Findings of a National Bio-Behavioural Survey In 2010. PLoS One 2016; 11:e0166042. [PMID: 27861487 PMCID: PMC5115696 DOI: 10.1371/journal.pone.0166042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/22/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Unintended pregnancies and abortion may be considered as occupational hazards for female sex workers (FSWs). As our understanding of contraceptive and abortion practices of Iranian FSWs is very limited, this study tries to assess the dynamics of contraception and abortion among this sub-population. Methods This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 14 cities in Iran. Data were collected through face-to-face interviews using a pilot-tested standardized risk assessment questionnaire. We applied the logistic regression model to investigate the correlates of induced abortion among FSWs. Results Of the 863 participants with valid responses to the abortion variable, 35.3% (95% CI: 32.1–38.6) acknowledged ever induced abortion and the annual rate of abortion was estimated at 20.7 per 1000 women. Around 31.2% of FSWs reported no usual contraceptive use, 32.6% barrier method, 23.6% non-barrier modern contraception methods, and 12.5% dual protection. In our multivariable model, older age (Adjusted Odds Ratio (AOR) = 1.74, 95% Confidence Interval (CI): 1.02, 2.96), group sex (AOR = 1.92, 95% CI: 1.10, 3.35), history of travel for sex work (AOR = 1.55, 95% CI: 1.09, 2.20), sexual violence (AOR = 1.77, 95% CI: 1.25, 2.50), STIs in last year (AOR = 1.53, 95% CI: 1.09, 2.14), and accessing family planning services (AOR = 1.76, 95% CI: 1.24, 2.49) were significant predictors of lifetime abortion. Conclusions The reproductive health needs of Iranian FSWs are unmet and around one-third of FSWs reported induced abortion. Scaling-up comprehensive family planning services and empowering FSWs to have safer sex practices may help them to prevent unintended pregnancies and further risk of HIV transmission.
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Affiliation(s)
- Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Razieh Khajehkazemi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sedaghat
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- * E-mail:
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Luchters S, Bosire W, Feng A, Richter ML, King’ola N, Ampt F, Temmerman M, Chersich MF. "A Baby Was an Added Burden": Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study. PLoS One 2016; 11:e0162871. [PMID: 27689699 PMCID: PMC5045288 DOI: 10.1371/journal.pone.0162871] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/30/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya. METHODS A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant during the study, and interviews with five key informants. These data were transcribed, translated and analysed thematically. RESULTS Four hundred women were enrolled, with 92% remaining in the cohort after one year. Fifty-seven percent reported using a modern contraceptive method (including condoms when used consistently). Over one-third (36%) of women were using condoms inconsistently without another method. Twenty-four percent had an unintended pregnancy during the study. Younger age, having an emotional partner and using traditional or no contraception, or condoms only, were independent predictors of unintended pregnancy. Women attributed pregnancy to forgetting to use contraception and being pressured not to by clients and emotional partners, as well as "bad luck". They described numerous negative consequences of unintended pregnancy. CONCLUSION Modern contraceptive uptake is surprisingly low in this at-risk population, which in turn has a high rate of unintended pregnancy. The latter may result in financial hardship, social stigma, risk of abandonment, or dangerous abortion practices. FSWs face considerable barriers to the adoption of dual method contraceptive use, including low levels of control in their emotional and commercial relationships. Reproductive health services need to be incorporated into programs for sexually transmitted infections and HIV, which address the socially-determined barriers to contraceptive use.
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Affiliation(s)
- Stanley Luchters
- Burnet Institute, Melbourne, Australia
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- * E-mail:
| | - Wilkister Bosire
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Amy Feng
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Melbourne, Australia
| | - Marlise L. Richter
- Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa
| | - Nzioki King’ola
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Frances Ampt
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Marleen Temmerman
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Matthew F. Chersich
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lancaster KE, Go VF, Lungu T, Mmodzi P, Hosseinipour MC, Chadwick K, Powers KA, Pence BW, Hoffman IF, Miller WC. Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:124-31. [PMID: 26987607 DOI: 10.1016/j.drugpo.2016.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and cannabis use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. METHODS From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and cannabis use and lack of HIV infection awareness. RESULTS Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current cannabis use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). CONCLUSION Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.
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Affiliation(s)
- Kathryn E Lancaster
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thandie Lungu
- UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi
| | - Pearson Mmodzi
- UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi
| | - Mina C Hosseinipour
- UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Irving F Hoffman
- UNC Project Malawi, University of North Carolina at Chapel Hill, Lilongwe, Malawi; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Grosso AL, Lei EL, Ketende SC, Peitzmeier S, Mason K, Ceesay N, Diouf D, Drame FM, Loum J, Papworth E, Baral S. Correlates of condom use among female sex workers in The Gambia: results of a cross-sectional survey. PeerJ 2015; 3:e1076. [PMID: 26290781 PMCID: PMC4540013 DOI: 10.7717/peerj.1076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 06/13/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives. This study examined correlates of condom use among 248 female sex workers (FSW) in The Gambia. Methods. Between July and August 2011, FSW in The Gambia who were older than 16 years of age, the age of consent in The Gambia, were recruited for the study using venue-based sampling and snowball sampling, beginning with seeds who were established clients with the Network of AIDS Services Organizations. To be eligible, FSW must have reported selling sex for money, favors, or goods in the past 12 months. Bivariate and multivariate logistic regressions were used to determine associations and the relative odds of the independent variables with condom use. Four different condom use dependent variables were used: consistent condom use in the past six months during vaginal or anal sex with all clients and partners; consistent condom use in the past month during vaginal sex with new clients; consistent condom use in the past month during vaginal sex with nonpaying partners (including boyfriends, husbands, or casual sexual partners); and condom use at last vaginal or anal sex with a nonpaying partner. Results. Many FSW (67.34%, n = 167) reported it was not at all difficult to negotiate condom use with clients in all applicable situations, and these FSW were more likely to report consistent condom use with all clients and partners in the past 6 months (aOR 3.47, 95% CI [1.70–7.07]) compared to those perceiving any difficulty in condom negotiation. In addition, FSW were more likely to report using condoms in the past month with new clients (aOR 8.04, 95% CI [2.11–30.65]) and in the past month with nonpaying partners (aOR 2.93, 95% CI [1.09–7.89]) if they had been tested for HIV in the past year. Women who bought all their condoms were less likely than those who received all of their condoms for free (aOR 0.38, 95% CI [0.15–0.97]) to have used a condom at last vaginal or anal sex with a nonpaying partner. Conclusions. HIV and sexually transmitted infection (STI) prevention interventions for FSW should aim to improve condom negotiation self-efficacy since women who report less difficulty negotiating condom use are more likely to use condoms with clients. Interventions should also be aimed at structural issues such as increasing access to free condoms and HIV testing since these were positively associated with condom use among FSW.
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Affiliation(s)
- Ashley L Grosso
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Esther L Lei
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Sosthenes C Ketende
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Sarah Peitzmeier
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | - Krystal Mason
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
| | | | | | - Fatou Maria Drame
- Department of Geography, School of Social Sciences, Gaston Berger University , Saint-Louis , Senegal
| | - Jaegan Loum
- Network of AIDS Service Organizations , Banjul , The Gambia
| | - Erin Papworth
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Dakar , Senegal
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA
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Schwartz SR, Baral S. Fertility-related research needs among women at the margins. REPRODUCTIVE HEALTH MATTERS 2015; 23:30-46. [PMID: 26278831 DOI: 10.1016/j.rhm.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/15/2022] Open
Abstract
Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on post-conception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.
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Affiliation(s)
- Sheree R Schwartz
- Assistant Scientist, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stefan Baral
- Associate Professor, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Reorienting the HIV response in Niger toward sex work interventions: from better evidence to targeted and expanded practice. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S213-20. [PMID: 25723987 DOI: 10.1097/qai.0000000000000456] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Niger's low-burden, sex-work-driven HIV epidemic is situated in a context of high economic and demographic growth. Resource availability of HIV/AIDS has been decreasing recently. In 2007-2012, only 1% of HIV expenditure was for sex work interventions, but an estimated 37% of HIV incidence was directly linked to sex work in 2012. The Government of Niger requested assistance to determine an efficient allocation of its HIV resources and to strengthen HIV programming for sex workers. METHODS Optima, an integrated epidemiologic and optimization tool, was applied using local HIV epidemic, demographic, programmatic, expenditure, and cost data. A mathematical optimization algorithm was used to determine the best resource allocation for minimizing HIV incidence and disability-adjusted life years (DALYs) over 10 years. RESULTS Efficient allocation of the available HIV resources, to minimize incidence and DALYs, would increase expenditure for sex work interventions from 1% to 4%-5%, almost double expenditure for antiretroviral treatment and for the prevention of mother-to-child transmission, and reduce expenditure for HIV programs focusing on the general population. Such an investment could prevent an additional 12% of new infections despite a budget of less than half of the 2012 reference year. Most averted infections would arise from increased funding for sex work interventions. CONCLUSIONS This allocative efficiency analysis makes the case for increased investment in sex work interventions to minimize future HIV incidence and DALYs. Optimal HIV resource allocation combined with improved program implementation could have even greater HIV impact. Technical assistance is being provided to make the money invested in sex work programs work better and help Niger to achieve a cost-effective and sustainable HIV response.
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Abstract
BACKGROUND Despite decades of HIV responses in pockets of West and Central Africa (WCA), the HIV response with key populations remains an understudied area. Recently, there has been a proliferation of studies highlighting epidemiologic and behavioral data that challenge attitudes of complacency among donors and country governments uncomfortable in addressing key populations. METHODS The articles in this series highlight new studies that provide a better understanding of the epidemiologic and structural burden facing key populations in the WCA region and how to improve responses through more effective targeting. RESULTS Key populations face pervasive structural barriers including institutional and sexual violence and an intersection of stigma, criminalization, and marginalization as sexual minorities. Despite decades of smaller interventions that have shown the importance of integrated services for key populations, there remains incongruent provision of outreach or testing or family planning pointing to sustained risk. There remains an incongruent resource provision for key populations where they shoulder the burden of HIV and their access to services alone could turn around HIV epidemics within the region. CONCLUSIONS These proximal and distal determinants must be addressed in regional efforts, led by the community, and resourced for scale, targeting those most at risk for the acquisition and transmission of HIV. This special issue builds the knowledge base for the region focusing on interventions that remove barriers to service access including treatment uptake for those living with HIV. Better analysis and use of data for strategic planning are shown to lead to more effective targeting of prevention, care, and HIV treatment programs with key populations. These articles further demonstrate the immediate need for comprehensive action to address HIV among key populations throughout the WCA region.
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