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Dulai J, Hassan A, Stewart M, Ryu H, Anand P, Worthington C, Gilbert M, Grace D. Perspectives on digital testing services for sexually transmitted and blood-borne infections from Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour living in Ontario, Canada. ETHNICITY & HEALTH 2024; 29:533-552. [PMID: 38576062 DOI: 10.1080/13557858.2024.2337623] [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: 07/05/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Increased sexually transmitted and blood-borne infections (STBBI) testing can reduce the burden of disease among Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour (2SGBTQ+ BIPOC). However, this population encounters barriers, such as discrimination, when accessing in-person STBBI testing services. Digital STBBI testing, such as self-testing/collection kits ordered online and digital requisitions, may address some of these barriers. Our aim was to understand acceptability of free digital STBBI testing among 2SGBTQ+ BIPOC living in Ontario, Canada. DESIGN We approached this analysis using Implementation Science and Critical Race Theory. We conducted interviews and focus groups with 21 2SGBTQ + BIPOC individuals from 2020-2021. Participants were asked about their perceptions of the benefits and drawbacks of digital STBBI testing, populations that would benefit from using these services, and recommendations for how these services may be implemented in Ontario. Interviews and focus groups were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS Six themes emerged. Digital STBBI testing services: (1) May reduce oppression experienced by 2SGBTQ + BIPOC when testing in-person; (2) Should address the unique needs that 2SGBTQ + BIPOC experience due to other intersecting identities they possess; (3) Should adapt their services to suit the varying cultural contexts and living circumstances of 2SGBTQ + BIPOC; (4) Should be accessible to 2SGBTQ + BIPOC who hold diverse or no documentation; (5) Should be offered in multiple languages; (6) May be inaccessible to those without Internet access or devices. CONCLUSION Digital STBBI testing is one strategy that may reduce discrimination experienced by 2SGBTQ + BIPOC when getting tested in-person. However, digital STBBI testing services may not address all the needs of 2SGBTQ + BIPOC. Racism and other forms of oppression embedded into in-person and digital testing services will need to be addressed to meet the needs of this diverse population.
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Affiliation(s)
- Joshun Dulai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Abdi Hassan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - MacKenzie Stewart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Heeho Ryu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Praney Anand
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Alliance for South Asian AIDS Prevention, Toronto, Canada
| | | | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Kislovskiy Y, Erpenbeck S, Martina J, Judkins C, Miller E, Chang JC. HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study. BMC Public Health 2022; 22:1844. [PMID: 36183063 PMCID: PMC9526910 DOI: 10.1186/s12889-022-14235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background People who exchange sex for money, favors, goods or services, combat higher risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Understanding barriers to STD and HIV related healthcare from the perspective of this stigmatized and marginalized community may improve access to sexual health services including pre-exposure prophylaxis (PrEP). Methods We used community-partnered participatory and qualitative methods to conduct anonymous one-on-one interviews with people who exchange sex to understand their perspectives and experiences related to pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We conducted twenty-two interviews and coded them to perform thematic analysis. Results We identified five themes: (1) Appreciation of HIV risk and prevention strategies grew from information accumulated over time. (2) PrEP information came from a variety of sources with mixed messages and uncertain credibility. (3) Decision-making about use of PrEP was relative to other behavioral decisions regarding exchange sex. (4) The multi-step process of obtaining PrEP presented multiple potential barriers. (5) Healthcare providers were seen as powerful facilitators to PrEP utilization. Conclusions Our findings suggest that PrEP education and care needs to be made more relevant and accessible to individuals who exchange sex. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14235-0.
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Affiliation(s)
- Yasaswi Kislovskiy
- Department of OB/GYN and Women's Institute, Drexel University College of Medicine, Allegheny Health Network, 4800 Friendship Ave, Pittsburgh Pennsylvania, PA, USA. .,Magee-Womens Research Institute (MWRI), Pittsburgh, PA, USA.
| | - Sarah Erpenbeck
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Martina
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Courtney Judkins
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Judy C Chang
- Magee-Womens Research Institute (MWRI), Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Cowan FM, Chabata ST, Musemburi S, Fearon E, Davey C, Ndori-Mharadze T, Bansi-Matharu L, Cambiano V, Steen R, Busza J, Yekeye R, Mugurungi O, Hargreaves JR, Phillips AN. Strengthening the scale-up and uptake of effective interventions for sex workers for population impact in Zimbabwe. J Int AIDS Soc 2020; 22 Suppl 4:e25320. [PMID: 31328445 PMCID: PMC6643097 DOI: 10.1002/jia2.25320] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction UNAIDS’ goal of ending AIDS by 2030 is unreachable without better targeting of testing, prevention and care. Female sex workers (FSW) in Zimbabwe are at high risk of HIV acquisition and transmission. Here, we report on collated programme and research data from Zimbabwe's national sex work programme. We also assess the potential for wider population impact of FSW programmes by modelling the impact on HIV incidence of eliminating transmission through FSW (i.e. calculate the population attributable fraction of incidence attributable to sex work). Methods Descriptive analyses of individual‐level programme data collected from FSW between 2009 and June 2018 are triangulated with data collected through 37 respondent driven sampling surveys from 19 sites in Zimbabwe 2011 to 2017. We describe programme coverage, uptake, retention and patterns of sex work behaviour and gaps in service provision. An individual‐level stochastic simulation model is used to reconstruct the epidemic and then the incidence compared with the counter‐factual trend in incidence from 2010 had transmission through sex work been eliminated from that date. Results Sisters has reached >67,000 FSW since 2009, increasing attendance as number of sites, programme staff and peer educators were increased. Over 57% of all FSW estimated to be working in Zimbabwe in 2017 (n = 40,000) attended the programme at least once. The proportion of young FSW reached has increased with introduction of the “Young Sisters programme.” There are no clear differences in pattern of sex work across settings. Almost all women report condom use with clients at last sex (95%); however, consistent condom use with clients in the last month varies from 52% to 95% by site. Knowledge of HIV‐positive status has increased from 48 to 78% between 2011 and 2016, as has prevalence of ART use among diagnosed women (29 to 67%). Although subject to uncertainty, modelling suggests that 70% (90% range: 32%, 93%) of all new infections in Zimbabwe from 2010 are directly or indirectly attributable to transmission via sex work. Conclusions It is feasible to increase coverage and impact of sex work programming through community‐led scale‐up of evidence‐based interventions. Eliminating transmission through commercial sex would likely have a substantial impact on new infections occurring more widely across Zimbabwe.
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Affiliation(s)
- Frances M Cowan
- Department of International Public Health, Liverpool School of Medicine, Liverpool, United Kingdom.,Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Sungai T Chabata
- Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Sithembile Musemburi
- Centre for Sexual Health and HIV AIDS Research (CSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Fearon
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Calum Davey
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Valentina Cambiano
- Institute for Global Health, University College London, London, United Kingdom
| | - Richard Steen
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands
| | - Joanna Busza
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Owen Mugurungi
- AIDS and TB Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | - James R Hargreaves
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew N Phillips
- Institute for Global Health, University College London, London, United Kingdom
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Sex Worker Community-led Interventions Interrupt Sexually Transmitted Infection/Human Immunodeficiency Virus Transmission and Improve Human Immunodeficiency Virus Cascade Outcomes: A Program Review from South India. Sex Transm Dis 2020; 46:556-562. [PMID: 31295225 PMCID: PMC6629169 DOI: 10.1097/olq.0000000000001020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A review of a community-led sex worker program in 2 districts of South India that has achieved near elimination of curable sexually transmitted infections and optimal human immunodeficiency virus cascade outcomes. Supplemental digital content is available in the text. Ashodaya Samithi, an organization run by and for female, male, and transgender sex workers in Mysore, India, has worked since 2004 to prevent sexually transmitted infection (STI)/human immunodeficiency virus (HIV) transmission and improve HIV cascade outcomes. We reviewed published and programmatic data, including measures of coverage, uptake, utilization and retention, and relate STI/HIV outcomes to evolving phases of community mobilization. Early interventions designed “for” sex workers mapped areas of sex work and reached half the sex workers in Mysore with condoms and STI services. By late 2005, when Ashodaya Samithi registered as a community-based organization, interventions were implemented “with” sex workers as active partners. Microplanning was introduced to enable peer educators to better organize and monitor their outreach work to reach full coverage. By 2008, programs were run “by” sex workers, with active community decision making. Program data show complete coverage of community outreach and greater than 90% clinic attendance for quarterly checkups by 2010. Reported condom use with last occasional client increased from 65% to 90%. Surveys documented halving of HIV and syphilis prevalence between 2004 and 2009, while gonorrhoea declined by 80%. Between 2005 and 2013, clinic checkups tripled, whereas the number of STIs requiring treatment declined by 99%. New HIV infections also declined, and Ashodaya achieved strong cascade outcomes for HIV testing, antiretroviral treatment linkage, and retention. Program performance dropped markedly during several periods of interrupted funding, then rebounded when restored. Ashodaya appear to have achieved rapid STI/HIV control with community-led approaches including microplanning. Available data support near elimination of curable STIs and optimal cascade outcomes.
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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.
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Bhattacharjee P, Musyoki HK, Becker M, Musimbi J, Kaosa S, Kioko J, Mishra S, Isac SK, Moses S, Blanchard JF. HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya. J Int AIDS Soc 2019; 22 Suppl 4:e25311. [PMID: 31328436 PMCID: PMC6643069 DOI: 10.1002/jia2.25311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/10/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya. METHODS Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub-national and implementing partner level cascades. RESULTS At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy-nine per cent of the HIV-positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub-national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub-population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level. CONCLUSIONS HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision-making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- Partners for Health and Development in AfricaNairobiKenya
| | - Helgar K Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Marissa Becker
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - Janet Musimbi
- Partners for Health and Development in AfricaNairobiKenya
| | - Shem Kaosa
- Partners for Health and Development in AfricaNairobiKenya
| | - Japheth Kioko
- Partners for Health and Development in AfricaNairobiKenya
| | - Sharmistha Mishra
- Department of MedicineSt. Michael's HospitalUniversity of TorontoTorontoOntarioCanada
- Institute of Medical SciencesUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Shajy K Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
- Karnataka Health Promotion TrustBangaloreKarnatakaIndia
| | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
| | - James F Blanchard
- Centre for Global Public HealthUniversity of ManitobaWinnipegManitobaCanada
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Emmanuel F, Persaud N, Weir SS, Bhattacharjee P, Isac S. Programmatic Mapping: Providing Evidence for High Impact HIV Prevention Programs for Female Sex Workers. JMIR Public Health Surveill 2019; 5:e12636. [PMID: 31172964 PMCID: PMC6592495 DOI: 10.2196/12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 02/06/2023] Open
Abstract
Programmatic mapping (PM) is a rapid and efficient mechanism to develop size estimates of key populations including female sex workers (FSWs) and geolocate them at physical locations in a systematic and scientific manner. At the macro level, this information forms the basis for allocating program resources, setting performance targets, and assess coverage. At a micro level, PM data provide specific information on hot spots, estimates of FSWs at those spots, and hot spot typology and days and times of operation, all of which provides targeted service delivery strategies. This information can provide a reliable platform to plan HIV prevention and treatment services to considerable scale and intensity. Above all, the entire PM process requires deep involvement of FSWs, which increases community ownership of the data and can lead to an increased uptake of services. Despite a few limitations, the approach is versatile and can be used in varied country contexts to generate important information about sex work and its dynamics. In this paper, we describe experiences and lessons learned from using evidence generated from PM of FSWs in multiple countries to develop HIV prevention programs at scale.
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Affiliation(s)
| | - Navindra Persaud
- Family Health International 360, Washington DC, WA, United States
| | - Sharon S Weir
- University of North Carolina, Chapel Hill, NC, United States
| | | | - Shajy Isac
- Centre for Global Public Health, Winnipeg, MB, Canada
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Bhattacharjee P, Musyoki H, Prakash R, Malaba S, Dallabetta G, Wheeler T, Moses S, Isac S, Steen R. Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation. PLoS One 2018; 13:e0205056. [PMID: 30383786 PMCID: PMC6211676 DOI: 10.1371/journal.pone.0205056] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Peer education with micro-planning has been integral to scaling up key population (KP) HIV/STI programmes in Kenya since 2013. Micro-planning reinforces community cohesion within peer networks and standardizes programme inputs, processes and targets for outreach, including peer educator (PE) workloads. We assessed programme performance for outreach-in relation to the mean number of KPs for which one PE is responsible (KP:PE ratio)-and effects on HIV/STI service utilisation. Quarterly programmatic monitoring data were analysed from October 2013 to September 2016 from implementing partners working with female sex workers (FSWs) and men who have sex with men (MSM) across the country. All implementing partners are expected to follow national guidelines and receive micro-planning training for PEs with support from a Technical Support Unit for KP programmes. We examined correlations between KP:PE ratios and regular outreach contacts, condom distribution, risk reduction counselling, STI screening, HIV testing and violence reporting by KPs. Kenya conducted population size estimates (PSEs) of KPs in 2012. From 2013 to 2016, KP programmes were scaled up to reach 85% of FSWs (PSE 133,675) and 90% of MSM (PSE 18,460). Overall, mean KP:PE ratios decreased from 147 to 91 for FSWs, and from 79 to 58 for MSM. Lower KP:PE ratios, up to 90:1 for FSW and 60:1 for MSM, were significantly associated with more regular outreach contacts (p<0.001), as well as more frequent risk reduction counselling (p<0.001), STI screening (p<0.001) and HIV testing (p<0.001). Condom distribution and reporting of violence by KPs did not differ significantly between the two groups over all time periods. Micro-planning with adequate KP:PE ratios is an effective approach to scaling up HIV prevention programmes among KPs, resulting in high levels of programme uptake and service utilisation.
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Affiliation(s)
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Ravi Prakash
- Karnataka Health Promotion Trust, Bangalore, India
| | - Serah Malaba
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Gina Dallabetta
- Bill & Melinda Gates Foundation, Washington DC, United States of America
| | - Tisha Wheeler
- Office of HIV/AIDS, Bureau for Global Health, U.S. Agency for International Development, Washington DC, United States of America
| | - Stephen Moses
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Richard Steen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Urada LA, Smith LR, Yore J, Triplett DP, Hucks-Ortiz C, Raj A. Sex Trade and Health Care Utilization Among People Living with HIV/AIDS. AIDS Behav 2018; 22:2553-2563. [PMID: 29748844 PMCID: PMC6443569 DOI: 10.1007/s10461-018-2131-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People living with HIV/AIDS (PLWH) are more likely to have a history of trading sex, but little research has examined whether trading sex is associated with lower health care utilization amongst PLWH. This study assesses this association with PLWH (N = 583) recruited and surveyed from seven community sites in six US cities participating in a multi-site community-based HIV test and treat initiative. Participants were 90.6% Black or Latino, 30.4% homeless, and 9.0% (1 in 11) sold sex (past 90 days). Most reported receiving HIV clinical care (63.9%, past 6 months) and HIV case management (68.9%, past year), but 35.7% reported a missed health care appointment (past 3 months). In adjusted regression models, trading sex was associated with a missed health care appointment (OR = 2.44) and receiving psychological assistance (OR = 2.31), past 90 days, but not receipt of HIV care or supportive HIV services. Trading sex may compromise consistent health care utilization among PLWH.
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Affiliation(s)
- Lianne A Urada
- School of Social Work, San Diego State University, Hepner Hall #119, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA.
| | - Laramie R Smith
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Jennifer Yore
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Daniel P Triplett
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, La Jolla, USA
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Prakash R, Bhattacharjee P, Blanchard A, Musyoki H, Anthony J, Kimani J, Gakii G, Sirengo M, Muraguri N, Mziray E, Kasonde L, Blanchard J, Isac S, Moses S. Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018. [PMID: 29514590 DOI: 10.2989/16085906.2017.1377268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
While Kenya has had a long-standing national HIV-prevention programme, evidence on the level of exposure to its interventions and related effects on behavioural changes among female sex workers (FSWs) is limited. Using cross-sectional behavioural data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW programme exposure levels and behavioural outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorised programme exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention programme, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive programme exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57; 95% CI: 1.08-2.31) and seeking treatment for STIs (AOR: 3.37; 95% CI: 1.63-7.02) compared to FSWs with no or moderate exposure. Intensive programme exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63; 95% CI: 1.19-2.24), reporting of violence to police (AOR: 2.45; 95% CI: 1.03-5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63; 95% CI: 0.94-2.82). Although HIV prevention programmes in Kenya have been underway for over a decade, programme efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified programme exposure (intervention depth) to enhance gains in behavioural change among FSWs and preventing the burden of HIV infection among them.
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Affiliation(s)
- Ravi Prakash
- a Karnataka Health Promotion Trust (KHPT) , Bangalore , India
| | - Parinita Bhattacharjee
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Andrea Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Helgar Musyoki
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | - John Anthony
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Joshua Kimani
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Gloria Gakii
- d Partners for Health and Development in Africa (PHDA) , Nairobi , Kenya
| | - Martin Sirengo
- c National AIDS and STI Control Programme (NASCOP), Ministry of Health , Nairobi , Kenya
| | | | | | | | - James Blanchard
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Shajy Isac
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
| | - Stephen Moses
- b Department of Community Health Sciences , University of Manitoba (UoM) , Winnipeg , Canada
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Duby Z, Nkosi B, Scheibe A, Brown B, Bekker LG. 'Scared of going to the clinic': Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities. South Afr J HIV Med 2018; 19:701. [PMID: 29568645 PMCID: PMC5843994 DOI: 10.4102/sajhivmed.v19i1.701] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services. Objective To examine the context of access to healthcare experienced by these three ‘Key Populations’, we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province. Method We carried out in-depth interviews to explore healthcare workers’ perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare. Results Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing Key Populations. Female SW, MSM and PWUD described their experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. Our findings suggest that the uptake and effectiveness of health services amongst Key Populations in South Africa is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers. Conclusion This research highlights the need to address the broader healthcare provision environment, improving alignment of policies and programming in order to strengthen provision of effective health services that people from Key Populations will be able to access.
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Affiliation(s)
- Zoe Duby
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Busisiwe Nkosi
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Andrew Scheibe
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Ben Brown
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
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The HIV Care Cascade Among Female Sex Workers in Zimbabwe: Results of a Population-Based Survey From the Sisters Antiretroviral Therapy Programme for Prevention of HIV, an Integrated Response (SAPPH-IRe) Trial. J Acquir Immune Defic Syndr 2017; 74:375-382. [PMID: 27930599 DOI: 10.1097/qai.0000000000001255] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Female sex workers (FSW) in sub-Saharan Africa have a higher prevalence of HIV than other women of reproductive age. Social, legal, and structural barriers influence their access to care. Little is known about the HIV diagnosis and care cascade in most countries in Southern Africa. We aimed to describe the HIV diagnosis and care cascade among FSW in Zimbabwe. METHODS We conducted cross-sectional respondent driven sampling (RDS) surveys of FSW in 14 sites across Zimbabwe as the baseline for a cluster-randomised controlled trial investigating a combination HIV prevention and care package. We administered a questionnaire, tested women for HIV and measured viral load. We report the mean, minimum, and maximum respondent-driven sampling-2 weighted site values. RESULTS The survey included 2722 women, approximately 200 per site. The mean HIV prevalence was 57.5% (42.8-79.2 site minimum and maximum). Of HIV-positive women, 64.0% (51.6-73.7) were aware of their status, 67.7% (53.4-84.1) of these reported taking antiretroviral therapy, and 77.8% (64.4-90.8) of these had a suppressed HIV viral load (<1000 copies/mL). Among all HIV-positive women, 49.5% had a viral load < 1000 copies/mL. CONCLUSIONS Although most HIV-positive women aware of their status are accessing antiretroviral therapy, 36.0% of HIV-positive women are unaware of their status and 29.3% of all FSW have an unsuppressed HIV viral load. Investigation and investment into models of testing, treatment, and care are necessary to reach UNAIDS targets for HIV elimination.
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Abstract
There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.
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Affiliation(s)
- David Wilson
- World Bank, Global HIV/AIDS Program, Washington, D.C., United States of America
- * E-mail:
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