1
|
Carr C, King LM, Maizel J, Scaglione NM, Stetten NE, Varnes JR, Tomko C. Strategies and Interventions Used to Prevent Violence Against Sex Workers in the United States: A Scoping Review Using the Social-Ecological Model. TRAUMA, VIOLENCE & ABUSE 2024; 25:2436-2451. [PMID: 38054440 DOI: 10.1177/15248380231214786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Structural factors in the United States, such as criminalization, contribute to disproportionate rates of violence against sex workers and subsequent risk of adverse health outcomes. There is a clear need for systemic interventions and risk reduction strategies to reduce violence in this population. To inform next steps in prevention, this scoping review provides an overview of the literature on violence prevention efforts targeting sex workers in the United States, mapped out according to the social-ecological model (SEM). A comprehensive search of peer-reviewed literature across five databases with no limit on publication date yielded 2,372 documents. Studies were eligible for inclusion if they focused on the U.S. population of sex workers and had a clearly defined aim or purpose of exploring, describing, or evaluating sex work violence prevention interventions or risk reduction strategies. Twelve studies met all eligibility criteria and were selected. Only two of the studies evaluated sexual violence prevention interventions, while the remaining 10 explored strategies sex workers use to minimize the risk of violence. Most research focused on female sex workers, violence from paying clients, and prevention at the individual level of the SEM. Our findings suggest a need for additional violence prevention interventions tailored for diverse groups of sex workers and cognizant of the overlapping forms of violence they face. This scoping review contributes to the limited body of research on the prevention of violence against sex workers in the United States by providing future directions for research and program development that span across the SEM.
Collapse
Affiliation(s)
- Cary Carr
- University of Florida, Gainesville, USA
| | | | - Jennifer Maizel
- University of Florida, Gainesville, USA
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | | | | |
Collapse
|
2
|
Ssenyonjo J, Mistler C, Adler T, Shrestha R, Kyambadde P, Copenhaver M. Examining HIV Knowledge and Sexually Risky Behaviors among Female Sex Workers in Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:163. [PMID: 38397654 PMCID: PMC10888220 DOI: 10.3390/ijerph21020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
HIV incidence remains alarmingly high among female sex workers (FSWs) in Uganda, necessitating targeted interventions. This study aimed to identify individual and provider-level barriers and facilitators to primary HIV prevention among FSWs in an urban setting. Focus groups involving FSWs and healthcare providers (HCPs) were conducted to inform the development of tailored prevention interventions. Results revealed that all participants had mobile phones, recent sexual activity, and a history of HIV testing, with high rates of sexually transmitted infections and varying HIV test results. FSWs displayed a well-informed awareness of HIV transmission risks, emphasizing the threat for those not testing positive. They unanimously recognized the crucial role of HIV testing in informing, mitigating risks, promoting ART use, and endorsing consistent condom usage. Despite heightened awareness, HCPs noted potential underestimation of vulnerability. Various challenges, including inadequate condom usage, substance abuse, and client dynamics, underscored the complexity of safeguarding against HIV transmission among FSWs. Widespread alcohol and drug use, including marijuana, kuber, and khat, served as coping mechanisms and social facilitators. Some FSWs successfully reduced alcohol intake, highlighting challenges in addressing substance use. FSWs preferred group discussions in health education programs, emphasizing peer interactions and the effectiveness of visual aids in HIV prevention education. This study provides comprehensive insights to guide the development of targeted interventions addressing the multi-faceted challenges FSWs face in HIV prevention.
Collapse
Affiliation(s)
- Jude Ssenyonjo
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen Mistler
- Division of Prevention and Community Research, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Tanya Adler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Peter Kyambadde
- Most At-Risk Populations Initiative-MARPI, Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| |
Collapse
|
3
|
Nakiganda LJ, Bavinton BR, Poynten IM, Serwadda D, Bazaale JM, Grulich AE. Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda. Sex Health 2024; 21:SH23056. [PMID: 38267368 DOI: 10.1071/sh23056] [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: 03/20/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda. METHODS In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP. RESULTS Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR=1.19, 95% CI=1.07-1.32, P =0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) and being On PrEP for the past 1-2years (aPR=1.18, 95% CI=1.00-1.38, P =0.032) was significantly associated with HIV-related worry (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) Conclusions : We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.
Collapse
Affiliation(s)
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - Isobel Mary Poynten
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda; and Makerere University School of Public Health, Kampala, Uganda
| | | | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Pearce LA, Borschmann R, Young JT, Kinner SA. Advancing cross-sectoral data linkage to understand and address the health impacts of social exclusion: Challenges and potential solutions. Int J Popul Data Sci 2023; 8:2116. [PMID: 37670956 PMCID: PMC10476462 DOI: 10.23889/ijpds.v8i1.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
The use of administrative health data for research, monitoring, and quality improvement has proliferated in recent decades, leading to improvements in health across many disease areas and across the life course. However, not all populations are equally visible in administrative health data, and those that are less visible may be excluded from the benefits of associated research. Socially excluded populations - including the homeless, people with substance dependence, people involved in sex work, migrants or asylum seekers, and people with a history of incarceration - are typically characterised by health inequity. Yet people who experience social exclusion are often invisible within routinely collected administrative health data because information on their markers of social exclusion are not routinely recorded by healthcare providers. These circumstances make it difficult to understand the often complex health needs of socially excluded populations, evaluate and improve the quality of health services that they interact with, provide more accessible and appropriate health services, and develop effective and integrated responses to reduce health inequity. In this commentary we discuss how linking data from multiple sectors with administrative health data, often called cross-sectoral data linkage, is a key method for systematically identifying socially excluded populations in administrative health data and addressing other issues related to data quality and representativeness. We discuss how cross-sectoral data linkage can improve the representation of socially excluded populations in research, monitoring, and quality improvement initiatives, which can in turn inform coordinated responses across multiple sectors of service delivery. Finally, we articulate key challenges and potential solutions for advancing the use of cross-sectoral data linkage to improve the health of socially excluded populations, using international examples.
Collapse
Affiliation(s)
- Lindsay A. Pearce
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Rohan Borschmann
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry; University of Oxford, Oxford, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse T. Young
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stuart A. Kinner
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Yang LS, Nattabi J, Magorokosho N, Ssewamala FM. Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav 2023; 27:969-977. [PMID: 36112259 PMCID: PMC9974574 DOI: 10.1007/s10461-022-03833-z] [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] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
We examined the factors associated with consistent condom use among women engaged in sex work in the Southern parts of Uganda. We used baseline data from a longitudinal study involving WESW from 19 hotspots in Southern Uganda. We conducted hierarchical models to determine the individual, economic, behavioral, and health-related factors associated with consistent condom use. We found that, alcohol use (b=-0.48, 95% CI=-0.77, -0.19), accepting money for condomless sex (b=-0.33, 95% CI=-0.38, -0.28), multiple customers (b=-0.01, 95% CI=-0.01, -0.005), being married (b = 0.50, 95% CI = 0.01, 0.99), owning more assets (b = 0.08, 95% CI = 0.05, 0.13), having another income earner in the household (b = 0.55, 95% CI = 0.27, 0.83), condom use self-efficacy (b = 0.11, 95% CI = 0.03, 0.19), condom use communication (b = 0.06, 95% CI = 0.001, 0.12), and being knowledgeable about HIV/STIs transmission (b = 0.08, 95% CI = 0.01, 0.15) were associated with consistent condom use. Additionally, 29% of the women were consistent condom users. Hence, there is need to implement interventions that promote consistent condom use among WESW.
Collapse
Affiliation(s)
- Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Susan Witte
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Proscovia Nabunnya
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka Office, Kampala, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Larissa Jennings Mayo-Wilson
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall CB7400, 27599, Chapel Hill, NC, USA
| | - Lyla Sunyoung Yang
- Columbia University School of Social Work, 1255 Amsterdam Avenue, 10027, New York, NY, USA
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Washington University in St. Louis Brown School, 1 Brookings Drive, 63130, St. Louis, MO, USA.
| |
Collapse
|
6
|
Nouaman MN, Becquet V, Plazy M, Coffie PA, Zébago C, Montoyo A, Anoma C, Eholié S, Dabis F, Larmarange J. Incidence of HIV infection and associated factors among female sex workers in Côte d’Ivoire, results of the ANRS 12361 PrEP-CI study using recent infection assays. PLoS One 2022; 17:e0271988. [PMCID: PMC9671321 DOI: 10.1371/journal.pone.0271988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to estimate, using an HIV Recent Infection Testing Algorithm (RITA), the HIV incidence and its associated factors among female sex workers (FSW) in Côte d’Ivoire. Methods A cross-sectional study was conducted in 2016–2017 in Abidjan and San Pedro’s region among FSW aged ≥ 18 years. In addition, a sociodemographic questionnaire, HIV screening was carried out by two rapid tests. In the event of a positive result, a dried blood spot sample was taken to determine, using a RITA adapted to the Ivorian context, if it was a recent HIV infection. Results A total of 1000 FSW were surveyed with a median age of 25 years (interquartile range: 21–29 years). 39 (3.9%) tested positive for HIV. The incidence of HIV was estimated to be 2.3 per 100 person-years, with higher incidence rates among those 24 years old or less (3.0% vs. 1.9%), non-Ivorian FSW (3.2% vs. 1.9%) and those with the lowest education level (4.6% in FSW who never went to school vs. 2.6%). The incidence seemed to be associated with the sex work practice conditions: higher incidence among FSW whose usual price was less than 3.50$ (4.3% vs.1.0%), FSW who had a larger number of clients on the last day of work (6.1% in those with 7 clients or more vs. 1.8%), FSW who reported not always using condoms with their clients (8.5% vs. 1.5%) and FSW who reported agreeing to sex without a condom in exchange for a large sum of money (10.1% vs. 1.2%). Conclusion This study confirms that FSW remain highly exposed to HIV infection. Exposure to HIV is also clearly associated with certain sex-work factors and the material conditions of sex work. Efforts in the fight against HIV infection must be intensified to reduce new infections among FSW.
Collapse
Affiliation(s)
- Marcellin N. Nouaman
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Santé Publique et d’odontologie légale, UFR d’Odonto-Stomatologie, Université Félix Houphouet-Boigny, Abidjan, Côte d’Ivoire
- * E-mail:
| | - Valentine Becquet
- Ined, Aubervilliers, France
- Ceped, IRD, Université de Paris, Inserm, Paris, France
| | - Mélanie Plazy
- Bordeaux Population Health Research Center, Université de Bordeaux, Inserm, IRD, Bordeaux, France
| | - Patrick A. Coffie
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouet Boigny, Abidjan, Côte d’Ivoire
| | | | | | | | - Serge Eholié
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouet Boigny, Abidjan, Côte d’Ivoire
| | - François Dabis
- Bordeaux Population Health Research Center, Université de Bordeaux, Inserm, IRD, Bordeaux, France
| | | | | |
Collapse
|
7
|
Kiyingi J, Nabunya P, Bahar OS, Mayo-Wilson LJ, Tozan Y, Nabayinda J, Namuwonge F, Nsubuga E, Kizito S, Nattabi J, Nakabuye F, Kagayi J, Mwebembezi A, Witte SS, Ssewamala FM. Prevalence and predictors of HIV and sexually transmitted infections among vulnerable women engaged in sex work: Findings from the Kyaterekera Project in Southern Uganda. PLoS One 2022; 17:e0273238. [PMID: 36174054 PMCID: PMC9522279 DOI: 10.1371/journal.pone.0273238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/03/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Women engaged in sex work (WESW) have an elevated risk of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Estimates are three times higher than the general population. Understanding the predictors of HIV and STI among WESW is crucial in developing more focused HIV and STI prevention interventions among this population. The study examined the prevalence and predictors of HIV and STI among WESW in the Southern part of Uganda. METHODOLOGY Baseline data from the Kyaterekera study involving 542 WESW (ages 18-55) recruited from 19 HIV hotspots in the greater Masaka region in Uganda was utilized. HIV and STI prevalence was estimated using blood and vaginal fluid samples bioassay. Hierarchical regression models were used to determine the predictors of HIV and STI among WESW. RESULTS Of the total sample, 41% (n = 220) were found to be HIV positive; and 10.5% (n = 57) tested positive for at least one of the three STI (Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis) regardless of their HIV status. Older age (b = 0.09, 95%CI = 0.06, 0.13, p≤0.001), lower levels of education (b = -0.79, 95%CI = -1.46, -0.11, p≤0.05), fewer numbers of children in the household (b = -0.18, 95%CI = -0.36, -0.01), p≤0.05), location (i.e., fishing village (b = 0.51, 95%CI = 0.16, 0.85, p≤0.01) or small town (b = -0.60, 95%CI = -0.92, -0.28, p≤0.001)), drug use (b = 0.58, 95%CI = 0.076, 1.08, p≤0.05) and financial self-efficacy (b = 0.05, 95%CI = -0.10, 0.00, p≤0.05), were associated with the risk of HIV infections among WESW. Domestic violence attitudes (b = -0.24, 95%CI = -0.42, -0.07, p≤0.01) and financial distress (b = -0.07, 95%CI = -0.14, -0.004, p≤0.05) were associated with the risk of STI infection among WESW. CONCLUSION Study findings show a high prevalence of HIV among WESW compared to the general women population. Individual and family level, behavioural and economic factors were associated with increased HIV and STI infection among WESW. Therefore, there is a need for WESW focused HIV and STI risk reduction and economic empowerment interventions to reduce these burdens.
Collapse
Affiliation(s)
- Joshua Kiyingi
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
- Reach the Youth Uganda, Kampala, Uganda
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana, United States of America
| | - Yesim Tozan
- College of Global Public Health, New York University, New York, NY, United States of America
| | - Josephine Nabayinda
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Edward Nsubuga
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Samuel Kizito
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| | - Jennifer Nattabi
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| | - Fatuma Nakabuye
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | | | | | - Susan S. Witte
- School of Social Work, Columbia University, New York, NY, United States of America
| | - Fred M. Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis Brown School, St. Louis, Missouri, United States of America
| |
Collapse
|
8
|
Mbonye M, Siu G, Seeley J. Conflicted masculinities: understanding dilemmas and (re)configurations of masculinity among men in long-term relationships with female sex workers, in Kampala, Uganda. CULTURE, HEALTH & SEXUALITY 2022; 24:856-869. [PMID: 33821770 PMCID: PMC7612843 DOI: 10.1080/13691058.2021.1891569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
This ethnographic study explores the experience of men in long-term relationships with sex workers and their construction of masculine identities in Kampala, Uganda. Data were collected in 2019 and comprise in-depth interviews with 13 male partners and two group discussions of women with long-term male partners. Thematic analysis used an intersectional lens to frame reconfigurations of gender and masculinity in the context of relationships with sex workers. All men had been clients of sex workers before progressing to become long-term partners. We discuss the complex ways in which men participated in value systems of respectability and reputation to (re)configure gender relations that made sense of their long-term relationships with sex workers. Men viewed their relationships with women through the normative lens of traditional masculine roles associated with monopoly over a partner's sexuality, provider and father. However, poverty, HIV, the failure to have exclusive sexual rights over a partner, and the shame associated with sex work intersected and disrupted masculinities. Despite this, men found meaning in these relationships through the woman's commitment to the relationship, her financial support, her help in accessing HIV services, and the children from the relationship, thereby attaining respectability and avoiding a crisis of masculinity.
Collapse
Affiliation(s)
- Martin Mbonye
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Godfrey Siu
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
9
|
Musema GMA, Akilimali PZ, za Balega TKN, Tshala-Katumbay D, Lusamba PSD. Predictive Factors of HIV-1 Drug Resistance and Its Distribution among Female Sex Workers in the Democratic Republic of the Congo (DRC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042021. [PMID: 35206211 PMCID: PMC8872192 DOI: 10.3390/ijerph19042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/27/2023]
Abstract
The predictive factors of HIV-1 drug resistance and its distribution are poorly documented in female sex workers (FSWs) in the Democratic Republic of the Congo (DRC). However, the identification of predictive factors can lead to the development of improved and effective antiretroviral therapy (ART). The objective of the current study was to determine the predictive factors of HIV-1 drug resistance and its distribution based on FSWs in the studied regions in the Democratic Republic of the Congo (DRC). HIV-positive FSWs who were diagnosed as part of the DRC Integrated Biological and Behavioral Surveillance Survey (IBBS) were included in this study. A total of 325 FSWs participated. The HIV-1 viral load (VL) was measured according to the Abbott m2000sp and m2000rt protocols. The homogeneity chi-square test was conducted to determine the homogeneity of HIV-1 drug resistance distribution. Using a significance level of 0.05, multivariate analyses were performed to identify factors associated with HIV-1 drug resistance to ART. HIV drug resistance mutation (HIVDRM) distribution was homogeneous in the three study regions (p = 0.554) but differed based on the HIV-1 VLs of the FSWs. FSWs with high HIV-1 VLs harbored more HIVDRMs (p = 0.028) of predominantly pure HIV-1 strains compared with those that had low HIV-1 VLs. Sexually transmitted infection (STI) history (aOR [95%CI] = 8.51 [1.62, 44.74]), high HIV-1 VLs (aOR [95%CI] = 5.39 [1.09, 26.74]), and HIV-1-syphilis coinfection (aOR [95%CI] = 9.71 [1.84, 51.27]) were associated with HIV drug resistance among FSWs in the DRC. A history of STIs (e.g., abnormal fluid) in the 12 months prior to the survey, a high HIV-1 VL, and HIV-1-syphilis coinfection were associated with HIV-1 drug resistance among FSWs in the DRC. Efforts should be made to systematically test for other infections which increase the HIV-1 VL, in the case of HIV-1 coinfection, in order to maintain ART effectiveness across the DRC.
Collapse
Affiliation(s)
- Godefroid Mulakilwa Ali Musema
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
| | - Pierre Zalagile Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
- Correspondence: ; Tel.: +24-38-1580-0288
| | | | - Désiré Tshala-Katumbay
- Department of Neurology, School of Medicine and School of Public Health, Oregon Health & Science University, Portland, OR 97239, USA;
- Department of Neurology, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
- Institut National de Recherches Biomédicales, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Paul-Samson Dikasa Lusamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
| |
Collapse
|
10
|
Mulholland GE, Markiewicz M, Arimi P, Ssengooba F, Weir S, Edwards JK. HIV Prevalence and the HIV Treatment Cascade Among Female Sex Workers in Cross-Border Areas in East Africa. AIDS Behav 2022; 26:556-568. [PMID: 34379274 DOI: 10.1007/s10461-021-03411-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90-90-90 targets. The 2016-2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing.
Collapse
Affiliation(s)
- Grace E Mulholland
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA.
| | - Milissa Markiewicz
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peter Arimi
- Centre for Research, Innovation and Grants Advancement, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Freddie Ssengooba
- Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC, 27599-7435, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Owachi D, Anguzu G, Kigozi J, Cox J, Castelnuovo B, Semitala F, Meya D. Virologic suppression and associated factors in HIV infected Ugandan female sex workers: a cross-sectional study. Afr Health Sci 2021; 21:603-613. [PMID: 34795713 PMCID: PMC8568220 DOI: 10.4314/ahs.v21i2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Key populations have disproportionately higher HIV prevalence rates than the general population. OBJECTIVE To determine the level of virologic suppression and associated factors in female Commercial Sex Workers (CSW) who completed six months of ART and compare with the female general population (GP). METHODS Clinical records of CSW and GPs who initiated ART between December 2014 to December 2016 from seven urban clinics were analyzed to determine virologic suppression (viral load < 1000 copies/ml) and associated factors. RESULTS We identified 218 CSW and 182 female GPs. CSW had median age of 28 (IQR 25-31) vs 31 (IQR 26-37); median baseline CD4 446 (IQR 308-696) vs 352 (IQR 164-493) cells/microL; and optimal ART adherence levels at 70.6% vs 92.8% respectively, compared to GP. Virologic suppression in CSW and GPs was 85.7% and 89.6% respectively, P=0.28. Overall virologic suppression in CSW was 55% while Retention in care after 6 months of ART was 77.5%. Immediate ART initiation (<2weeks) and tuberculosis independently predicted virologic suppression in CSW with adjusted odds ratios 0.07 (95% C.I. 0.01-0.55, P=0.01) and 0.09 (95% C.I. 0.01-0.96, P=0.046) respectively. CONCLUSION Virologic suppression in both groups is similar, however, intensified follow-up is needed to improve treatment outcomes.
Collapse
|
13
|
Muhindo R, Mujugira A, Castelnuovo B, Sewankambo NK, Parkes-Ratanshi R, Kiguli J, Tumwesigye NM, Nakku-Joloba E. Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda. BMC Health Serv Res 2021; 21:436. [PMID: 33962611 PMCID: PMC8103763 DOI: 10.1186/s12913-021-06461-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/29/2021] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Globally, female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). However, uptake of STI and HIV testing services among FSW in sub-Saharan Africa remains low. We aimed to assess the effect of FSW-led peer education and text message reminders on 3-monthly syphilis and HIV testing among FSW in Uganda. METHODS Between September 2019 and February 2020, we implemented weekly peer education sessions and bi-monthly SMS reminders for FSW in Mbarara (intervention city). Peer education sessions were implemented by 20 FSW, who received five days of basic training as peer educators. We held monthly meetings with peer educators throughout the six-month implementation period. FSW in Mbale (control city) continued to receive standard of care consisting of HIV testing outreach campaigns, and facility-based testing. Using a quasi-experimental design in one intervention city, and one control city, we conducted pre- and post- questionnaire-based surveys on recent syphilis and HIV testing behavior among FSW in July-October 2018, and March 2020. We compared proportions and prevalence ratios at baseline and follow-up using chi-square tests and negative binomial regression. RESULTS We conducted 436 interviews (200 before/236 after) with FSW. At baseline similar proportions reported taking an HIV test (57 % vs. 54 %; p = 0.72), and a syphilis serology test (35 % vs. 39 %; p = 0.67) in the intervention and control cities, respectively, in the prior three months. After the intervention, this proportion increased to 82 % (95 % confidence interval [CI] 74.0-88.2) for HIV, and 81 % (95 % CI: 73.0-87.0) for syphilis in the intervention city. Relative to baseline in the control city, the proportion testing for HIV was unchanged (52 %) but decreased for syphilis (26 %). CONCLUSIONS Bi-monthly text message reminders with weekly peer education sessions increased uptake of 3-monthly syphilis and HIV testing in a Ugandan female sex work population and could help increase sex worker engagement in HIV/STI services in line with World Health Organization recommendations.
Collapse
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, United Kingdom
| | - Juliet Kiguli
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Edith Nakku-Joloba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
14
|
Mbote DK, Nyblade L, Kemunto C, Giger K, Kimani J, Mingkwan P, Njuguna S, Oga E, Kraemer JD. Police Discrimination, Misconduct, and Stigmatization of Female Sex Workers in Kenya: Associations with Delayed and Avoided Health Care Utilization and Lower Consistent Condom Use. Health Hum Rights 2020; 22:199-212. [PMID: 33390707 PMCID: PMC7762893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Discrimination and violence against sex workers by police are common in many populations and are associated with negative health outcomes, as well as being per se violations of human rights laws and norms. There is a close and mutually reinforcing nexus between legally actionable rights violations and stigma, and reducing human rights violations against sex workers likely requires both legal and societal interventions that address both. In this paper, we first aim to estimate levels of discrimination, violence, and stigma against women sex workers by police in Kenya. Second, we aim to estimate the association between manifestations of discrimination and stigma, on the one hand, and general health care utilization and consistent condom use, on the other. Using data from a survey of Kenyan sex workers, we document widespread discrimination and stigma. Through regression analyses, participants with the highest levels of all three categories of manifestations of discrimination and stigma reported significant lower consistent condom use. Those with the highest levels of witnessed/heard manifestations were significantly more likely to delay or avoid needed health care, and the highest level of experienced manifestations were associated with a marginally significant increase in delay or avoidance. Our findings document a plethora of violations of human rights obligations under Kenyan and international law.
Collapse
Affiliation(s)
- David Kuria Mbote
- Independent researcher and Director at the Kuria Foundation for Social Enterprise, Nairobi, Kenya
| | - Laura Nyblade
- Fellow and Senior Technical Advisor, Stigma and Discrimination, RTI International, Washington, DC, USA
| | | | - Kayla Giger
- Public Health Analyst at RTI International, Washington, DC, USA
| | - Joshua Kimani
- Clinical Director at Partners for Health and Development in Africa and Lecturer at the Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Pia Mingkwan
- Research Associate at RTI International, Washington, DC, USA
| | - Stella Njuguna
- Research Officer at the Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Oga
- Senior Epidemiologist at RTI International, Rockville, MD, USA
| | - John D. Kraemer
- Associate Professor in the Department of Health Systems Administration at Georgetown University and Visiting Scholar at RTI International, Washington, DC, USA
| |
Collapse
|
15
|
Missed Study Visits and Subsequent HIV Incidence Among Women in a Predominantly Sex Worker Cohort Attending a Dedicated Clinic Service in Kampala, Uganda. J Acquir Immune Defic Syndr 2020; 82:343-354. [PMID: 31658178 DOI: 10.1097/qai.0000000000002143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is limited evidence on the relationship between sustained exposure of female sex workers (FSWs) to targeted HIV programmes and HIV incidence. We investigate the relationship between the number of missed study visits (MSVs) within each episode of 2 consecutively attended visits (MSVs) and subsequent HIV risk in a predominantly FSW cohort. METHODS Women at high risk of HIV are invited to attend an ongoing dedicated clinic offering a combination HIV prevention intervention in Kampala, Uganda. Study visits are scheduled once every 3 months. The analysis included HIV-seronegative women with ≥1 follow-up visit from enrollment (between April 2008 and May 2017) to August 2017. Cox regression models were fitted adjusted for characteristics on sociodemographic, reproductive, behavioral, and sexually transmitted infections (through clinical examination and serological testing for syphilis). FINDINGS Among 2206 participants, HIV incidence was 3.1/100 (170/5540) person-years [95% confidence interval (CI): 2.6 to 3.5]. Incidence increased from 2.6/100 person-years (95% CI: 2.1 to 3.2) in episodes without a MSV to 3.0/100 (95% CI: 2.2 to 4.1) for 1-2 MSVs and 4.3/100 (95% CI: 3.3 to 5.6) for ≥3 MSVs. Relative to episodes without a MSV, the hazard ratios (adjusted for confounding variables) were 1.40 (95% CI: 0.93 to 2.12) for 1-2 MSVs and 2.00 (95% CI: 1.35 to 2.95) for ≥3 MSVs (P-trend = 0.001). CONCLUSION Missing study visits was associated with increased subsequent HIV risk. Although several factors may underlie this association, the finding suggests effectiveness of targeted combination HIV prevention. But exposure to targeted interventions needs to be monitored, facilitated, and sustained in FSWs.
Collapse
|
16
|
Human Immunodeficiency Virus Incidence Among Women at High-Risk of Human Immunodeficiency Virus Infection Attending a Dedicated Clinic in Kampala, Uganda: 2008-2017. Sex Transm Dis 2020; 46:407-415. [PMID: 31095103 DOI: 10.1097/olq.0000000000000978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High attrition and irregular testing for human immunodeficiency virus (HIV) in cohort studies for high-risk populations can bias incidence estimates. We compare incidence trends for high-risk women attending a dedicated HIV prevention and treatment clinic, using common methods for assigning when seroconversion occurs and whether seroconversion occurs among those with attrition. METHODS Between April 2008 and May 2009, women were enrolled into cohort 1 and from January 2013 into cohort 2, then scheduled for follow-up once every 3 months. Incidence trends based on assuming a midpoint in the seroconversion interval were compared with those of assigning a random-point. We also compared estimates based on the random-point with and without multiple imputation (MI) of serostatuses for participants with attrition. RESULTS By May 2017, 3084 HIV-negative women had been enrolled with 18,364 clinic visits. Before attrition, 27.6% (6990 of 25,354) were missed visits. By August 2017, 65.8% (426 of 647) of those enrolled in cohort 1 and 49.0% (1194 of 2437) in cohort 2 were defined with attrition. Among women with 1 or more follow-up visit, 93 of 605 in cohort 1 and 77 of 1601 in cohort 2 seroconverted. Periods with longer seroconversion intervals appeared to have noticeable differences in incidences when comparing the midpoint and random-point values. The MI for attrition is likely to have overestimated incidence after escalated attrition of participants. Based on random-point without MI for attrition, incidence at end of observation was 3.8/100 person-years in cohort 1 and 1.8/100 in cohort 2. CONCLUSIONS The random-point approach attenuated variation in incidence observed using midpoint. The high incidence after years of ongoing prevention efforts in this vulnerable population should be investigated to further reduce incidence.
Collapse
|
17
|
Magalhães RDLB, Sousa LRM, Gir E, Galvão MTG, Oliveira VMCD, Reis RK. Factors associated to inconsistent condom use among sex workers. Rev Lat Am Enfermagem 2019; 27:e3226. [PMID: 31826167 PMCID: PMC6896796 DOI: 10.1590/1518-8345.2951.3226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/07/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE to analyze the factors associated to the inconsistent condom use among sex workers. METHOD a transversal study, carried out in prostitution area, using the Respondent Drive Sampling. The sample was calculated based on the information by the Sex Workers Association: 600 female sex workers. The study selected seven women with different characteristics regarding color, age, and place of work, who were called seeds. After the participation, they received three coupons to recruit other participants in order to obtain a representative sample. The definition of inconsistent condom use was determined as occasional use or never using it. Univariate analyses and a multivariate logistic regression were performed. RESULTS 416 female sex workers participated in the study. The associated factors were having studied for less than eight years (Odds Ratio = 27.28), not having a permanent partner (Odds Ratio = 2.79), high alcohol use (Odds Ratio = 5.07), and being black (Odds Ratio = 2.21). CONCLUSION the factors associated to inconsistent condom use were: lower education levels, not having a permanent partner, high alcohol use, and being black.
Collapse
Affiliation(s)
| | - Laelson Rochelle Milanês Sousa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Vanessa Moura Carvalho de Oliveira
- Universidade Federal do Piauí, Departamento de Enfermagem, Teresina, PI, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Renata Karina Reis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/OMS Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| |
Collapse
|
18
|
Muhindo R, Castelnuovo B, Mujugira A, Parkes-Ratanshi R, Sewankambo NK, Kiguli J, Tumwesigye NM, Nakku-Joloba E. Psychosocial correlates of regular syphilis and HIV screening practices among female sex workers in Uganda: a cross-sectional survey. AIDS Res Ther 2019; 16:28. [PMID: 31533749 PMCID: PMC6751878 DOI: 10.1186/s12981-019-0244-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Limited data are available regarding correlates of regular sexually transmitted infections (STIs) and HIV screening among female sex workers (FSW) in Sub-Saharan Africa. In this study, we aimed to assess the frequency of regular syphilis and HIV screening and the psychosocial correlates associated with screening among FSW in Uganda. METHODS This cross-sectional correlational study was conducted among 441 FSW, aged 17-49 years. We enrolled FSW through peer referrals and ascertained self-reported data on number of serological tests for HIV, syphilis and other STIs in the prior 12 months using an interviewer-administered questionnaire. In addition, we assessed attitudes, norms, social influences and self-efficacy towards 3-monthly Syphilis and 6-monthly HIV testing. We estimated the correlates of regular STI and HIV testing using negative binomial regression. RESULTS Of the respondents 420 (95.2%) reported to have ever taken an HIV test with 297 (67.4%) testing two or more times in the prior 12 months. Over half of the respondents (59%) reported ever taking a syphilis test with only 62 (14.1%) reporting testing three or more times in the prior 12 months. After adjusting for socio-demographics, attitude and norms, high perceived self-efficacy was associated with a 33% increase in the likelihood of repeated HIV testing [prevalence ratio (PR), 1.33, 95% confidence interval (CI) 1.15-1.53] while low perceived confidence was associated with a 25% decrease in the likelihood of repeated HIV testing (PR, 0.75, 95% CI 0.63-0.89). Similarly low attitudes and norms were associated with a decrease of 52.6% (PR, 0.47, 95% CI 0.37-0.61) and 47% (PR, 0.53, 95% CI 0.41-0.69) in the likelihood of repeated syphilis testing respectively. CONCLUSION Compared to HIV, uptake of repeated syphilis testing was very low. Correlates of HIV testing include; perceived self-efficacy amidst barriers and perceived confidence for HIV and low attitudes and accepting norms for syphilis. Health campaigns should emphasize overcoming barriers to HIV testing while promoting attitudes and norms including integration of serological syphilis testing and other STIs into HIV services.
Collapse
Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Mujugira
- 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
| | - Juliet Kiguli
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Edith Nakku-Joloba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
19
|
Swahn MH, Culbreth R, Salazar LF, Tumwesigye NM, Kasirye R. Psychosocial correlates of self-reported HIV among youth in the slums of Kampala. BMC Public Health 2019; 19:1176. [PMID: 31455348 PMCID: PMC6712737 DOI: 10.1186/s12889-019-7480-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) rates are high in Uganda (6.7%), and rates are especially high among at-risk groups such as youth living in the slums of Kampala, Uganda. The objective of this study was to assess the psychosocial correlates, particularly alcohol use, associated with HIV among youth living in the slums of Kampala, Uganda. Methods Analyses are based on cross-sectional survey data collected in Spring of 2014. Participants comprised a convenience sample (N = 1134) of urban service-seeking youth living on the streets or in the slums, 12–18 years of age who were participating in a Uganda Youth Development Link drop-in center (56.1% female and 43.9% male). Chi-Square Tests were used to determine differences in the proportions of alcohol use patterns between self-reported HIV-positive and HIV-negative youth. Bivariate and multivariable logistic regression were conducted to determine the associated risk factors with self-reported HIV. Institutional Review Board approvals were obtained from the Georgia State University and the Uganda National Council for Science and Technology. Results Among the total sample of youth (N = 1103), 10.5% (n = 116) reported being HIV-positive. There were statistically significant differences between HIV-positive and HIV-negative youth on ever living on the streets (χ2 =10.14, df = 1, p = 0.002), past 12-month alcohol use (χ2 =16.38, df = 1, p < .0001), ever having sexual intercourse (χ2 =14.52, df = 1, p = 0.0001), ever engaging in sex work (χ2 =13.19, df = 1, p = 0.0003), inconsistent condom use in the past 3 months (χ2 =5.03, df = 1, p = 0.03), and ever being raped (χ2 =15.29, df = 1, p < 0.0001). A higher percentage of HIV-positive youth were classified as problem drinkers, defined by the CAGE scores (21.6% vs. 13.9%, respectively). In the multivariable analysis, previously being raped (OR: 1.70; 95% CI: 1.02, 2.83) and alcohol use without problem drinking (OR: 2.14; 95% CI: 1.24, 3.69) was associated with HIV. Conclusion Youth living in the slums of Kampala, Uganda have a high prevalence of HIV. These youth are in dire need of interventions which address both alcohol use behaviors and sexual risk behaviors to reduce further complications of their existing health conditions, including HIV.
Collapse
Affiliation(s)
- Monica H Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA.
| | - Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Laura F Salazar
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302-3984, USA
| | - Nazarius M Tumwesigye
- Department of Epidemology and Biostatistics, School of Public Health, Makerere University, PO Box 7062, Kampala, Uganda
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda
| |
Collapse
|
20
|
Leddy AM, Kerrigan D, Kennedy C, Mbwambo J, Likindikoki S, Underwood C. 'You already drank my beer, I can decide anything': using structuration theory to explore the dynamics of alcohol use, gender-based violence and HIV risk among female sex workers in Tanzania. CULTURE, HEALTH & SEXUALITY 2018; 20:1409-1423. [PMID: 29547070 PMCID: PMC6167187 DOI: 10.1080/13691058.2018.1438667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
Female sex workers experience high rates of gender-based violence and HIV. Alcohol has been shown to facilitate women's risk of both gender-based violence and HIV; however, little research has explored how aspects of the sex work environment shape this risk. Drawing on structuration theory, this study explored how social conduct is patterned across time and space within the sex work environment to influence alcohol consumption, gender-based violence and HIV risk among female sex workers. Qualitative in-depth interviews were conducted with 24 female sex workers enrolled in an ongoing community randomised controlled trial of a combination HIV prevention intervention in Iringa, Tanzania. Data were analysed using both inductive and deductive approaches. Findings reveal how routine interactions between female sex workers and their clients occur at three moments of time and space during the sex exchange process to facilitate alcohol consumption and increase women's risk of gender-based violence and HIV. Findings also highlight how sex workers utilise collective agency to address aspects of the sex work environment that place them at risk of alcohol abuse, gender-based violence and HIV. Implications for future interventions to prevent gender-based violence and HIV among female sex workers in Tanzania and similar contexts are discussed.
Collapse
Affiliation(s)
- Anna M. Leddy
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205 USA
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, United Nations Rd., Dar es Salaam, Tanzania
| | - Carol Underwood
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Mutagoma M, Nyirazinyoye L, Sebuhoro D, Riedel DJ, Ntaganira J. Sexual risk behaviors and practices of female sex workers in Rwanda in over a decade, 2006-2015. Int J STD AIDS 2018; 29:1316-1323. [PMID: 30049257 DOI: 10.1177/0956462418785297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Female sex workers (FSWs) are at high risk for HIV. Cross-sectional surveys using a venue-day-time approach for recruitment were conducted among FSWs in Rwanda in 2006, 2010 and 2015. Chi square test for trends was computed to determine behavior changes. Logistic regression models were computed to determine risk factors associated with consistent condom use for the 2015 survey. There were 1041, 1338, and 1978 FSWs surveyed in 2006, 2010, and 2015, respectively. Condom use at the last sexual encounter with a client was similar in all surveys: 84.2%, 64.1%, and 83.3% (p = 1.0), respectively. Comprehensive HIV knowledge among FSWs was higher in 2015 than in 2006: 18.4%, 53.1%, and 71.1% (p = 0.00), respectively. Living in Kigali City and the Western province (aOR = 1.9 [95% CI: 1.3-2.8] and aOR = 2.0 [95% CI: 1.4-2.9], respectively) and higher level of education (OR = 2.0 [95% CI: 1.4-2.9]) were positively associated with consistent condom use with a client. Street-based FSWs (aOR = 0.7 [95% CI: 0.6-0.9]); FSWs with sex work as sole occupation (aOR = 0.6 [95% CI: 0.5-0.7]); FSWs who experienced sexually transmitted infections in the last year (aOR = 0.7 [95% CI: 0.5-0.8]) and HIV-positive FSWs (aOR = 0.8 [95% CI: 0.6-0.9]) were less likely to report consistent condom use. HIV prevention methods have evolved among FSWs in RWanda over the last decade, but HIV prevalence remains high. Condom use among many FSWs is inconsistent. New approaches for behavior change and income-generating activities are needed to reduce the vulnerability of FSWs in Rwanda.
Collapse
Affiliation(s)
- Mwumvaneza Mutagoma
- 1 Rwanda School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,2 Ministry of Health, Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- 1 Rwanda School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Dieudonné Sebuhoro
- 3 Division (HIV, AIDS, STIs, and OBBI), Rwanda Biomedical Center, Kigali, Rwanda
| | - David J Riedel
- 4 Institute of Human Virology and Division of Infectious Diseases, Baltimore, MD, USA
| | - Joseph Ntaganira
- 1 Rwanda School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
22
|
Erickson M, Goldenberg SM, Master A, Muzaaya G, Akello M, Braschel M, Birungi J, Shannon K. Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda. Women Health 2017; 58:759-773. [PMID: 28682194 DOI: 10.1080/03630242.2017.1342742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011-January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31-5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46-4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20-3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86-5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.
Collapse
Affiliation(s)
- Margaret Erickson
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Shira M Goldenberg
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,b Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia, Canada
| | - Aditi Master
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | | | | | - Melissa Braschel
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | | | - Kate Shannon
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada.,c Faculty of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| |
Collapse
|
23
|
Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting. J Urban Health 2017; 94:563-571. [PMID: 28470544 PMCID: PMC5533660 DOI: 10.1007/s11524-017-0155-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.
Collapse
|
24
|
Wanyenze RK, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, Arinaitwe J, Matovu JKB. "When they know that you are a sex worker, you will be the last person to be treated": Perceptions and experiences of female sex workers in accessing HIV services in Uganda. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:11. [PMID: 28476153 PMCID: PMC5420144 DOI: 10.1186/s12914-017-0119-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022]
Abstract
Background HIV prevalence among female sex workers (FSWs) in high burden countries in sub-Saharan Africa varies between 24 and 72%, however their access to HIV services remains limited. This study explored FSWs’ perspectives of the barriers and opportunities to HIV service access in Uganda. Methods The cross-sectional qualitative study was conducted between October and December 2013. Twenty-four focus group discussions were conducted with 190 FSWs in 12 districts. Data were analysed using manifest content analysis, using Atlas.ti software, based on the socio-ecological model. Results FSWs indicated that HIV services were available and these included condoms, HIV testing and treatment, and management of sexually transmitted infections. However, access to HIV services was affected by several individual, societal, structural, and policy related barriers. Individual level factors included limited awareness of some prevention services, fears, and misconceptions while societal stigma was prominent. Structural and policy level barriers included inconvenient hours of operation of the clinics, inflexible facility based distribution of condoms, interuptions in the supply of condoms and other commodities, and limited package of services with virtually no access to lubricants, HIV pre- and post-exposure prophylaxis, and support following client perpetrated violence. Policies such as partner testing and involvement at antenatal care, and using only one facility for antiretroviral drug refills hindered HIV service uptake and retention in care. FSWs had major concerns with the quality of services especially discrimination and rude remarks from providers, denial or delay of services, and potential for breach of confidentiality. However, some FSWs reported positive experiences including interface with friendly providers and participated in formal and informal FSW groups, which supported them to access health services. Conclusion Despite availability of services, FSWs faced major challenges in access to services. Comprehensive multilevel interventions targeting individual, societal, structural and policy level barriers are required to increase access to HIVservices among FSWs in Uganda. Policy and institutional adjustments should emphasize quality friendly services and expanding the package of services to meet the needs of FSWs.
Collapse
Affiliation(s)
- Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, 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 & Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | - Joseph K B Matovu
- Department of Community Health & Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|