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Barnhart DA, Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Mboggo E, Oldenburg CE, Bärnighausen TW, Spiegelman D. Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania. AIDS Care 2019; 31:1096-1105. [PMID: 31079476 PMCID: PMC6657807 DOI: 10.1080/09540121.2019.1612018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher - though sub-optimal - engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.
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Affiliation(s)
- Dale A Barnhart
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Guy Harling
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA
- b Institute for Global Health , University College London , London , UK
- c Africa Health Research Institute , KwaZulu-Natal , South Africa
| | - Aisa Muya
- d Amref Health Africa , Dar es Salaam , Tanzania
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Katrina F Ortblad
- f Department of Global Health , University of Washington , Seattle , USA
| | - Irene Mashasi
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Peter Dambach
- g Institute of Public Health , University of Heidelberg , Heidelberg , Germany
| | - Nzovu Ulenga
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Eric Mboggo
- e Management and Development for Health , Dar es Salaam , Tanzania
| | - Catherine E Oldenburg
- h Francis I. Proctor Foundation , University of California , San Francisco , USA
- i Department of Ophthalmology , University of California , San Francisco , USA
- j Department of Epidemiology and Biostatistics , University of California , San Francisco , USA
| | - Till W Bärnighausen
- c Africa Health Research Institute , KwaZulu-Natal , South Africa
- g Institute of Public Health , University of Heidelberg , Heidelberg , Germany
- k Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Donna Spiegelman
- l Departments of Epidemiology, Biostatistics, Nutrition, and Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
- m Center for Methods in Implementation and Prevention Science , Yale School of Public Health , New Haven , USA
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Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Barnhart D, Mboggo E, Oldenburg CE, Bärnighausen T, Spiegelman D. HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey. BMJ Open 2019; 9:e023272. [PMID: 30898799 PMCID: PMC6475445 DOI: 10.1136/bmjopen-2018-023272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW's sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa. DESIGN Cross-sectional survey covering respondents' work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC). SETTING Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM). PARTICIPANTS 66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit. RESULTS Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive. CONCLUSIONS FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Aisa Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Katrina F Ortblad
- International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | - Irene Mashasi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Peter Dambach
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Dale Barnhart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric Mboggo
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Departments of Ophthalmology & Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
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