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Khumaidi K, Yona S, Waluyo A. Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study. J Public Health Res 2021; 10. [PMID: 34060741 PMCID: PMC9309626 DOI: 10.4081/jphr.2021.2334] [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] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Female Sex Workers (FSW) play a crucial part in HIV transmission. Having
unprotective condom during sexual activity can lead to HIV infection. Having
lower power in condom negotiation with client can lead FSW not to using
condoms during the sexual act. Alcohol consumption was also mediated HIV
risk behavior among FSW. This study aimed to evaluate the relationship
between condom use-negotiation, alcohol consumption and HIV-risk sexual
behavior among female sex workers (FSW) in Kupang. Design and Methods A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years
recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The
data were analyzed using univariate and the Chi-square test. Results The majority of FSWs (61.6%) reported had low negotiation condom use with
their clients, about 77.6% reported high levels of alcohol consumption and
64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003)
and alcohol consumption (p-value: 0.037) were found to be significantly
associated with HIV-risk sexual behavior. Conclusions Future interventions on HIV prevention should focus on empowering young FSWs
with condom negotation skills in order to increase condum use. It is also
recommended to include information about alcohol consumption and it's
relationship wit HIV-risk behavior in order to have better health outcomes
for FSW.
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Affiliation(s)
| | - Sri Yona
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
| | - Agung Waluyo
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, West Java.
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2
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Motsoeneng M. Violence and HIV among female street sex workers in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2020.1871219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Molefi Motsoeneng
- Scholarship of Teaching and Learning, Central University of Technology, Free Sate, Bloemfontein, South Africa
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Bowring AL, Schwartz S, Lyons C, Rao A, Olawore O, Njindam IM, Nzau J, Fouda G, Fako GH, Turpin G, Levitt D, Georges S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi AC, Baral S. Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:82-99. [PMID: 32234842 PMCID: PMC7108938 DOI: 10.9745/ghsp-d-19-00330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022]
Abstract
Female sex workers (FSWs) in Cameroon have unmet need for effective contraception, and experience of unintended pregnancy and pregnancy termination is common. Reducing barriers to accessing high-quality, voluntary family planning services in FSW-focused community services is a key strategy to promote client-centered care, promote informed choice, reduce unintended pregnancies, and improve quality of life for FSWs. Background: Female sex workers (FSWs) in Cameroon commonly have unmet need for contraception posing a high risk of unintended pregnancy. Unintended pregnancy leads to a range of outcomes, and due to legal restrictions, FSWs often seek unsafe abortions. Aside from the high burden of HIV, little is known about the broader sexual and reproductive health of FSWs in Cameroon. Methods: From December 2015 to October 2016, we recruited FSWs aged ≥18 years through respondent-driven sampling across 5 Cameroonian cities. Cross-sectional data were collected through a behavioral questionnaire. Modified-robust Poisson regression was used to approximate adjusted prevalence ratios (aPR) for TOP and current use of effective nonbarrier contraception. Results: Among 2,255 FSWs (median age 28 years), 57.6% reported history of unintended pregnancy and 40.0% reported prior TOP. In multivariable analysis, TOP history was associated with current nonbarrier contraceptive use (aPR=1.23, 95% confidence interval [CI]=1.07, 1.42); ever using emergency contraception (aPR=1.34, 95% CI=1.17, 1.55); >60 clients in the past month (aPR=1.29, 95% CI= 1.07, 1.54) compared to ≤30; inconsistent condom use with clients (aPR=1.17, 95% CI=1.00, 1.37); ever experiencing physical violence (aPR=1.24, 95% CI=1.09, 1.42); and older age. Most (76.5%) women used male condoms for contraception, but only 33.2% reported consistent condom use with all partners. Overall, 26.4% of women reported currently using a nonbarrier contraceptive method, and 6.2% reported using a long-acting method. Previous TOP (aPR=1.41, 95%CI=1.16, 1.72) and ever using emergency contraception (aPR=2.70, 95% CI=2.23, 3.26) were associated with higher nonbarrier contraceptive use. Recent receipt of HIV information (aPR=0.72, 95% CI=0.59, 0.89) and membership in an FSW community-based organization (aPR=0.73, 95% CI=0.57, 0.92) were associated with lower use nonbarrier contraceptive use. Conclusions: Experience of unintended pregnancies and TOP is common among FSWs in Cameroon. Given the low use of nonbarrier contraceptive methods and inconsistent condom use, FSWs are at risk of repeat unintended pregnancies. Improved integration of client-centered, voluntary family planning within community-led HIV services may better support the sexual and reproductive health and human rights of FSWs consistent with the United Nations Declaration of Human Rights.
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Affiliation(s)
- Anna L Bowring
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Burnet Institute, Melbourne, Australia
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oluwasolape Olawore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iliassou Mfochive Njindam
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Metabiota, Yaounde, Cameroon
| | | | | | | | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ubald Tamoufe
- Metabiota, Yaounde, Cameroon.,Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Serge C Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Oudou Njoya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Anne-Cécile Zoung-Kanyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.,Division of Operations Research, Ministry of Health, Yaounde, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Consistent Condom Use and Dual Protection Among Female Sex Workers: Surveillance Findings from a Large-Scale, Community-Based Combination HIV Prevention Program in Tanzania. AIDS Behav 2020; 24:802-811. [PMID: 31444713 PMCID: PMC7018834 DOI: 10.1007/s10461-019-02642-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Tanzania, HIV infection remains much higher among female sex workers (FSWs) than among other adult women. In addition to HIV, sexually transmitted infections (STIs) and pregnancy prevention are major concerns for FSWs in Tanzania. This study used a programmatic surveillance approach to examine protection against STIs/HIV and unintended pregnancy (dual method use) among FSWs in an outreach-based HIV prevention, care, and treatment program in Tanzania. 119,728 FSWs made a first visit to services served by the Sauti Project from January 2016 to September 2017. Of these 79,774 were current contraceptive users—of those, 4548 (5.7%) took a contraceptive as well as condoms, the study measure of dual family planning (FP) method use. Ninety-one percent (n = 4139) of FSWs taking dual FP methods were provided with an injectable in addition to condoms. Dual method use was lower in this study than in research studies in the region, highlighting potential differences between findings from research studies and evidence from a routine service provision setting. Self-reported consistent condom use among FSWs was 16.1%. The findings call for further research and programs to address FSW agency to increase dual protection against STIs/HIV and unintended pregnancy.
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5
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Bowring AL, Ampt FH, Schwartz S, Stoové MA, Luchters S, Baral S, Hellard M. HIV pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind. J Int AIDS Soc 2020; 23:e25442. [PMID: 32064765 PMCID: PMC7025091 DOI: 10.1002/jia2.25442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. DISCUSSION FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. CONCLUSIONS As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights.
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Affiliation(s)
- Anna L Bowring
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
- Burnet InstituteMelbourneVictoriaAustralia
| | - Frances H Ampt
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Mark A Stoové
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stanley Luchters
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Population HealthAga Khan UniversityNairobiKenya
- International Centre for Reproductive HealthDepartment of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMDUSA
| | - Margaret Hellard
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe Alfred HospitalMelbourneVictoriaAustralia
- Doherty Institute and Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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6
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Putra IGNE, Phuengsamran D, Jampaklay A, Thammawijaya P, Januraga PP. Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia. AIDS Care 2019; 32:749-757. [PMID: 31288546 DOI: 10.1080/09540121.2019.1640851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand.,Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Dusita Phuengsamran
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand
| | - Aree Jampaklay
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand
| | - Panithee Thammawijaya
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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7
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Grosso AL, Ketende SC, Stahlman S, Ky-Zerbo O, Ouedraogo HG, Kouanda S, Samadoulougou C, Lougue M, Tchalla J, Anato S, Dometo S, Nadedjo FD, Pitche V, Baral SD. Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso. BMC Infect Dis 2019; 19:208. [PMID: 30832604 PMCID: PMC6399877 DOI: 10.1186/s12879-019-3693-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. Methods This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures’ convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. Results One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach’s alpha ranged from 0.71–0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. Conclusions Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.
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Affiliation(s)
- Ashley L Grosso
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA. .,Research and Evaluation Unit, Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.
| | - Sosthenes C Ketende
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Shauna Stahlman
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
| | - Odette Ky-Zerbo
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Henri Gautier Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Cesaire Samadoulougou
- Institut de Recherche en Sciences de la Santé (IRSS), 03 BP 7192, Ouagadougou, 03, Burkina Faso
| | - Marcel Lougue
- Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023, Avenue du Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Vincent Pitche
- Conseil National de Lutte contre le SIDA et les IST, 01 BP 2237, Lomé, 01, Togo
| | - Stefan D Baral
- Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, 5th Floor, Baltimore, MD, USA
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8
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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: 3] [Impact Index Per Article: 0.5] [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.
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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
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Broel E, Huber LB, Warren-Findlow J, Racine E. The association between client type and condom use with steady and unsteady partners among persons seeking HIV testing and counseling services in Kenya. Afr Health Sci 2017; 17:979-990. [PMID: 29937868 PMCID: PMC5870265 DOI: 10.4314/ahs.v17i4.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 70% of global HIV infections are located in sub-Saharan Africa, and the prevalence of HIV infection in Kenya remains high. OBJECTIVES This study examined the association between client type (general population, commercial sex worker [CSW], or truck driver) and consistent condom use with steady and unsteady partners. METHODS Self-reported data included in the Kenyan Ministry of Health 2010-2011 National HIV Testing and Counseling Registry were used (n=11,567). Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using logistic regression. RESULTS After adjustment, CSWs and truck drivers had decreased odds of consistent condom use with steady partners compared to the general population (OR=0.52; 95% CI: 0.41-0.67 and OR=0.29; 95% CI: 0.13-0.63; respectively). CSWs had 1.95 times the odds of consistent condom use (95% CI: 1.58-2.42) and truck drivers had 0.64 times the odds of consistent condom use with unsteady partners (95% CI: 0.45-0.91) compared to the general population. CONCLUSION Although CSWs consistently use condoms with their unsteady partners, truck drivers do not consistently use condoms with any partners. Future HIV prevention efforts should target CSWs and truck drivers to increase consistent condom use with all partners. Such efforts may decrease the prevalence of HIV in Kenya.
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Affiliation(s)
- Elizabeth Broel
- University of North Carolina at Charlotte, Department of Public Health Sciences
| | | | - Jan Warren-Findlow
- University of North Carolina at Charlotte, Department of Public Health Sciences
| | - Elizabeth Racine
- University of North Carolina at Charlotte, Department of Public Health Sciences
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10
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Duff P, Birungi J, Dobrer S, Akello M, Muzaaya G, Shannon K. Social and structural factors increase inconsistent condom use by sex workers' one-time and regular clients in Northern Uganda. AIDS Care 2017; 30:751-759. [PMID: 29067831 DOI: 10.1080/09540121.2017.1394966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While sex workers (SWs) bear the brunt of the epidemic in Uganda, there remains a dearth of empirical research on the structural drivers of HIV prevention among SWs. This study examined the drivers of inconsistent condom use by one-time and regular clients of young women SWs in Gulu, Northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young SWs, aged 14 years and older (2011-2012). SWs were recruited using peer/SW-led outreach, in partnership with The AIDS Support Organization and other CBOs. Multivariable logistic regression was used to examine the correlates of inconsistent condom use by one-time and regular clients. In total, 84.5% of the 381 SWs servicing regular clients and 76.8% of the 393 SWs servicing one-time clients reported inconsistent client condom use. In multivariable analysis, physical/sexual violence by clients (AOR = 5.39; 95%CI 3.05-9.49), low sexual control by workers (measured by the validated Pulweritz scale) (AOR = 2.86; 95%CI 1.47-5.58), alcohol/drug use while working (AOR = 1.98; 95%CI 1.17-3.35) and migration to Gulu for sex work (AOR = 1.73; 95%CI 0.95-3.14) were positively correlated with inconsistent condom use by one-time clients. Correlates of inconsistent condom use by regular clients included: low sexual control by workers (AOR = 4.63; 95%CI 2.32-9.23); physical/sexual violence by clients (AOR = 3.48; 95%CI 1.85-6.53); police harassment (AOR = 2.57; 95%CI 1.17-5.65); and being a single mother (AOR = 2.07; 95%CI 1.09-3.93). Structural and interpersonal factors strongly influence inconsistent condom use by clients, with violence by clients and police, low sexual control by workers, migration and single-parenthood all linked to non-condom use. There is a need for peer-led structural interventions that improve access to occupational health and safety standards (e.g., violence prevention and alcohol/drug harm reduction policies/programming). Shifts away from the current punitive approaches towards SWs are integral to the success of such interventions, as they continue to undermine HIV prevention efforts.
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Affiliation(s)
- Putu Duff
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
| | | | - Sabina Dobrer
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada
| | | | | | - Kate Shannon
- a Gender and Sexual Health Initiative , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.,b Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada
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11
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Zhang L, Shah IH, Li X, Zhou Y, Zhang C, Zhang L, Zhang X, Cui Y, Xu J. Does the use of HIV testing and counseling services influence condom use among low-paid female sex workers in Guangxi, China? AIDS Care 2016; 29:335-338. [PMID: 27684289 DOI: 10.1080/09540121.2016.1220482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV testing and counseling (HTC) are increasingly used in China during routine medical care visits to health facilities. However, limited data are available regarding the association between the utilization of HTC services and condom use among low-paid female sex workers (FSWs) who are at high risk of HIV infection but are hard to reach. A cross-sectional study was conducted among 794 low-paid FSWs in a city of Guangxi Zhuang Autonomous Region in 2011. Results showed that 71.7% of low-paid FSWs had utilized HTC services in the previous year and 65.7% reported having used a condom during the last sexual intercourse with their clients. Multivariate logistic regression analysis showed that utilizing HTC services was significantly and positively associated with the condom use. It also indicated that low-paid FSWs who were older, married, had higher education, earned less money, had high number of clients, had a history of sexually transmitted diseases, or had little or no HIV knowledge were less likely to use a condom during the last sexual encounter. The study suggests that HTC services need to be scaled up and made more accessible for this vulnerable population.
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Affiliation(s)
- Liying Zhang
- a Department of Family Medicine and Public Health Sciences , Wayne State University School of Medicine , Detroit , MI 48201 , USA
| | - Iqbal H Shah
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Xiaoming Li
- c Health Promotion, Education, and Behavior , South Carolina SmartState Center for HealthCare Quality (CHQ) , Columbia , SC , USA
| | - Yuejiao Zhou
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Chen Zhang
- e Vanderbilt Institute of Global Health, Vanderbilt University , Nashville , TN , USA
| | - Lihong Zhang
- f Maternal and Child Health Hospital, and Key Laboratory of Fertility Regulation and Technology of National Health and Family Planning Commission , Jinan , People's Republic of China
| | - Xiaojuan Zhang
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Yan Cui
- d Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Jinping Xu
- a Department of Family Medicine and Public Health Sciences , Wayne State University School of Medicine , Detroit , MI 48201 , USA
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