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Dirisu O, Eluwa GIE, Callens S, Adams E, Akinwunmi A, Geibel S, Iyortim I. 'I take the drugs… to make the sickness to move out of me': key populations' and service provider perspectives about facilitators and barriers to ART adherence and retention in care in Nigeria. Arch Public Health 2024; 82:88. [PMID: 38886824 PMCID: PMC11181523 DOI: 10.1186/s13690-024-01282-9] [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: 08/25/2023] [Accepted: 04/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) has individual and public health benefits and is critical to improving life expectancy, achieving viral suppression, and reducing the risk of HIV transmission. This qualitative study explored the experience of receiving care as well as perceived facilitators and barriers of treatment initiation, retention in ART care, and adherence to treatment. METHODS In-depth interviews were conducted among 28 men who have sex with men (MSM) and female sex workers (FSWs) receiving ART services in Lagos and Benue states. Key informant interviews were also conducted among 16 service providers engaged in counselling, clinical care, and ART treatment for MSM and FSWs. The Social Ecology Model guided the exploration of perceived barriers and facilitators of treatment initiation, retention in ART care and adherence to treatment. Qualitative data analysis was managed using NVIVO 11 software and themes were analysed using thematic analysis. RESULTS We found that the key barriers to ART adherence were low motivation to comply with medication regimen, work commitments, socioeconomic factors, stigma, negative provider attitude and distance to health facilities. Facilitators of adherence identified include the desire to live a productive life, strong family support and participation in support group programs. Comprehensive adherence counselling, support group programs and an effective follow-up system were factors identified by service providers as key to facilitating adherence. CONCLUSION To be effective, ART programs must address the unique challenges key populations face in accessing treatment and achieving optimal adherence regarding establishing a strong support system and follow-up. Community level interventions that support a stigma-free environment are critical to sustaining engagement in care.
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Affiliation(s)
- Osasuyi Dirisu
- Policy Innovation Center, Snr Fellow Nigerian Economic Summit Group, Abuja, Nigeria
| | | | - Steve Callens
- Faculty of Medicine and Health Sciences, University of Gent, Ghent, Belgium
| | | | | | | | - Isa Iyortim
- United States Agency for International Development, Abuja, Nigeria
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Buh A, Deonandan R, Gomes J, Krentel A, Oladimeji O, Yaya S. Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0295046. [PMID: 38032918 PMCID: PMC10688728 DOI: 10.1371/journal.pone.0295046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The HIV/AIDS pandemic remains a significant public health issue, with sub-Saharan Africa (SSA) at its epicentre. Although antiretroviral therapy (ART) has been introduced to decrease new infections and deaths, SSA reports the highest incidence of HIV/AIDS, constituting two-thirds of the global new infections. This review aimed to elucidate the predominant barriers and facilitators influencing ART adherence and to identify effective strategies to enhance ART adherence across SSA. METHODS A comprehensive review was conducted on studies examining barriers to ART adherence and interventions to boost adherence among HIV-positive adults aged 15 and above in SSA, published from January 2010 onwards. The research utilized databases like Medline Ovid, CINAHL, Embase, and Scopus. Included were experimental and quasi-experimental studies, randomized and non-randomized controlled trials, comparative before and after studies, and observational studies such as cross-sectional, cohort, prospective and retrospective studies. Two independent reviewers screened the articles, extracted pertinent data, and evaluated the studies' methodological integrity using Joanna Briggs Institute's standardized appraisal tools. The compiled data underwent both meta-analysis and narrative synthesis. RESULTS From an initial pool of 12,538 papers, 45 were selected (30 for narrative synthesis and 15 for meta-analysis). The identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Noteworthy interventions enhancing ART adherence encompassed counselling, incentives, mobile phone short message service (SMS), peer delivered behavioural intervention, community ART delivery intervention, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between the intervention and control groups (pooled OR = 1.56, 95%CI:1.35-1.80, p = <0.01), with evidence of low none statistically significant heterogeneity between studies (I2 = 0%, p = 0.49). CONCLUSION ART adherence in SSA is influenced by seven key factors. Multiple interventions, either standalone or combined, have shown effectiveness in enhancing ART adherence. To optimize ART's impact and mitigate HIV's prevalence in SSA, stakeholders must consider these barriers, facilitators, and interventions when formulating policies or treatment modalities. For sustained positive ART outcomes, future research should target specific underrepresented groups like HIV-infected children, adolescents, and pregnant women in SSA to further delve into the barriers, facilitators and interventions promoting ART adherence.
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Affiliation(s)
- Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Raywat Deonandan
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
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Mavhu W, Makamba M, Hatzold K, Maringwa G, Takaruza A, Mutseta M, Ncube G, Cowan FM, Sibanda EL. Preferences for oral-fluid-based or blood-based HIV self-testing and provider-delivered testing: an observational study among different populations in Zimbabwe. BMC Infect Dis 2023; 22:973. [PMID: 37848810 PMCID: PMC10583299 DOI: 10.1186/s12879-023-08624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations. METHODS At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings. RESULTS May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34-0.93) and those previously married aOR0.56 (0.34-0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28-3.13), 2.55 (1.28-5.07), 2.76 (1.48-5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96-0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47-17.41), 3.38 (2.03-5.62) and 2.23 (1.38-3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09-0.92). CONCLUSIONS Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.
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Affiliation(s)
- Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Memory Makamba
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Galven Maringwa
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | | | | | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Euphemia L Sibanda
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
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Mizinduko M, Moen K, Tersbøl BP, Likindikoki SL, Mwijage AI, Leyna GH, Makyao N, Leshabari MT, Ramadhan A, Meyrowitsch DW, Lange T, Mmbaga EJ. HIV testing and associated factors among female sex workers in Tanzania: approaching the first 90% target? AIDS Care 2023; 35:850-858. [PMID: 34927487 PMCID: PMC9206036 DOI: 10.1080/09540121.2021.2014779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
Use of HIV testing services among FSW in sub-Saharan Africa (SSA) is below the desired UNAIDS target of 90%. We estimated the prevalence and factors associated with HIV testing among FSW in Dar es Salaam, Tanzania. A respondent-driven sampling method was used to recruit FSW aged 18. Modified Poisson regression models were used to determine factors associated with recent HIV testing. Of 958 surveyed FSW (median age 26 years), 85.4% (95% CI: 82.3, 88.1) reported to have ever been tested for HIV and 65.3% (95% CI: 61.2, 69.3) tested in the past 12 months. Condom use on the last day worked (prevalence ratio (PR) = 1.17; 95% CI: 0.99, 1.38), no or low self-perceived risk of HIV acquisition (PR = 1.16; 95% CI: 1.02, 1.32), having never felt stigmatized as a sex worker (PR = 1.18; 95% CI: 1.04, 1.33), and having been in contact with a peer educator (PR = 1.33; 95% CI: 1.18, 1.49) during the past year preceding the survey were associated with recent HIV testing. Interventions aiming to mitigate stigma due to sex work, improve health education to address risk perception as a barrier to HIV testing, and scaling up peer educator's engagement should be given priority.
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Affiliation(s)
- Mucho Mizinduko
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Britt P. Tersbøl
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Samuel L. Likindikoki
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alexander I. Mwijage
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Neema Makyao
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Melkizedeck T. Leshabari
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Angela Ramadhan
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Dan W. Meyrowitsch
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elia J. Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Machingura F, Busza J, Jamali GM, Makamba M, Mushati P, Chiyaka T, Hargreaves J, Hensen B, Birdthistle I, Cowan FM. Facilitators and barriers to engaging with the DREAMS initiative among young women who sell sex aged 18-24 in Zimbabwe: a qualitative study. BMC Womens Health 2023; 23:257. [PMID: 37173783 PMCID: PMC10182710 DOI: 10.1186/s12905-023-02374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Adolescent girls and young women (AGYW) are at high risk of contracting HIV and exchanging sex for financial or material support heightens their risk. In Zimbabwe, the DREAMS initiative integrated education and employment opportunities within HIV health promotion and clinical services for vulnerable young women, including those who sell sex. While most participants accessed health services, fewer than 10% participated in any social programmes. METHODS We conducted semi-structured qualitative interviews with 43 young women aged 18-24 to understand their experiences of engaging with the DREAMS programme. We purposively sampled participants for diversity in level of education, type and location of selling sex. We analysed the data by applying the Theoretical Domains Framework to explore facilitators and barriers to engaging with DREAMS. RESULTS Eligible women were motivated by hopes of escaping poverty, and their longer-term engagement was sustained through exposure to new social networks, including friendships with less vulnerable peers. Barriers included opportunity costs and expenses such as transport or equipment required for job placements. Participants also described pervasive stigma and discrimination related to their involvement in selling sex. Interviews highlighted the young women's struggles in a context of entrenched social and material deprivation and structural discrimination that hindered their ability to take up most of the social services offered. CONCLUSIONS This study demonstrates that while poverty was a key driver of participation in an integrated package of support, it also constrained the ability of highly vulnerable young women to benefit fully from the DREAMS initiative. Multi-layered HIV prevention approaches such as DREAMS that seek to alter complex and longstanding social and economic deprivation address many of the challenges faced by YWSS but will only succeed if the underlying drivers of HIV risk among YWSS are also addressed.
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Affiliation(s)
- Fortunate Machingura
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Gracious Madimutsa Jamali
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Memory Makamba
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
| | - James Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernadette Hensen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frances Mary Cowan
- Centre for Sexual Health and HIV/AIDS Research, (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Busza J, Matambanadzo P, Phiri L, Meki B, Cowan FM. HIV prevention in individuals engaged in sex work. Curr Opin Infect Dis 2023; 36:1-8. [PMID: 36729746 DOI: 10.1097/qco.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW People who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidence-based HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention. RECENT FINDINGS New preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers' access to available services and prevention tools. SUMMARY Meaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bee Meki
- Trans and Intersex Rising Zimbabwe, Zimbabwe
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe
- Department for International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Sensoy Bahar O, Nabunya P, Nabayinda J, Witte S, Kiyingi J, Nsubuga E, Schriger S, Nattabi J, Mayo-Wilson LJ, Nakigudde J, Tozan Y, Ssewamala FM. "I decided in my heart I have to complete the sessions": A qualitative study on the acceptability of an evidence-based HIV risk reduction intervention among women engaged in sex work in Uganda. PLoS One 2023; 18:e0280138. [PMID: 36634037 PMCID: PMC9836279 DOI: 10.1371/journal.pone.0280138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. METHODS We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018-2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. RESULTS The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. DISCUSSION AND CONCLUSIONS Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. CLINICAL TRIAL REGISTRATION NCT03583541.
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Affiliation(s)
- Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- * E-mail:
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Josephine Nabayinda
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Susan Witte
- Columbia University School of Social Work, New York City, NY, United States of America
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Edward Nsubuga
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Simone Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jennifer Nattabi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Janet Nakigudde
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Yesim Tozan
- School of Global Public Health, New York University, New York City, NY, United States of America
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
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Jaffer M, Christofides N, Hlongwane K, Otwombe K, Milovanovic M, Hopkins KL, Matuludi M, Mbowane V, Abdullah F, Gray G, Jewkes R, Coetzee J. The HIV Cascade of Care and Service Utilisation at Sex Work Programmes Among Female Sex Workers in South Africa. AIDS Behav 2022; 26:2907-2919. [PMID: 35247114 PMCID: PMC8897612 DOI: 10.1007/s10461-022-03616-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Female sex workers (FSWs) in South Africa experience a uniquely high prevalence of HIV. We describe the HIV cascade of care (CoC) in FSWs in South Africa, and explored service utilisation at sex work programmes. A cross-sectional, study enrolled FSWs across 12 sites in South Africa. Participants were recruited using chain-referral method. Inclusion criteria: ≥ 18 years, cis-gender female, sold/transacted in sex, HIV positive. 1862 HIV positive FSWs were enrolled. 92% were known positive, 87% were on antiretroviral treatment (ART). Of those on ART, 74% were virally suppressed. Younger FSWs were significantly less likely to be on ART or virally suppressed. Female sex workers using HIV services from specialised programs were 1.4 times more likely to be virally suppressed than non-program users. The pre-COVID-19 pandemic HIV CoC amongst FSWs in South Africa shows striking improvement from previous estimates, and approaches achievement of 90:90:90 goals.
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Affiliation(s)
- Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- African Potential Management Consultancy, Kyalami, South Africa.
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Moyo I, Tshivhase L, Mavhandu-Mudzusi AH. Utilisation of HIV services by female sex workers in Zimbabwe during the COVID-19 pandemic: a descriptive phenomenological study. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:183-193. [PMID: 35901301 DOI: 10.2989/16085906.2022.2101934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers' experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba's trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.
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Affiliation(s)
- Idah Moyo
- Department of HIV Services, Populations Solutions for Health, Harare, Zimbabwe
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Livhuwani Tshivhase
- Department of Nursing Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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10
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Nakiganda LJ, Bavinton BR, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bell S. Social Influences on Engagement With HIV Testing, Treatment and Care Services Among Men Who Have Sex With Men Living in Rural Uganda. QUALITATIVE HEALTH RESEARCH 2022; 32:635-645. [PMID: 34923882 DOI: 10.1177/10497323211058162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Men who have sex with men in Uganda are a heterogenous, discriminated population, experiencing high HIV burden, limited access to HIV testing, and low treatment adherence. We contribute to the lack of information about men who have sex with men in rural Uganda by using socio-ecological analyses to examine the social influences shaping their engagement with HIV services. Based on in-depth interviews with 16 men, our findings reveal the inhibitive influence of interpersonal relationships with sexual partners, peers and families, and institutional influences within health service and non-governmental organizational settings. Yet men take action to strategize and seek support to enhance engagement with HIV care in heavily criminalized and stigmatized settings. Future HIV prevention, testing, treatment, and care responses could draw on what affected individuals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.
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Affiliation(s)
- Lydia J Nakiganda
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- 561068Rakai Health Sciences Program, Kalisizo, Uganda
- 58589Makerere University School of Public Health, Kampala, Uganda
| | | | - Isobel M Poynten
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- School of Public Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Social Research in Health, 7800UNSW Sydney, Sydney, NSW, Australia
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11
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Rock A, Comins C, Mulumba N, Young K, Mcingana M, Guddera V, Hausler H, Phetlhu R, Baral S, Schwartz S. Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success. J Int Assoc Provid AIDS Care 2022; 21:23259582221110820. [PMID: 35786210 PMCID: PMC9263844 DOI: 10.1177/23259582221110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting.
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Affiliation(s)
- Amelia Rock
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly Comins
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | | | | | - Rene Phetlhu
- TB HIV Care, Cape Town, South Africa.,School of Nursing, 108325University of the Western Cape, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study. BMJ Open 2021. [PMCID: PMC8718425 DOI: 10.1136/bmjopen-2021-049248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesHIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.DesignQualitative study.SettingMalawi.ParticipantsThirty-nine FSW who had obtained a HIVST kit and eight peer distributors.ResultsPeer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.ConclusionsThis study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.
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13
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Muhindo R, Mujugira A, Castelnuovo B, Sewankambo NK, Parkes-Ratanshi R, Tumwesigye NM, Nakku-Joloba E, Kiguli J. "I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis": barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda. BMC Public Health 2021; 21:1982. [PMID: 34727898 PMCID: PMC8564957 DOI: 10.1186/s12889-021-12095-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators. Conclusions HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Edith Nakku-Joloba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juliet Kiguli
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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14
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Sherman SG, Tomko C, White RH, Nestadt DF, Silberzahn BE, Clouse E, Haney K, Galai N. Structural and Environmental Influences Increase the Risk of Sexually Transmitted Infection in a Sample of Female Sex Workers. Sex Transm Dis 2021; 48:648-653. [PMID: 33633073 PMCID: PMC8360669 DOI: 10.1097/olq.0000000000001400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Female sex workers (FSWs) have elevated rates of sexually transmitted infections (STIs) including HIV, yet few studies in the United States have characterized the STI burden in this population. METHODS Data were derived from the EMERALD study, a structural community-based intervention with FSWs in Baltimore, MD. Participants (n = 385) were recruited through targeted sampling on a mobile van. Prevalent positive chlamydia or gonorrhea infections were determined by biological samples. Multivariable logistic regressions modeled correlates of confirmed positive STI (gonorrhea or chlamydia). RESULTS Confirmed STI positive prevalence was 28%, 15% chlamydia and 18% gonorrhea. Approximately two-thirds of the sample (64%) was younger than 40 years, one-third (36%) were Black, and 10% entered sex work in the past year. The sample was characterized by high levels of structural vulnerabilities (e.g., housing instability and food insecurity) and illicit substance use. Female sex workers were more likely to have a positive STI if they had financial dependent(s) (P = 0.04), experienced food insecurity at least weekly (P = 0.01), entered sex work in the past year (P = 0.002), and had 6 or more clients in the past week (P = 0.01). Female sex workers were less likely to have a positive STI test result if they were 40 years or older compared with FSW 18 to 29 years old (P = 0.02), and marginally (P = 0.08) less likely with high (vs. low) social cohesion. CONCLUSIONS More than a quarter of FSWs had confirmed chlamydia or gonorrhea. In addition to STI risks at the individual level, STIs are driven by structural vulnerabilities. Results point to a number of salient factors to be targeted in STI prevention among FSWs.
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Affiliation(s)
- Susan G. Sherman
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Tomko
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca Hamilton White
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Danielle Friedman Nestadt
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Emily Clouse
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine Haney
- From the Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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15
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Mnyaka OR, Mabunda SA, Chitha WW, Nomatshila SC, Ntlongweni X. Barriers to the Implementation of the HIV Universal Test and Treat Strategy in Selected Primary Care Facilities in South Africa's Eastern Cape Province. J Prim Care Community Health 2021; 12:21501327211028706. [PMID: 34189991 PMCID: PMC8252362 DOI: 10.1177/21501327211028706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The South African government implemented the Universal Test and Treat (UTT) approach to treating HIV in the second half of 2016. As part of a contribution to the successful implementation of UTT, this study looked at barriers to implementation of UTT emanating from weaknesses of the health system in 2 Community Health Centers in South Africa’s Eastern Cape Province. Methods: This was a quantitative cross-sectional design which had both descriptive and analytical components. Convenience sampling was used to select and recruit 2 primary care facilities and 30 nurses. Self-administered questionnaires were used to solicit data from facility managers and nurses. In addition, a record review was used to access 6 months’ data for the period 1 October 2017 to 31 March 2018. Data were analyzed using Stata 14.1. Categorical data were presented using frequency and contingency tables. The 95% confidence interval (95% CI) is used for the precision of estimates and the P-value of statistical significance is P < .05. Results: Facilities were found to have poor leadership and governance; human resource challenges that include shortages, lack of skills and lack of developmental support; poorly resourced service delivery platforms and poor information management. Of the three 90-90-90 targets, health facilities only satisfactorily achieved the second 90 of initiating all who test positive for HIV within a week (93.1% or n = 288/307). Conclusions: This study has been able to identify potential barriers to the implementation of the UTT strategy at the selected facilities including the lack of structured programs in place to monitor performance of healthcare staff, knowledge gaps, and a lack of good clinical governance practices as evidenced by the lack of customized protocols and Standard Operating Procedures.
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Affiliation(s)
- Onke R Mnyaka
- University of the Witwatersrand, Johannesburg, South Africa
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16
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Moyo I, Macherera M. The experiences of sex workers accessing HIV care services in Bulawayo, Zimbabwe. Afr Health Sci 2021; 21:593-602. [PMID: 34795712 PMCID: PMC8568253 DOI: 10.4314/ahs.v21i2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although sub-Saharan African countries have rolled out massive HIV treatment and care programmes, there is little evidence of these having embraced key population groups particularly female sex workers. Due to the criminalisation of sex work in countries like Zimbabwe, research on HIV and its impact on this group is sparse. The absence of an enabling environment has hindered access to HIV care and treatment services for female sex workers. OBJECTIVES To gain an in-depth understanding of the experiences of female sex workers accessing HIV care and treatment services to enhance programming and planning for this key population group. METHODS This study was qualitative and phenomenological. Data saturation determined the sample size of 20 participants. Data was collected using in-depth interviews that were audio recorded, transcribed, and subjected to thematic content analysis. RESULTS Our findings demonstrate varying dynamics between the private and public sector HIV care services for sex workers, with facilitators and barriers to access to care. CONCLUSION Health workers need sensitization and training in the provision of differentiated care. For effective linkage to and retention in care an enabling environment is critical.
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17
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Lo J, Nwafor SU, Schwitters AM, Mitchell A, Sebastian V, Stafford KA, Ezirim I, Charurat M, McIntyre AF. Key Population Hotspots in Nigeria for Targeted HIV Program Planning: Mapping, Validation, and Reconciliation. JMIR Public Health Surveill 2021; 7:e25623. [PMID: 33616537 PMCID: PMC7939933 DOI: 10.2196/25623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. Objective We aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort. Methods In August 2018, 261 trained data collectors from 36 key population–led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President’s Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population–defining behaviors. Hotspots were visited by data collectors, and each hotspot’s name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots. Results A total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals. Conclusions The number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population–led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.
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Affiliation(s)
- Julia Lo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Samuel U Nwafor
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Abuja, Nigeria
| | - Amee M Schwitters
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Andrew Mitchell
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victor Sebastian
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Kristen A Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.,Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Anne F McIntyre
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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18
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Abstract
BACKGROUND Stigma is considered a major barrier to accessing healthcare services by female sex workers. Current knowledge of nurses' attitudes appears to imply a stigma toward female sex workers. But in-depth understanding of their perceptions is scarce. Furthermore, factors that inform a conceptual understanding of how this occurs are lacking. OBJECTIVES The study aimed to explore nurses' attitudes toward female sex workers and factors affecting caring for female sex workers. RESEARCH DESIGN This was a qualitative study. A content analysis approach was adopted in analyzing the data. PARTICIPANTS AND RESEARCH CONTEXT Thirty-three practicing nurses participated in seven semi-structured focus group interviews and three key informants participated in three individual interviews in Hong Kong. ETHICAL CONSIDERATIONS This study was approved by the Ethics Committee of one university in Hong Kong. FINDINGS The findings revealed three themes: (1) accept, stigmatize, or against sex work; (2) reluctance, hesitation, or willingness to care for female sex workers; and (3) factors affecting the care of female sex workers. DISCUSSION AND CONCLUSION This study found that nurses held different attitudes toward female sex workers, and they experienced feelings of reluctance, hesitation, or willingness to care for female sex workers. Multi-level factors could affect their level of comfort of caring for female sex workers. Intervention should be developed to encourage health professionals to examine their personal views toward female sex workers introspectively, how their attitude may have affected the provision of quality services, and to enhance the provision of sensitive non-discriminative services to female sex workers.
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Affiliation(s)
- Haixia Ma
- 26680The Hong Kong Polytechnic University, Hong Kong
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19
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Busza J, Phillips AN, Mushati P, Chiyaka T, Magutshwa S, Musemburi S, Cowan FM. Understanding early uptake of PrEP by female sex workers in Zimbabwe. AIDS Care 2020; 33:729-735. [PMID: 33043688 DOI: 10.1080/09540121.2020.1832192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Female sex workers (FSW) are prioritised for increased access to pre-exposure prophylaxis (PrEP), although rates of uptake remain sub-optimal, particularly across Southern Africa. In the first two years of its availability in Zimbabwe, 37.1% of FSW in trial sites initiated PrEP and received at least one re-supply. We conducted a qualitative study on perceptions of PrEP among 19 early users selected from sites with varying rates of PrEP initiation. Narrative interviews examined the pathways taken by FSW from hearing about PrEP, through their decision to start taking it, and early experiences. FSW appreciated PrEP's introduction within familiar and trusted "friendly" services tailored for sex workers and valued positive encouragement from clinic staff and peers over negative influence from family members. They also found PrEP difficult to understand at first, and feared side effects and rare adverse complications described in information leaflets. While FSW identified individual strategies for remembering to take their medication, they also relied on structured peer adherence support, leading some FSW to actively promote the method to other FSW as "PrEP champions". Information on how early users experience a new prevention technology such as PrEP can inform design of interventions that leverage existing support structures and target key barriers.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
| | | | | | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe.,Liverpool School of Tropical Medicine, Liverpool, UK
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20
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Olawore O, Astatke H, Lillie T, Persaud N, Lyons C, Kamali D, Wilcher R, Baral S. Peer Recruitment Strategies for Female Sex Workers Not Engaged in HIV Prevention and Treatment Services in Côte d'Ivoire: Program Data Analysis. JMIR Public Health Surveill 2020; 6:e18000. [PMID: 33001039 PMCID: PMC7563635 DOI: 10.2196/18000] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 02/02/2023] Open
Abstract
Background In the context of the mostly generalized HIV epidemic in Côte d’Ivoire, key populations bear a higher burden of HIV than that borne by the general reproductive-aged population. Mathematical models have demonstrated the significant potential impact and cost-effectiveness of improving the coverage of HIV prevention and treatment services for key populations in Côte d’Ivoire. However, in 2019, coverage of these services remained limited by multiple intersecting stigmas affecting key populations, necessitating the study of innovative implementation strategies to better meet the needs of those most marginalized. Here, we leverage programmatic data to compare the effectiveness of the enhanced and traditional peer outreach approaches in reaching and providing community HIV testing to female sex workers not readily engaged in HIV prevention and treatment services in Côte d’Ivoire. Objective The aim of this study was to describe the characteristics of female sex workers reached by the LINKAGES project in Côte d’Ivoire with enhanced peer outreach and traditional peer outreach and to compare HIV-related outcomes between the women reached by both strategies. Methods Deidentified routine programmatic data collected as part of LINKAGES Côte d’Ivoire between October 2017 and April 2018 were used in these analyses. Demographic characteristics and HIV indicators including HIV testing history, HIV case-finding, linkage to HIV treatment, and treatment initiation were assessed using descriptive statistics. Differences in these indicators were compared by outreach strategy using Pearson chi-square tests. Results There were 9761 women reached with enhanced peer outreach and routine peer outreach included in these analyses. The overall case-finding rate in the sample was 7.8% (698/8851). Compared with women reached by routine outreach, those reached by enhanced peer outreach were more likely to have previously been tested for HIV (enhanced: 1695/2509, 67.6%; routine: 4302/7252, 60.0%; χ21=43.8; P=.001). The enhanced peer outreach approach was associated with a higher HIV case-finding rate (enhanced: 269/2507 10.7%; routine: 429/6344, 6.8%; χ21=32.3; P=.001), higher proportion of linkage to treatment (enhanced: 258/269, 95.9%; routine: 306/429, 71.3%; χ21=64.4; P=.001), and higher proportion of treatment initiation (enhanced: 212/269, 78.8%; routine: 315/429, 73.3%; χ21=2.6; P=.11). Women reached by both approaches were categorized as high risk for HIV-related behaviors such as condomless sex and number of sex acts in the previous week. Conclusions These analyses suggest that the novel peer-referral strategy, the enhanced peer outreach approach, was effective in reaching female sex workeres in Côte d’Ivoire with demonstrated acquisition risks for HIV and who had not been effectively engaged by routine outreach approaches. Scaling up novel strategies such as enhanced peer outreach in the context of differentiated service models may be needed to optimize HIV prevention and treatment outcomes for key populations in Côte d’Ivoire.
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Affiliation(s)
- Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
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21
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Lau JYC, Hung C, Lee S. A review of HIV pre-exposure prophylaxis (PrEP) programmes by delivery models in the Asia-Pacific through the healthcare accessibility framework. J Int AIDS Soc 2020; 23:e25531. [PMID: 32603517 PMCID: PMC7326464 DOI: 10.1002/jia2.25531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. The best delivery models and strategies for broadening access of the vulnerable communities are not fully known. This review identified PrEP programmes reported in the Asia-Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework. METHODS We performed a literature search on PubMed and Ovid MEDLINE using relevant search terms, manual searched grey literature by visiting relevant websites, examined reference lists and contacted authors for clarification of included PrEP programmes reported through July 2019. A structured table was used for data extraction and summarizing findings in accordance with the five constructs of approachability, acceptability, availability, affordability and appropriateness grounded in the conceptual framework of Healthcare Accessibility. RESULTS AND DISCUSSION This literature search yielded a total of 1308 publications; 119 full texts and abstracts were screened, and 24 publications were included in the review. We identified 11 programmes implemented in seven cities/countries in the Asia-Pacific. A typology of four PrEP delivery models was delineated: (a) fee-based public service model; (b) fee-based community setting model; (c) free public service model; and (d) free community setting model. Overall, the free community setting model was most commonly adopted in the Asia-Pacific, with the strength to boost the capacity of facility and human resources, which enhanced "approachability", "availability" and "acceptability." The free public service model was characterized by components designed in improving "approachability," "availability" and "appropriateness," with attention on equity in accessing PrEP. Among free-based models, long-term affordability both to the government and PrEP users would need to be maximized to increase accessibility. Alongside the need for raising awareness, supportive environments and ensuring timely access were means for enabling the development of a sustainable PrEP service. CONCLUSION PrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia-Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed.
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Affiliation(s)
- Janice YC Lau
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Chi‐Tim Hung
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Shui‐Shan Lee
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
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Kerrigan D, Sanchez Karver T, Muraleetharan O, Savage V, Mbwambo J, Donastorg Y, Likindikoki S, Perez M, Gomez H, Mantsios A, Murray M, Beckham SW, Davis W, Galai N, Barrington C. "A dream come true": Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania. PLoS One 2020; 15:e0234666. [PMID: 32530939 PMCID: PMC7292359 DOI: 10.1371/journal.pone.0234666] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens. METHODS Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis. RESULTS Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be "likely" or "very likely" to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90-11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05-12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41-6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27-4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00-1.34/DR: AOR 1.07 per year; 95% CI 1.00-1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use. CONCLUSIONS We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.
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Affiliation(s)
- Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ohvia Muraleetharan
- Department of Health Policy, Yale University, New Haven, Connecticut, United States of America
| | - Virginia Savage
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Andrea Mantsios
- Public Health Innovation and Action, New York, New York, United States of America
| | | | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, United States of America
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Mitchell E, Lazuardi E, Anintya I, Rowe E, Whitford K, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor J, Bell S. A Qualitative Exploration of Family, Work, Community, and Health Service Influences on HIV Treatment Uptake and Adherence Among Female Sex Workers in Three Cities in Indonesia. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:243-259. [PMID: 32749879 DOI: 10.1521/aeap.2020.32.3.243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Qualitative data were collected from 34 Indonesian female sex workers to understand their engagement with HIV treatment. Influences that enhanced treatment initiation and adherence included women's desires to stay healthy to continue working to provide for families; awareness of the biomedical benefits of treatment; support from bosses, outreach workers, and peer support groups; and flexible, nonjudgmental HIV service provision. Influences inhibiting treatment initiation and adherence included concerns about unwanted disclosure in the workplace and side effects of medication on women's capacity to earn money through sex work; geographical location of services; discrimination and confidentiality concerns in HIV care services. To improve HIV treatment initiation and adherence among Indonesian female sex workers, future responses should explore health promotion messages that engage with women's family and livelihood obligations; increased funding for community-based peer outreach workers; community-based treatment initiation and supply; and advocacy in work environments to secure support for treatment initiatives.
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Affiliation(s)
| | - Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Irma Anintya
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | | | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen D Prameswari
- HIV AIDS and STI Sub directorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney
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Busza J, Chiyaka T, Musemburi S, Fearon E, Davey C, Chabata S, Mushati P, Dirawo J, Napierala S, Phillips AN, Cowan FM, Hargreaves JR. Enhancing national prevention and treatment services for sex workers in Zimbabwe: a process evaluation of the SAPPH-IRe trial. Health Policy Plan 2020; 34:337-345. [PMID: 31157368 DOI: 10.1093/heapol/czz037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Targeted HIV interventions for female sex workers (FSW) combine biomedical technologies, behavioural change and community mobilization with the aim of empowering FSW and improving prevention and treatment. Understanding how to deliver combined interventions most effectively in sub-Saharan Africa is critical to the HIV response. The Sisters' Antiretroviral Programme for Prevention of HIV: an Integrated Response (SAPPH-Ire) randomized controlled trial in Zimbabwe tested an intervention to improve FSW engagement with HIV services. After 2 years, results of the trial showed no significant difference between study arms in proportion of FSW with HIV viral load ≥1000 copies/ml as steep declines occurred in both. We present the results of a process evaluation aiming to track the intervention's implementation, assess its feasibility and accessibility, and situate trial results within the national HIV policy context. We conducted a mixed methods study using data from routine programme statistics, qualitative interviews with participants and respondent driven surveys. The intervention proved feasible to deliver and was acceptable to FSW and providers. Intervention clinics saw more new FSW (4082 vs 2754), performed over twice as many HIV tests (2606 vs 1151) and nearly double the number of women were diagnosed with HIV (1042 vs 546). Community mobilization meetings in intervention sites also attracted higher numbers. We identified some gaps in programme fidelity: offering pre-exposure prophylaxis took time to engage FSW, viral load monitoring was not performed, and ratio of peer educators to FSW was lower than intended. During the trial, reaching FSW with HIV testing and treatment became a national priority, leading to increasing attendance at both intervention and control clinics. Throughout Zimbabwe, antiretroviral therapy coverage improved and HIV-stigma declined. Zimbabwe's changing HIV policy context appeared to contribute to positive improvements across the HIV care continuum for all FSW over the course of the trial. More intense community-based interventions for FSW may be needed to make further gains.
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Affiliation(s)
- Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Elizabeth Fearon
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Calum Davey
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sungai Chabata
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe
| | - Sue Napierala
- RTI International, 351 California Street, Suite 500, San Francisco, CA, USA
| | - Andrew N Phillips
- Institute for Global Health, UCL, Royal Free Hospital, Rowland Hill Street, London, UK and
| | - Frances M Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) Zimbabwe, 9 Monmouth Road, Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - James R Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Tsang EYH, Qiao S, Wilkinson JS, Fung ALC, Lipeleke F, Li X. Multilayered Stigma and Vulnerabilities for HIV Infection and Transmission: A Qualitative Study on Male Sex Workers in Zimbabwe. Am J Mens Health 2020; 13:1557988318823883. [PMID: 30819062 PMCID: PMC6440054 DOI: 10.1177/1557988318823883] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Male sex workers are marginalized in most societies due to intersectional stigma between prostitution and homosexuality. In Zimbabwe, a proliferation of male sex workers in major cities such as Harare and Bulawayo has been reported. However, there is a shortage of studies that explore their lives. The current qualitative study aims to describe the practices of sex work, life contexts, and HIV risks and vulnerabilities based on in-depth interviews among 15 male sex workers in Bulawayo. Our studies suggest that the stigma against male sex workers comes from diverse sectors including culture (“homosexuality is un-African, introduced by the Whites”), religion (“same sex is a sin before the God”), law and police (“homosexuality is illegal in Zimbabwe. Engaging in it can send one to prison”), media (“the media is hostile to sex workers particularly men as we are regarded as abnormal and unclean”), and their family (“should they get to know about it, they will disown me”). In this context, male sex workers were excluded from national HIV prevention and treatment programs. They had limited knowledge and many misconceptions about HIV. The stigma and discrimination from health-care providers also discouraged them from health seeking or HIV testing. The non-disclosure to female partners of convenience and sexual relations further increased their vulnerabilities to HIV infection and transmission. Current efforts to address the HIV epidemic should pay attention to male sex workers and tackle the intersecting stigma issues. male sex workers need support and tailored HIV prevention and treatment services to improve their HIV prevention practices, health, and well-being.
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Diallo M, Béhanzin L, Guédou FA, Geraldo N, Goma-Matsétsé E, Kania D, Kêkê RK, Bachabi M, Affolabi D, Diabaté S, Gangbo F, Zannou MD, Alary M. HIV treatment response among female sex workers participating in a treatment as prevention demonstration project in Cotonou, Benin. PLoS One 2020; 15:e0227184. [PMID: 31971957 PMCID: PMC6977752 DOI: 10.1371/journal.pone.0227184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/14/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Female sex workers (FSWs) play a key role in HIV transmission in West Africa, while they have limited access to antiretroviral therapy (ART). In line with UNAIDS recommendations extending ART to all HIV-infected individuals, we conducted this demonstration project on immediate treatment as prevention (TasP) among FSWs in Cotonou, Benin. We report data on treatment response and its relation to adherence, as well as on ART-resistant genotypes. METHODS Complete follow-up varied between 12 and 24 months. At each three-monthly visit, a questionnaire was administered, clinical examinations were carried out and blood samples collected. Adherence to treatment was estimated by self-report. Viral RNA was genotyped at baseline and final visits for drug resistance. Generalized estimating equations for repeated measures with a log-binomial link were used to analyze time trends and the association between adherence and virological response to treatment. RESULTS One-hundred-seven HIV-positive and ART-naive FSWs were enrolled; 59.8% remained in the cohort till study completion and 62.6% had a final visit. Viral load<1000 (below quantification limit [<50]) was attained in 73.1% (64.6%) of participants at month-6, 84.8% (71.2%) at month-12, and 80.9% (65.1%) at the final visit. The proportion of women with suppressed (below quantification limit) viral load increased with increasing self-reported adherence (p = 0.06 (0.003), tests for trend). The proportion of participants with CD4≤500 also decreased drastically throughout follow-up (p < .0001). Twelve participants exhibited ART-resistant genotypes at baseline, but only two at their final visit. CONCLUSION Our findings indicate that TasP is widely accepted among FSWs in Cotonou and could be implemented with relative success. However, due to mobility in this population, follow-up was sub-optimal, suggesting that large geographical coverage of FSW-friendly clinics is needed for sustained treatment implementation. We also fell short of the UNAIDS objective of 90% viral suppression among treated patients, underlining the need for better adherence support programs.
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Affiliation(s)
- Mamadou Diallo
- Département de médecine sociale et préventive, Université Laval, Québec
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | - 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
- Ecole Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou, Bénin
| | - Fernand A. 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
| | - Nassirou Geraldo
- Dispensaire IST, Centre de santé communal de Cotonou 1, Cotonou, Bénin
| | | | - Dramane Kania
- National Reference Laboratory of Viral Hemorrhagic Fever Centre MURAZ, Bobo-Dioulasso, Burkina Faso
| | | | - Moussa Bachabi
- Programme Santé de Lutte contre le Sida (PSLS), Cotonou, Bénin
| | - Dissou Affolabi
- Centre national hospitalier universitaire HMK de Cotonou, Bénin
- Faculté des sciences de la santé, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Souleymane Diabaté
- Département de médecine sociale et préventive, Université Laval, Québec
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
- Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Flore Gangbo
- Programme Santé de Lutte contre le Sida (PSLS), Cotonou, Bénin
- Centre national hospitalier universitaire HMK de Cotonou, Bénin
- Faculté des sciences de la santé, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Marcel Djimon Zannou
- Centre national hospitalier universitaire HMK de Cotonou, Bénin
- Faculté des sciences de la santé, Université d’Abomey-Calavi, Cotonou, Bénin
| | - Michel Alary
- Département de médecine sociale et préventive, Université Laval, Québec
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
- * E-mail:
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Krishnaratne S, Bond V, Stangl A, Pliakas T, Mathema H, Lilleston P, Hoddinott G, Bock P, Ayles H, Fidler S, Hargreaves JR. Stigma and Judgment Toward People Living with HIV and Key Population Groups Among Three Cadres of Health Workers in South Africa and Zambia: Analysis of Data from the HPTN 071 (PopART) Trial. AIDS Patient Care STDS 2020; 34:38-50. [PMID: 31944852 DOI: 10.1089/apc.2019.0131] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stigma and judgment by health workers toward people living with HIV (PLHIV) and key populations can undermine the uptake of HIV services. In 2014, we recruited health workers delivering HIV services from 21 urban communities in South Africa and Zambia participating in the first year of the HPTN 071 (PopART) cluster-randomized trial. We analyzed self-reported levels of stigma and judgment toward (1) PLHIV, (2) women who sell sex, (3) men who have sex with men (MSM), and (4) young women who become pregnant before marriage. Using logistic regression, we compared responses between three health worker cadres and explored risk factors for stigmatizing attitudes. Highest levels of stigma and judgment were in relation to women who sell sex and MSM, especially in Zambia. Heath workers did not generally think that clients should be denied services, although this was reported slightly more commonly by community health workers. Higher education levels were associated with lower judgmental beliefs, whereas higher perceptions of coworker stigmatizing behaviors toward PLHIV and each key population were associated with holding judgmental beliefs. Training experience was not associated with judgmental attitudes for any of the key populations. Our findings confirm a high prevalence of judgmental attitudes toward key population groups but lower levels in relation to PLHIV, among all cadres of health workers in both countries. Planning and implementing targeted stigma reduction interventions within health settings are critical to meet the needs of vulnerable populations that face more stigmatizing attitudes from health workers.
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Affiliation(s)
- Shari Krishnaratne
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Bond
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
| | - Anne Stangl
- International Centre for Research on Women, Washington, District of Columbia
| | - Triantafyllos Pliakas
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hlengani Mathema
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Pamela Lilleston
- International Centre for Research on Women, Washington, District of Columbia
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Helen Ayles
- Zambart, The School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - James R. Hargreaves
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nyato D, Nnko S, Komba A, Kuringe E, Plotkin M, Mbita G, Shao A, Changalucha J, Wambura M. Facilitators and barriers to linkage to HIV care and treatment among female sex workers in a community-based HIV prevention intervention in Tanzania: A qualitative study. PLoS One 2019; 14:e0219032. [PMID: 31743336 PMCID: PMC6863533 DOI: 10.1371/journal.pone.0219032] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND HIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa. METHODS We conducted 21 participatory group discussions (PGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania. RESULTS Influences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one's status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks. CONCLUSION Findings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.
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Affiliation(s)
- Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
- * E-mail:
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Albert Komba
- Jhpiego Tanzania - An Affiliate of Johns Hopkins University, Dar-es-Salaam, Tanzania
| | - Evodius Kuringe
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Marya Plotkin
- Jhpiego Tanzania - An Affiliate of Johns Hopkins University, Dar-es-Salaam, Tanzania
| | - Gaspar Mbita
- Jhpiego Tanzania - An Affiliate of Johns Hopkins University, Dar-es-Salaam, Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
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Ma H, Loke AY. A qualitative study into female sex workers' experience of stigma in the health care setting in Hong Kong. Int J Equity Health 2019; 18:175. [PMID: 31727157 PMCID: PMC6857210 DOI: 10.1186/s12939-019-1084-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background Hong Kong has gained a good reputation for its quality public health care services. However, there is a growing recognition that social stigma is a potential obstacle when female sex workers (FSWs) access health care services. There are a lack of studies focusing on how FSWs experience and cope with stigma when accessing health care services in Hong Kong. Objective This study aims to explore how FSWs experience stigma and develop coping strategies when accessing health care services in Hong Kong. Methods This is a qualitative interview study. Staff of non-governmental organizations (NGOs) that serve sex workers in Hong Kong facilitated the process of recruiting the participants. In-depth individual interviews were conducted with 22 FSWs, focusing on their experiences of stigma and coping strategies when accessing health care services. A directed content analysis approach was adopted to analyze the data. Results The interview data can be grouped into three themes: experience of stigma in the health care setting; coping with the stigma of sex work; and the call for non-judgmental holistic health care. Conclusion This study contributes to an understanding of the experience of stigma and stigma coping strategies of FSWs when accessing health care services in Hong Kong. stigma remains an important issue for a large proportion of FSWs when they seek timely professional help, openly disclose their sex work identity, and receive comprehensive health care services. The study also highlights the need to address multiple healthcare needs of FSWs beyond STDs. Moreover, the study contributes to increasing awareness of, and respect for, the human right of FSWs to receive non-discriminatory health services.
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Affiliation(s)
- Haixia Ma
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, GH 525, Hong Kong, China.
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Makhakhe NF, Meyer-Weitz A, Struthers H, McIntyre J. The role of health and advocacy organisations in assisting female sex workers to gain access to health care in South Africa. BMC Health Serv Res 2019; 19:746. [PMID: 31651300 PMCID: PMC6814112 DOI: 10.1186/s12913-019-4552-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, female sex workers (FSWs) are considered a key population group due to the high HIV prevalence. Studies show that there are various factors in some contexts that render FSWs marginalised, which limits their access to sexual reproductive health (SRH) services. Access to SRH services are particularly challenging in countries where sex work is criminalised such as is the case in South Africa. Evidently, there are alternative ways in which FSWs in this context receive non-stigmatising SRH care through non-governmental organisations. The aim of this study was to understand the functioning of these non-governmental health care services as well as to document the experiences of FSWs utilising these services. METHODS Eleven focus group discussions were held with 91 FSWs. In addition, 21 in-depth individual interviews with researchers, stakeholders and FSWs were conducted. Interview guides were utilised for data collection. Informed consent was obtained from all participants. Data were analysed thematically. RESULTS The FSWs expressed challenges related to SRH care access at public health facilities. The majority felt that they could not consult for SRH-related services because of stigma. The non-governmental health and advocacy organisations providing SRH services to FSWs through their mobile facilities utilising the peer approach, have done so in a way that promotes trust between FSWs and mobile health care providers. FSWs have access to tailored services, prevention materials as well as health information. This has resulted in the normalising of HIV testing as well as SRH seeking behaviours. CONCLUSION This study has established that health and advocacy organisations have attempted to fill the gap in responding to SRH care needs of FSWs amidst intersecting vulnerabilities. FSWs' engagement with these organisations has encouraged their willingness to test for HIV. However, it is important to note that these organisations operate in urban areas, thus FSWs operating outside these areas are most likely exposed to compounding health risks and lack access to tailored services.
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Affiliation(s)
- Nosipho Faith Makhakhe
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Howard College Campus, Memorial Tower Building, 238 Mazisi Kunene Road Glenwood, Durban, 4041, South Africa.
| | - Anna Meyer-Weitz
- School of Applied Human Sciences, Department of Psychology, University of KwaZulu-Natal, Howard College Campus, Memorial Tower Building, 238 Mazisi Kunene Road Glenwood, Durban, 4041, South Africa
| | - Helen Struthers
- Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, 2193, South Africa.,Anova Health Institute, Honorary research associate in the Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - James McIntyre
- Anova Health Institute, 12 Sherborne Road, Parktown, Johannesburg, 2193, South Africa.,Anova Health Institute, Honorary professor in the School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Brief Report: Intimate Partner Violence and Antiretroviral Therapy Initiation Among Female Sex Workers Newly Diagnosed With HIV in Zambia: A Prospective Study. J Acquir Immune Defic Syndr 2019; 79:435-439. [PMID: 30142141 PMCID: PMC6203637 DOI: 10.1097/qai.0000000000001841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Intimate partner violence (IPV) is common among female sex workers (FSW) globally. Here, we prospectively assessed the relationship between IPV and engagement in HIV care in a cohort of FSW who had been newly diagnosed with HIV. Methods: Data arose from the Zambian Peer Educators for HIV Self-Testing study, a randomized controlled trial of HIV self-test distribution among FSW in 3 transit towns in Zambia. Participants were self-reported to be HIV-uninfected or unaware of their status at baseline. IPV in the previous 12 months was assessed at baseline. At 4 months, participants were asked the results of their last HIV test and those who reported testing positive were asked whether they had engaged in HIV-related care and started antiretroviral therapy (ART). Results: Of 964 participants, 234 (24.3%) reported that they were living with HIV at 4 months. Of these 234 participants, 142 (60.7%) reported a history of IPV (past 12 months) at baseline and at 4 months, 152 (65.0%) reported that they were in HIV-related care, and 132 (56.7%) reported that they had initiated ART. Participants who reported IPV had significantly reduced odds of engagement in care (adjusted odds ratio = 0.48, 95% confidence interval: 0.26 to 0.91) and ART initiation (adjusted odds ratio = 0.40, 95% confidence interval: 0.22 to 0.72). Conclusions: FSW living with HIV in Zambia reported very high rates of IPV. Structural and individual interventions for violence prevention are urgently needed to better protect this population. Given the strong negative relationship between IPV and engagement in HIV-related care, such interventions could also substantially improve HIV-related health outcomes.
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Ranjan A, Shannon K, Chettiar J, Braschel M, Ti L, Goldenberg S. Barriers and facilitators to hepatitis B vaccination among sex workers in Vancouver, Canada: Implications for integrated HIV, STI, and viral hepatitis services. Int J Infect Dis 2019; 87:170-176. [PMID: 31404673 DOI: 10.1016/j.ijid.2019.07.032] [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] [Received: 03/28/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver. METHODS Questionnaire data were drawn from a community-based cohort of SWs (2010-2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination. RESULTS Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32-0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27- 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14-3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26-2.97) and recent STI testing (AOR 2.95, 95% CI 1.99-4.39) correlated with recent HBV vaccination. CONCLUSIONS Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.
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Affiliation(s)
- Anuisa Ranjan
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jill Chettiar
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - Lianping Ti
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use (BCCSU), Vancouver, British Columbia, Canada
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Global Public Health, University of California, La Jolla, CA, USA
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Nelson EUE, Abikoye GE. Multiple Barriers to Utilization of Drug Abuse Treatment by Female Street Sex Workers in Nigeria. J Psychoactive Drugs 2019; 51:383-390. [DOI: 10.1080/02791072.2019.1605103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Gboyega E. Abikoye
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
- Department of Psychology, University of Uyo, Uyo, Nigeria
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Tibbels NJ, Hendrickson ZM, Naugle DA, Dosso A, Van Lith L, Mallalieu EC, Kouadio AM, Kra W, Kamara D, Dailly-Ajavon P, Cisse A, Seifert-Ahanda K, Thaddeus S, Babalola S, Hoffmann CJ. Men's perceptions of HIV care engagement at the facility- and provider-levels: Experiences in Cote d'Ivoire. PLoS One 2019; 14:e0211385. [PMID: 30897098 PMCID: PMC6428322 DOI: 10.1371/journal.pone.0211385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022] Open
Abstract
Men in sub-Saharan Africa have lower rates of HIV testing and are less likely to initiate treatment compared to women. Service delivery dimensions are a key factor in facilitating engagement along the HIV treatment continuum for men and women, yet male specific overall perceptions of the service delivery environment have received little attention in West Africa. This study draws on qualitative data collected in Côte d’Ivoire to explore provider-level and structural factors affecting men’s engagement in HIV testing and treatment through interviews and focus group discussions conducted with health workers and men living with HIV (some on ART) or whose HIV status was unknown. Factors influencing decisions to test or initiate treatment were considered in terms of perceived benefits and costs. Men described costs at the interpersonal (client-provider) level, such as unwanted disclosure or stigma, which were weighed against the potential for social support and clinical guidance. Likewise, fear of unwanted disclosure operated at the facility level, as the layout of facilities sometimes grouped clients living with HIV together. Notably, the benefits men described from engaging in HIV testing and care all operated at the interpersonal level and none at the facility level. In light of the fact that provider- and facility-level factors influenced the perceptions and experiences of men along the treatment continuum, we offer recommendations to reduce barriers to testing and engagement in care related to service delivery.
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Affiliation(s)
- Natalie Jean Tibbels
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Zoé Mistrale Hendrickson
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Danielle Amani Naugle
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Abdul Dosso
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Lynn Van Lith
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth C. Mallalieu
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anne Marie Kouadio
- Sociology Department, Félix Houphouët-Boigny University in Cocody, Abidjan, Côte d’Ivoire
| | - Walter Kra
- Sociology Department, Alassane Ouattra University, Bouaké, Côte d’Ivoire
| | - Diarra Kamara
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Patricia Dailly-Ajavon
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Adama Cisse
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Abidjan, Côte d’Ivoire
| | - Kim Seifert-Ahanda
- United States Agency for International Development, Washington, D.C., United States of America
| | - Sereen Thaddeus
- United States Agency for International Development, Abidjan, Cote d’Ivoire
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Matovu JKB, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, Arinaitwe J, Wanyenze RK. Health providers' experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda - a qualitative study. BMC Infect Dis 2019; 19:214. [PMID: 30832612 PMCID: PMC6400025 DOI: 10.1186/s12879-019-3713-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Access to HIV services among men who have sex with men (MSM) and female sex workers (FSWs) remains suboptimal globally. While the reasons for this dismal performance have been documented, limited evidence exists on the experiences, perceptions and readiness of health providers to provide HIV services to MSM and FSWs. Methods This analysis uses data collected from 48 key informants (health providers in public and private health facilities) as part of a larger study conducted in 12 districts of Uganda between October and December 2013. Data were collected on health providers’ experiences and readiness to provide HIV services to MSM and FSWs and their perceptions on the effect of existing legislation on HIV services provision to MSM and FSWs. Data were captured verbatim, transcribed and analyzed following a thematic framework approach. Results All health providers reported that they had ever provided HIV services to FSWs and a majority of them were comfortable serving them. However, no health provider had ever served MSM. When asked if they would be willing to serve MSM, nearly three-quarters of the health providers indicated that they would be bound by the call of duty to serve them. However, some health providers reported that they “would feel very uncomfortable” handling MSM because they engage in “a culture imported into our country”. A majority of the health providers felt that they did not have adequate skills to effectively serve MSM and called for specific training to improve their clinical skills. There were mixed reactions as to whether existing criminal laws would affect MSM or FSWs access to HIV services but there was agreement that access to HIV services, under the existing laws, would be more constrained for MSM than FSWs since society “does not blame FSWs [as much as it does] with MSM”. Conclusion A majority of the health providers were generally comfortable serving FSWs but there were strong homophobic tendencies towards MSM. A majority of the health providers lacked skills in how to handle MSM. Interventions aimed at improving health providers’ skills in handling MSM while minimizing the negative attitude towards them are urgently needed. Electronic supplementary material The online version of this article (10.1186/s12879-019-3713-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joseph K B Matovu
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Jim Arinaitwe
- AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Evens E, Lanham M, Santi K, Cooke J, Ridgeway K, Morales G, Parker C, Brennan C, de Bruin M, Desrosiers PC, Diaz X, Drago M, McLean R, Mendizabal M, Davis D, Hershow RB, Dayton R. Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:9. [PMID: 30832664 PMCID: PMC6399914 DOI: 10.1186/s12914-019-0187-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.
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Affiliation(s)
- Emily Evens
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Karin Santi
- United Nations Development Programme, Panama City, Panama
| | - Juana Cooke
- United Nations Development Programme, Panama City, Panama
| | | | | | - Caleb Parker
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | | | - Marjan de Bruin
- University of the West Indies, Mona Campus, Kingston, Jamaica
| | | | - Xenia Diaz
- United Nations Development Programme, San Salvador, El Salvador
| | - Marta Drago
- United Nations Development Programme, San Salvador, El Salvador
| | - Roger McLean
- Centre for Health Economics, The University of the West Indies St. Augustine Campus, St Augustine, Trinidad and Tobago
| | - Modesto Mendizabal
- Asociación Diké de Hombres y Mujeres Transgénero y LGBTI+, San Salvador, El Salvador
| | - Dirk Davis
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
| | - Rebecca B. Hershow
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Robyn Dayton
- FHI 360, 359 Blackwell Street, Durham, NC 27707 USA
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Tomko C, Park JN, Allen ST, Glick J, Galai N, Decker MR, Footer KH, Sherman SG. Awareness and Interest in HIV Pre-Exposure Prophylaxis Among Street-Based Female Sex Workers: Results from a US Context. AIDS Patient Care STDS 2019; 33:49-57. [PMID: 30632769 PMCID: PMC6386071 DOI: 10.1089/apc.2018.0182] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to be an empowering HIV prevention tool among female sex workers (FSW), yet little is known about PrEP awareness and interest in this population. Sex workers and Police Promoting Health in Risky Environments (SAPPHIRE) is a prospective cohort study of street-based FSW in Baltimore, MD. A cross-sectional analysis explored awareness and interest in PrEP among HIV-negative FSW. Multivariable Poisson regressions modeled associations between individual, interpersonal, and structural variables and PrEP awareness and interest. Of n = 232 FSW, 66% were white, half were less than 35 years old, 59% injected drugs daily, and 66% sold sex daily. Only 21% of FSW were aware of PrEP, though 74% were interested. PrEP awareness was associated with experiencing client condom coercion [adjusted incidence rate ratio (aIRR) = 0.50, 95% CI: 0.28-0.90] and condomless sex with an intimate partner (aIRR = 0.54, 95% CI: 0.30-0.98). PrEP interest was associated with perceiving PrEP as "very easy" to take (aIRR = 1.91, 95% CI: 1.49-2.45) and moving to an unfamiliar geographic area to sell sex (aIRR = 1.20, 95% CI: 1.04-1.39). Women who had a current gonorrhea or chlamydia infection were less likely to be interested in PrEP (aIRR = 0.75, 95% CI: 0.59-0.95). Though PrEP awareness among FSW is low, there are FSW who are significantly more likely to express interest in PrEP and outreach efforts should target these women. Results suggest that women-controlled HIV prevention methods may be important for reducing incidence among FSW.
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Affiliation(s)
- Catherine Tomko
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sean T. Allen
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Glick
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michele R. Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine H.A. Footer
- Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. PLoS One 2019; 14:e0210408. [PMID: 30629648 PMCID: PMC6328200 DOI: 10.1371/journal.pone.0210408] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) and long-term uninterrupted engagement in HIV care is difficult for HIV-positive people, and randomized trials of specific techniques to promote adherence often show small or negligible effects. Understanding what influences decision-making in HIV-positive people in Africa may help researchers and policy makers in the development of broader, more effective interventions and policies. METHODS We used thematic synthesis and a grounded theory approach to generate a detailed narrative and theoretical model reflecting life with HIV in Africa, and how this influences ART adherence and engagement decisions. We included qualitative primary studies that explored perspectives, perceptions and experiences of HIV-positive people, caregivers and healthcare service providers. We searched databases from 1 January 2013 to 9 December 2016, screened all studies, and selected those for inclusion using purposeful sampling methods. Included studies were coded with Atlas.ti, and we assessed methodological quality across five domains. RESULTS We included 59 studies from Africa in the synthesis. Nine themes emerged which we grouped under three main headings. First, people who are HIV-positive live in a complicated world where they must navigate the challenges presented by poverty, competing priorities, unpredictable life events, social identity, gender norms, stigma, and medical pluralism-these influences can make initiating and maintaining ART difficult. Second, the health system is generally seen as punishing and uninviting and this can drive HIV-positive people out of care. Third, long-term engagement and adherence requires adaptation and incorporation of ART into daily life, a process which is facilitated by: inherent self-efficacy, social responsibilities, previous HIV-related illnesses and emotional, practical or financial support. These factors together can lead to a "tipping point", a point in time when patients choose to either engage or disengage from care. HIV-positive people may cycle in and out of these care states in response to fluctuations in influences over time. CONCLUSION This analysis provides a practical theory, arising from thematic synthesis of research, to help understand the dynamics of adherence to ART and engagement in HIV care. This can contribute to the design of service delivery approaches, and informed thinking and action on the part of policy makers, providers, and society: to understand what it is to be HIV-positive in Africa and how attitudes and the health service need to shift to help those with HIV lead 'normal' lives.
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Nnko S, Kuringe E, Nyato D, Drake M, Casalini C, Shao A, Komba A, Baral S, Wambura M, Changalucha J. Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review. BMC Public Health 2019; 19:15. [PMID: 30611219 PMCID: PMC6321716 DOI: 10.1186/s12889-018-6362-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs' access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. METHODS A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. RESULTS This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. CONCLUSIONS FSWs' access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.
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Affiliation(s)
- Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Evodius Kuringe
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Mary Drake
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Caterina Casalini
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - Albert Komba
- Sauti Program, Jhpiego Tanzania - an affiliate of Johns Hopkins University, P.O Box 9170, Dar es Salaam, Tanzania
| | - Stefan Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, E7146, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, P.O Box 1462, Mwanza, Tanzania
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Eshun-Wilson I, Rohwer A, Hendricks L, Oliver S, Garner P. Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. PLoS One 2019; 14:e0210408. [PMID: 30629648 PMCID: PMC6328200 DOI: 10.1371/journal.pone.0210408&type=printable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/21/2018] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) and long-term uninterrupted engagement in HIV care is difficult for HIV-positive people, and randomized trials of specific techniques to promote adherence often show small or negligible effects. Understanding what influences decision-making in HIV-positive people in Africa may help researchers and policy makers in the development of broader, more effective interventions and policies. METHODS We used thematic synthesis and a grounded theory approach to generate a detailed narrative and theoretical model reflecting life with HIV in Africa, and how this influences ART adherence and engagement decisions. We included qualitative primary studies that explored perspectives, perceptions and experiences of HIV-positive people, caregivers and healthcare service providers. We searched databases from 1 January 2013 to 9 December 2016, screened all studies, and selected those for inclusion using purposeful sampling methods. Included studies were coded with Atlas.ti, and we assessed methodological quality across five domains. RESULTS We included 59 studies from Africa in the synthesis. Nine themes emerged which we grouped under three main headings. First, people who are HIV-positive live in a complicated world where they must navigate the challenges presented by poverty, competing priorities, unpredictable life events, social identity, gender norms, stigma, and medical pluralism-these influences can make initiating and maintaining ART difficult. Second, the health system is generally seen as punishing and uninviting and this can drive HIV-positive people out of care. Third, long-term engagement and adherence requires adaptation and incorporation of ART into daily life, a process which is facilitated by: inherent self-efficacy, social responsibilities, previous HIV-related illnesses and emotional, practical or financial support. These factors together can lead to a "tipping point", a point in time when patients choose to either engage or disengage from care. HIV-positive people may cycle in and out of these care states in response to fluctuations in influences over time. CONCLUSION This analysis provides a practical theory, arising from thematic synthesis of research, to help understand the dynamics of adherence to ART and engagement in HIV care. This can contribute to the design of service delivery approaches, and informed thinking and action on the part of policy makers, providers, and society: to understand what it is to be HIV-positive in Africa and how attitudes and the health service need to shift to help those with HIV lead 'normal' lives.
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Affiliation(s)
- Ingrid Eshun-Wilson
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Anke Rohwer
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lynn Hendricks
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sandy Oliver
- UCL Institute of Education, University College London, London, United Kingdom
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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"Being seen" at the clinic: Zambian and South African health worker reflections on the relationship between health facility spatial organisation and items and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study. Health Place 2018; 55:87-99. [PMID: 30528346 PMCID: PMC6358039 DOI: 10.1016/j.healthplace.2018.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022]
Abstract
Health workers in 21 government health facilities in Zambia and South Africa linked spatial organisation of HIV services and material items signifying HIV-status (for example, coloured client cards) to the risk of People Living with HIV (PLHIV) ‘being seen’ or identified by others. Demarcated HIV services, distinctive client flow and associated-items were considered especially distinguishing. Strategies to circumvent any resulting stigma mostly involved PLHIV avoiding and/or reducing contact with services and health workers reducing visibility of PLHIV through alterations to structures, items and systems. HIV spatial organisation and item adjustments, enacting PLHIV-friendly policies and wider stigma reduction initiatives could combined reduce risks of identification and enhance the privacy of health facility space and diminish stigma. Spatial dimensions of stigma are linked to accessing HIV treatment in clinics.
Distinct demarcation and client flow trigger visibility of People Living with HIV.
Approaching HIV services carries a social risk of unwanted disclosure for PLHIV.
Thoughtful spatial organisation and labelling reduces the chance of “being seen”.
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Goldenberg SM, Muzaaya G, Akello M, Braschel M, Birungi J, Shannon K. High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda. Int J STD AIDS 2018; 30:275-283. [PMID: 30417750 DOI: 10.1177/0956462418804658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.
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Affiliation(s)
- Shira M Goldenberg
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,2 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | | | - Melissa Braschel
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kate Shannon
- 1 Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,5 Department of Medicine, University of British Columbia, Vancouver, Canada
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Ampt FH, Willenberg L, Agius PA, Chersich M, Luchters S, Lim MSC. Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2018; 8:e021779. [PMID: 30224388 PMCID: PMC6144321 DOI: 10.1136/bmjopen-2018-021779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the incidence of unintended pregnancy among female sex workers (FSWs) in low-income and middle-income countries (LMICs). DESIGN We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity. PARTICIPANTS Eligible studies targeted FSWs aged 15-49 years living or working in an LMIC. OUTCOME MEASURES Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence of pregnancy where intention is undefined. Secondary outcomes were also extracted when they were reported in included studies: incidence of induced abortion; incidence of birth; and correlates/predictors of pregnancy or unintended pregnancy. RESULTS Twenty-five eligible studies were identified from 3866 articles. Methodological quality was low overall. Unintended pregnancy incidence showed high heterogeneity (I²>95%), ranging from 7.2 to 59.6 per 100 person-years across 10 studies. Study design and duration were found to account for heterogeneity. On subgroup analysis, the three cohort studies in which no intervention was introduced had a pooled incidence of 27.1 per 100 person-years (95% CI 24.4 to 29.8; I2=0%). Incidence of pregnancy (intention undefined) was also highly heterogeneous, ranging from 2.0 to 23.4 per 100 person-years (15 studies). CONCLUSIONS Of the many studies examining FSWs' sexual and reproductive health in LMICs, very few measured pregnancy and fewer assessed pregnancy intention. Incidence varied widely, likely due to differences in study design, duration and baseline population risk, but was high in most studies, representing a considerable concern for this key population. Evidence-based approaches that place greater importance on unintended pregnancy prevention need to be incorporated into existing sexual and reproductive health programmes for FSWs. PROSPERO REGISTRATION NUMBER CRD42016029185.
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Affiliation(s)
- Frances H Ampt
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Paul A Agius
- Burnet Institute, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew Chersich
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Universiteit Gent, Ghent, Belgium
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
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Birdthistle I, Schaffnit SB, Kwaro D, Shahmanesh M, Ziraba A, Kabiru CW, Phillips-Howard P, Chimbindi N, Ondeng'e K, Gourlay A, Cowan FM, Hargreaves JR, Hensen B, Chiyaka T, Glynn JR, Floyd S. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health 2018; 18:912. [PMID: 30045711 PMCID: PMC6060450 DOI: 10.1186/s12889-018-5789-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background HIV risk remains unacceptably high among adolescent girls and young women (AGYW) in southern and eastern Africa, reflecting structural and social inequities that drive new infections. In 2015, PEPFAR (the United States President’s Emergency Plan for AIDS Relief) with private-sector partners launched the DREAMS Partnership, an ambitious package of interventions in 10 sub-Saharan African countries. DREAMS aims to reduce HIV incidence by 40% among AGYW over two years by addressing multiple causes of AGYW vulnerability. This protocol outlines an impact evaluation of DREAMS in four settings. Methods To achieve an impact evaluation that is credible and timely, we describe a mix of methods that build on longitudinal data available in existing surveillance sites prior to DREAMS roll-out. In three long-running surveillance sites (in rural and urban Kenya and rural South Africa), the evaluation will measure: (1) population-level changes over time in HIV incidence and socio-economic, behavioural and health outcomes among AGYW and young men (before, during, after DREAMS); and (2) causal pathways linking uptake of DREAMS interventions to ‘mediators’ of change such as empowerment, through to behavioural and health outcomes, using nested cohort studies with samples of ~ 1000–1500 AGYW selected randomly from the general population and followed for two years. In Zimbabwe, where DREAMS includes an offer of pre-exposure HIV prophylaxis (PrEP), cohorts of young women who sell sex will be followed for two years to measure the impact of ‘DREAMS+PrEP’ on HIV incidence among young women at highest risk of HIV. In all four settings, process evaluation and qualitative studies will monitor the delivery and context of DREAMS implementation. The primary evaluation outcome is HIV incidence, and secondary outcomes include indicators of sexual behavior change, and social and biological protection. Discussion DREAMS is, to date, the most ambitious effort to scale-up combinations or ‘packages’ of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication. Electronic supplementary material The online version of this article (10.1186/s12889-018-5789-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Susan B Schaffnit
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,University of California at Santa Barbara, Santa Barbara, USA
| | - Daniel Kwaro
- Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu, 40100, Kenya
| | - Maryam Shahmanesh
- Institute for Global Health, University College of London, Capper St, London, WC1E 6JB, UK.,Africa Health Research Institute, 719 Umbilo Road, Durban, KwaZulu-Natal, 4001, South Africa
| | - Abdhalah Ziraba
- African Population and Health Research Center, Manga Close off Kirawa Road, Nairobi, Kenya
| | - Caroline W Kabiru
- African Population and Health Research Center, Manga Close off Kirawa Road, Nairobi, Kenya
| | - Penelope Phillips-Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Natsayi Chimbindi
- Africa Health Research Institute, 719 Umbilo Road, Durban, KwaZulu-Natal, 4001, South Africa
| | - Kenneth Ondeng'e
- Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu, 40100, Kenya
| | - Annabelle Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, Zimbabwe.,Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 9 Monmouth Road, Avondale West Harare, Zimbabwe
| | - James R Hargreaves
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Bernadette Hensen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 9 Monmouth Road, Avondale West Harare, Zimbabwe
| | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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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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Ndori‐Mharadze T, Fearon E, Busza J, Dirawo J, Musemburi S, Davey C, Acharya X, Mtetwa S, Hargreaves JR, Cowan F. Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015. J Int AIDS Soc 2018; 21 Suppl 5:e25138. [PMID: 30033558 PMCID: PMC6055130 DOI: 10.1002/jia2.25138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION 'Sisters with a Voice', Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation. METHODS We used mixed methods to collect data at three sites: in-depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS-1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education. RESULTS 870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio-demographic differences, we found higher estimates of the proportion of HIV-positive FSWs and HIV-positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV-negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites. CONCLUSIONS Improvements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90-90-90 targets.
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Affiliation(s)
| | - Elizabeth Fearon
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Joanna Busza
- Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Jeffrey Dirawo
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | | | - Calum Davey
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Xeno Acharya
- Epidemiology and Public HealthHarvard TH Chan School of Public HealthBostonMA
| | - Sibongile Mtetwa
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
| | - James R Hargreaves
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Frances Cowan
- Centre for Sexual Health HIV and AIDS Research (CeSHHAR Zimbabwe)HarareZimbabwe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
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Hoddinott G, Myburgh H, de Villiers L, Ndubani R, Mantantana J, Thomas A, Mbewe M, Ayles H, Bock P, Seeley J, Shanaube K, Hargreaves J, Bond V, Reynolds L. Households, fluidity, and HIV service delivery in Zambia and South Africa - an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial. J Int AIDS Soc 2018; 21 Suppl 4:e25135. [PMID: 30027687 PMCID: PMC6053477 DOI: 10.1002/jia2.25135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Population distributions, family and household compositions, and people's sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity. METHODS HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas. RESULTS Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients' transient pressures, and participants' agency in ART-related decisions. CONCLUSIONS Choices made to manage one's experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.
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Affiliation(s)
- Graeme Hoddinott
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Hanlie Myburgh
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Laing de Villiers
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | | | - Jabulile Mantantana
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Angelique Thomas
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | | | - Helen Ayles
- Zambart, School of MedicineLusakaZambia
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Janet Seeley
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - James Hargreaves
- Department of Social and Environmental Health ResearchCentre for EvaluationLondon School of Hygiene and Tropical MedicineLondonUK
| | - Virginia Bond
- Zambart, School of MedicineLusakaZambia
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lindsey Reynolds
- Department of Sociology and Social AnthropologyFaculty of Arts and Social SciencesStellenbosch UniversityStellenboschSouth Africa
- Population Studies and Training CenterBrown UniversityProvidenceRIUSA
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Hakim AJ, MacDonald V, Hladik W, Zhao J, Burnett J, Sabin K, Prybylski D, Garcia Calleja JM. Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response. J Int AIDS Soc 2018; 21 Suppl 5:e25119. [PMID: 30033654 PMCID: PMC6055128 DOI: 10.1002/jia2.25119] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The UNAIDS 90-90-90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)- sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners- and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response. DISCUSSION The emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population-based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high-quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real-time. CONCLUSIONS Data are more important than ever for guiding the HIV response toward reaching 90-90-90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high-quality BBS data can be triangulated with high-quality programme data to provide a comprehensive picture of the epidemic response for KP.
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Affiliation(s)
- Avi Joseph Hakim
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | | | - Wolfgang Hladik
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Jinkou Zhao
- The Global Fund to Fight AIDS, Tuberculosis and MalariaGenevaSwitzerland
| | - Janet Burnett
- Division of HIV/AIDS PreventionUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Keith Sabin
- United Nations Joint Programme for HIV/AIDSGenevaSwitzerland
| | - Dimitri Prybylski
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
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Benoit C, Jansson SM, Smith M, Flagg J. Prostitution Stigma and Its Effect on the Working Conditions, Personal Lives, and Health of Sex Workers. JOURNAL OF SEX RESEARCH 2018; 55:457-471. [PMID: 29148837 DOI: 10.1080/00224499.2017.1393652] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Researchers have shown that stigma is a fundamental determinant of behavior, well-being, and health for many marginalized groups, but sex workers are notably absent from their analyses. This article aims to fill the empirical research gap on sex workers by reviewing the mounting evidence of stigmatization attached to sex workers' occupation, often referred to as "prostitution" or "whore" stigma. We give special attention to its negative effect on the working conditions, personal lives, and health of sex workers. The article first draws attention to the problem of terminology related to the subject area and makes the case for consideration of prostitution stigmatization as a fundamental cause of social inequality. We then examined the sources of prostitution stigma at macro, meso, and micro levels. The third section focuses on tactics sex workers employ to manage, reframe, or resist occupational stigma. We conclude with a call for more comparative studies of stigma related to sex work to contribute to the general stigma literature, as well as social policy and law reform.
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Affiliation(s)
- Cecilia Benoit
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - S Mikael Jansson
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - Michaela Smith
- a Centre for Addictions Research of British Columbia , University of Victoria
| | - Jackson Flagg
- a Centre for Addictions Research of British Columbia , University of Victoria
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Schwartz SR, Kavanagh MM, Sugarman J, Solomon SS, Njindam IM, Rebe K, Quinn TC, Toure-Kane C, Beyrer C, Baral S. HIV viral load monitoring among key populations in low- and middle-income countries: challenges and opportunities. J Int AIDS Soc 2018; 20 Suppl 7. [PMID: 29171178 PMCID: PMC5978693 DOI: 10.1002/jia2.25003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/08/2022] Open
Abstract
Introduction Key populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population‐level, community viral load is a metric of HIV programme effectiveness and can identify “hotspots” of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations. Discussion Viral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes. Conclusions Opportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.
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Affiliation(s)
- Sheree R Schwartz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Matthew M Kavanagh
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.,O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Sunil S Solomon
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Illiassou M Njindam
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kevin Rebe
- Anova Health Institute, Cape Town, South Africa
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Division of Intramural Research, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Coumba Toure-Kane
- Department of Bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA
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