A 15-year study of the impact of community antiretroviral therapy coverage on HIV incidence in Kenyan female sex workers

ObjectivesWhile female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial.MethodsFSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti.ResultsFSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV.ConclusionsConsidering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

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P1-S2.17 Modelling the impact of rapid test syphilis screening among female sex workers in China

Sexually Transmitted Infections ◽

10.1136/sextrans-2011-050108.74 ◽

2011 ◽

Vol 87 (Suppl 1) ◽

pp. A129-A130

Author(s):

K. Mitchell ◽

A. Cox

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Rapid Test ◽

Female Sex ◽

Syphilis Screening ◽

The Impact

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Application of the BED capture enzyme immunoassay for HIV incidence estimation among female sex workers in Kaiyuan City, China, 2006–2007

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2009.09.004 ◽

2010 ◽

Vol 14 (7) ◽

pp. e608-e612 ◽

Cited By ~ 15

Author(s):

Junjie Xu ◽

Haibo Wang ◽

Yan Jiang ◽

Guowei Ding ◽

Manhong Jia ◽

...

Keyword(s):

Enzyme Immunoassay ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Incidence ◽

Female Sex ◽

Incidence Estimation

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Engagement in the HIV care cascade and barriers to antiretroviral therapy uptake among female sex workers in Port Elizabeth, South Africa: findings from a respondent-driven sampling study

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052773 ◽

2016 ◽

Vol 93 (4) ◽

pp. 290-296 ◽

Cited By ~ 30

Author(s):

Sheree Schwartz ◽

Andrew Lambert ◽

Nancy Phaswana-Mafuya ◽

Zamakayise Kose ◽

Mfezi Mcingana ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Respondent Driven Sampling ◽

Hiv Care Cascade ◽

Female Sex ◽

Care Cascade ◽

Port Elizabeth

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“A dream come true”: Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania

PLoS ONE ◽

10.1371/journal.pone.0234666 ◽

2020 ◽

Vol 15 (6) ◽

pp. e0234666 ◽

Cited By ~ 4

Author(s):

Deanna Kerrigan ◽

Tahilin Sanchez Karver ◽

Ohvia Muraleetharan ◽

Virginia Savage ◽

Jessie Mbwambo ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Dominican Republic ◽

Sex Workers ◽

Female Sex Workers ◽

Female Sex ◽

Long Acting ◽

Living With Hiv

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Prevalence and incidence of HIV among female sex workers and their clients: modelling the potential effects of intervention in Rwanda

BMJ Global Health ◽

10.1136/bmjgh-2020-002300 ◽

2020 ◽

Vol 5 (8) ◽

pp. e002300

Author(s):

Sabin Nsanzimana ◽

Edward J Mills ◽

Ofir Harari ◽

Placidie Mugwaneza ◽

Etienne Karita ◽

...

Keyword(s):

General Population ◽

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Consistent Condom ◽

People Living With Hiv ◽

Hiv Incidence ◽

Female Sex ◽

Hiv Epidemic

BackgroundRwanda has identified several targeted HIV prevention strategies, such as promotion of condom use and provision of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for female sex workers (FSWs). Given this country’s limited resources, understanding how the HIV epidemic will be affected by these strategies is crucial.MethodsWe developed a Markov model to estimate the effects of targeted strategies to FSWs on the HIV prevalence/incidence in Rwanda from 2017 to 2027. Our model consists of the six states: HIV-; HIV+ undiagnosed/diagnosed pre-ART; HIV+ diagnosed with/without ART; and death. We considered three populations: FSWs, sex clients and the general population. For the period 2017–2027, the HIV epidemic among each of these population was estimated using Rwanda’s demographic, sexual risk behaviour and HIV-associated morbidity and mortality data.ResultsBetween 2017 and 2027, with no changes in the current condom and ART use, the overall number of people living with HIV is expected to increase from 344,971 to 402,451. HIV incidence will also decrease from 1.36 to 1.20 100 person-years. By 2027, a 30% improvement in consistent condom use among FSWs will result in absolute reduction of HIV prevalence among FSWs, sex clients and the general population by 7.86%, 5.97% and 0.17%, respectively. While recurring HIV testing and improving the ART coverage mildly reduced the prevalence/incidence among FSWs and sex clients, worsening the two (shown by our worst-case scenario) will result in an increase in the HIV prevalence/incidence among FSWs and sex clients. Introduction of PrEP to FSWs in 2019 will reduce the HIV incidence among FSWs by 1.28%.ConclusionsContinued efforts toward improving condom and ART use will be critical for Rwanda to continue their HIV epidemic control. Implementing a targeted intervention strategy in PrEP for FSWs will reduce the HIV epidemic in this high-risk population.

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