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Ghoma Linguissi LS, Sagna T, Soubeiga ST, Gwom LC, Nkenfou CN, Obiri-Yeboah D, Ouattara AK, Pietra V, Simpore J. Prevention of mother-to-child transmission (PMTCT) of HIV: a review of the achievements and challenges in Burkina-Faso. HIV AIDS (Auckl) 2019; 11:165-177. [PMID: 31440104 PMCID: PMC6664853 DOI: 10.2147/hiv.s204661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Burkina-Faso's HIV/AIDS program is one of the most successful in Africa, with a declining HIV prevalence and treatment outcomes that rival those of developed countries. Prevention of mother-to-child transmission (PMTCT) guidelines in Burkina-Faso, initiated in the year 2000, were revised in 2004, 2006 and 2010. The guideline document has since undergone several stages of improvement, largely based on recommendations from WHO, with adaptations by local experts in the field. Option B+ adopted since August 2014 in Burkina-Faso has enabled maintenance of mothers on longer treatment and increasing their survival and that of their children. Through this review, we describe the achievements and challenges of HIV PMTCT programs in Burkina-Faso. AIMS OF STUDY This study had the following objectives: 1) describing the historical perspective of PMTCT implementation in Burkina-Faso; 2) presenting the effectiveness of interventions at improving PMTCT service delivery and promoting retention of mothers and babies in care; and 3) determining the impact of male partner involvement on PMTCT in Burkina-Faso. METHODOLOGY A literature search was conducted in PubMed and Google. Search terms included the following keywords: "HIV testing"; "prevention"; "mother"; "child"; "male partner"; "counseling"; "involvement"; "participation"; and the grouped terms "PMTCT and partners"; "VCT"; "barriers and/or factors"; "Male involvement in PMTCT"; and "Burkina-Faso". Data collection took place from May to October 2015. The search was limited to articles published between January 2002 and December 2015. UNICEF and UNAIDS web sites were also used to find relevant abstracts and documents. RESULTS Studies have revealed that with PMTCT, HIV transmission rate moved from 10.4% in 2006 to 0% in 2015. The PMTCT program remains the best way to care for HIV-infected pregnant women and their babies. The current PMTCT policy is based on evidence that male partner involvement is associated with women's completion of PMTCT. CONCLUSION This study shows that the reduction in mother to child transmission of HIV in Burkina-Faso over the years is mainly due to the improvement of PMTCT programs. Efforts still need to be made about the involvement of male partners.
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Affiliation(s)
- Laure Stella Ghoma Linguissi
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Institut National de Recherche en Sciences de la Santé (IRSSA), Brazzaville, Republic of Congo
| | - Tani Sagna
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Serge Théophile Soubeiga
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Luc Christian Gwom
- “Chantal Biya” International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Céline Nguefeu Nkenfou
- “Chantal Biya” International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
- Higher Teachers’ Training College, University of Yaoundé I, Yaoundé, Cameroon
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdoul Karim Ouattara
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Virginio Pietra
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
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Long JE, Waruguru G, Yuhas K, Wilson KS, Masese LN, Wanje G, Kinuthia J, Jaoko W, Mandaliya KN, McClelland RS. Prevalence and predictors of unmet contraceptive need in HIV-positive female sex workers in Mombasa, Kenya. PLoS One 2019; 14:e0218291. [PMID: 31216298 PMCID: PMC6583985 DOI: 10.1371/journal.pone.0218291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs. STUDY DESIGN This cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need. RESULTS Among 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8-68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0-1.5), desire for (more) children (PR 1.3, 95%CI 1.1-1.5), and having 2-3 previous pregnancies compared to 0-1 prior pregnancies (PR 0.8, 95%CI 0.6-0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need. CONCLUSIONS Unmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0-1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.
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Affiliation(s)
- Jessica E. Long
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | | | - Krista Yuhas
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kate S. Wilson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Linnet N. Masese
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - George Wanje
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
| | | | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, GPO, Nairobi, Kenya
| | | | - R. Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, GPO, Nairobi, Kenya
- * E-mail:
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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: 22] [Impact Index Per Article: 4.4] [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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Cernigliaro D, Barrington C, Perez M, Donastorg Y, Kerrigan D. Factors related to fertility desire among female sex workers living with HIV in the Dominican Republic. BMC WOMENS HEALTH 2018; 18:117. [PMID: 29970060 PMCID: PMC6029388 DOI: 10.1186/s12905-018-0613-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
Background Female sex workers living with HIV are at increased risk for negative health outcomes and multiple levels of stigma. However, there is limited research on female sex workers living with HIV and even less focused on reproductive health. Methods We analyzed data using logistic regression from a cohort of 247 female sex workers of reproductive age living with HIV in Santo Domingo, Dominican Republic to assess factors associated with fertility desire. Results Most participants had children (93.1%; mean: 2.8; range: 1,8) and 28.3% reported fertility desire. Bivariate regression analysis uncovered that participants who desired children were less likely to report being on antiretroviral treatment and more likely to have a detectable viral load. Multivariate regression results showed participants who desired more children were: less likely to be older, have higher levels of HIV-related internalized stigma, have a history of pregnancy loss, have fewer children and have a perception that their partner has negative feelings about pregnancy. Conclusions Individual and interpersonal characteristics were found to be associated with fertility desire in this study. Additional in-depth research is needed to understand how the role of stigma, partner dynamics and reproductive history as it relates to fertility desire, in order to ensure the reproductive health and wellbeing of this population.
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Affiliation(s)
- Dana Cernigliaro
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Martha Perez
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway HH 257, Baltimore, MD, 21205, USA.
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Wilson KS, Wanje G, Masese L, Simoni JM, Shafi J, Adala L, Overbaugh J, Jaoko W, Richardson BA, McClelland RS. A Prospective Cohort Study of Fertility Desire, Unprotected Sex, and Detectable Viral Load in HIV-Positive Female Sex Workers in Mombasa, Kenya. J Acquir Immune Defic Syndr 2018; 78:276-282. [PMID: 29543635 PMCID: PMC5997523 DOI: 10.1097/qai.0000000000001680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known about fertility desire in HIV-positive female sex workers. Fertility desire could increase HIV transmission risk if it was associated with condomless sex or lower adherence to antiretroviral therapy. METHODS A prospective cohort study was conducted among 255 HIV-positive female sex workers in Mombasa, Kenya. Using generalized estimating equations, fertility desire was evaluated as a risk factor for semen detection in vaginal secretions by prostate-specific antigen (PSA) test, a biomarker of condomless sex, detectable plasma viral load (VL), and HIV transmission potential, defined as visits with positive PSA and detectable VL. RESULTS The effect of fertility desire on PSA detection varied significantly by nonbarrier contraception use (P-interaction < 0.01). At visits when women reported not using nonbarrier contraception, fertility desire was associated with higher risk of semen detection [82/385, 21.3% vs. 158/1007, 15.7%; adjusted relative risk (aRR) 1.58, 95% confidence interval (CI): 1.12 to 2.23]. However, when women used nonbarrier contraception, fertility desire was associated with lower risk of PSA detection (10/77, 13.0% vs. 121/536, 22.6%; aRR 0.58, 95% CI: 0.35 to 0.94). Fertility desire was not associated with detectable VL (31/219, 14.2% vs. 128/776, 16.5%; aRR 0.82, 95% CI: 0.46 to 1.45) or higher absolute risk of transmission potential (10/218, 4.6% vs. 21/769, 2.7%; adjusted risk difference = 0.011, 95% CI -0.031 to 0.050). CONCLUSIONS Fertility desire was associated with higher risk of biological evidence of semen exposure when women were not using nonbarrier contraceptives. Low HIV transmission potential regardless of fertility desire suggests that the combination of condoms and antiretroviral therapy adherence was effective.
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Affiliation(s)
| | | | | | | | | | | | - Julie Overbaugh
- Human Biology and Public Health Sciences Divisions, Fred Hutchison Cancer Research Center, Seattle, WA
| | | | - Barbra A Richardson
- Human Biology and Public Health Sciences Divisions, Fred Hutchison Cancer Research Center, Seattle, WA
| | - Raymond S McClelland
- Medicine
- Epidemiology, University of Washington, Seattle, WA
- University of Nairobi, Nairobi, Kenya
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HIV among Female Sex Workers in Five Cities in Burkina Faso: A Cross-Sectional Baseline Survey to Inform HIV/AIDS Programs. AIDS Res Treat 2017; 2017:9580548. [PMID: 29270318 PMCID: PMC5705869 DOI: 10.1155/2017/9580548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/15/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background Female sex workers (FSWs) are considered a vulnerable population for HIV infection and a priority for HIV/AIDS response programs. This study aimed to determine HIV prevalence among FSWs in five cities in Burkina Faso. Methods FSWs aged 18 and older were recruited using respondent driven sampling (RDS) in five cities (Ouagadougou, Bobo-Dioulasso, Koudougou, Ouahigouya, and Tenkodogo) in Burkina Faso from 2013 to 2014. HIV testing was performed using the HIV testing national algorithm. We conducted bivariate and multivariate logistic regression analysis to assess correlates of HIV in all cities combined (not RDS-adjusted). Results Among Ouagadougou, Koudougou, and Ouahigouya FSWs, RDS-adjusted HIV prevalence was 13.5% (95% Confidence Interval [CI]: 9.6-18.7), 13.3% (95% CI: 7.6-22.4), and 13.0% (95% CI: 7.6-21.3), respectively, compared to 30.1% (95% CI: 25.5-35.1) among Bobo-Dioulasso FSWs. Factors associated with HIV infection were age (adjusted odds ratio [aOR] = 7.84 95% CI: 3.78-16.20), being married or cohabitating (aOR = 2.43, 95% CI: 1.31-4.49), and history of pregnancy (aOR = 5.24, 95% CI: 1.44-18.97). Conclusion These results highlight the need to strengthen HIV prevention among FSWs, through behavior change strategies, and improve access to sexual and reproductive health services.
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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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Lancaster KE, Powers KA, Lungu T, Mmodzi P, Hosseinipour MC, Chadwick K, Go VF, Pence BW, Hoffman IF, Miller WC. The HIV Care Continuum among Female Sex Workers: A Key Population in Lilongwe, Malawi. PLoS One 2016; 11:e0147662. [PMID: 26808043 PMCID: PMC4726447 DOI: 10.1371/journal.pone.0147662] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/06/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The HIV care continuum among female sex workers (FSW), a key population, has not been well characterized, especially within the generalized epidemics of sub-Saharan Africa. This was the first study to characterize the HIV care continuum among FSW in Lilongwe, Malawi. METHODS From July through September 2014, we used venue-based sampling to enroll 200 adult FSW in Lilongwe, Malawi into a cross-sectional evaluation assessing HIV care continuum outcomes. Seropositive FSW, identified using HIV rapid testing, received rapid CD4 counts in addition to viral loads using dried blood spots. We calculated proportions of HIV-infected FSW who had history of care, were on ART, and had suppressed viral load and we used Poisson regression to estimate the associations of demographic characteristics and transmission risk behaviors with each outcome. RESULTS HIV seroprevalence was 69% (n = 138). Among all FSW the median age was 24 years (IQR: 22-28). Among the 20% who were newly diagnosed and reported previously testing negative, the median time since last HIV test was 11 months (interquartile range: 3-17). The majority (69%) of HIV-infected FSW had a history of HIV care, 52% reported current ART use, and 45% were virally suppressed. Of the FSW who reported current ART use, 86% were virally suppressed. Transmission risk behaviors were not associated with continuum outcomes. CONCLUSIONS FSW in Lilongwe were predominately young and have a high HIV prevalence. Only half of HIV-infected FSW reported current ART use, but the majority of those on ART were virally suppressed. To reduce ongoing transmission and improve health outcomes, increased HIV testing, care engagement, and ART coverage is urgently needed among FSW. Universal testing and treatment strategies for all FSW in Malawi must be strongly considered.
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Affiliation(s)
- Kathryn Elizabeth Lancaster
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Kimberly A. Powers
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - 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, North Carolina, United States of America
| | | | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - 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, North Carolina, United States of America
| | - William C. Miller
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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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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An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in Côte d'Ivoire. J Acquir Immune Defic Syndr 2015; 68 Suppl 2:S91-8. [PMID: 25723996 DOI: 10.1097/qai.0000000000000448] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND HIV infection and unintended pregnancy are occupational risks of commercial female sex work (FSW). The burden of unintended pregnancy among FSW including maternal and infant outcomes in the context of HIV is largely unknown. METHODS FSW ≥18 years were recruited through respondent driven sampling into a cross-sectional study in Abidjan, Côte d'Ivoire. Participants completed a sociobehavioral questionnaire and HIV counseling and testing. Pregnancy history by HIV status and contraceptive use were described, and Poisson regression used to estimate correlates of termination of pregnancy (TOP). RESULTS From March to July 2014, 466 FSW were enrolled. Unintended pregnancy was common, and 64% of participants had ≥1 TOP. Half of FSW experiencing TOPs did so without a medical professional, resulting in frequent complications. Contraceptive use was lowest among younger FSW, and 37% of 20-24 year olds reported multiple TOPs. FSW with a TOP history reported 19% less consistent condom use with clients than women who never had a TOP (adjusted-prevalence ratio, 0.81; 95% confidence interval: 0.74 to 0.88), whereas use of reliable nonbarrier contraceptive methods was comparable between the groups. Although FSW were engaged in HIV testing and prevention services, only 59% of FSW had received HIV testing before childbirth during their last pregnancy, and 30% of HIV-infected FSW had lost ≥1 children. CONCLUSIONS Low contraceptive use and high burden of unintended pregnancy result in poor reproductive outcomes for FSW and avoidable mother-to-child HIV transmission risks. Integration of family planning and antenatal services into HIV prevention and care programs accessed by FSW could enhance reproductive outcomes and HIV prevention goals.
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