scholarly journals “The Drug Will Help Protect My Tomorrow”: Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi

2019 ◽  
Vol 31 (5) ◽  
pp. 421-432
Author(s):  
Jaclyn Shea ◽  
Agatha Bula ◽  
Wezzie Dunda ◽  
Mina C. Hosseinipour ◽  
Carol E. Golin ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Behaviors ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Economic Effects ◽  
Sub Saharan Africa ◽  
Prevention Strategies ◽  
Female Sex ◽  
Hiv Prevention Strategies ◽  
Hiv Acquisition

Female sex workers (FSW) are disproportionately at risk for HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet approaches for incorporating PrEP within prevention strategies used by FSW are lacking. Semistructured focus group discussions were conducted with 44 HIV-negative FSW in Lilongwe, Malawi to explore perceptions of PrEP: acceptability, integration within HIV prevention behaviors, and barriers to use. Acceptability of PrEP was high. Motivation to use PrEP was rooted in love for one's life, anticipated negative economic effects associated with HIV acquisition. PrEP was viewed as complementary to existing norms for engaging in healthy sexual behaviors. Many felt PrEP may provide extra protection from HIV, along with condoms and frequent STI testing. Unpredictable daily lives, stigma, and side effects were barriers that could affect PrEP use. Leveraging existing HIV prevention strategies and social norms surrounding HIV prevention behaviors may positively impact PrEP uptake among FSW in Malawi and sub-Saharan Africa.

scholarly journals Differentiated Prevention And Care To Reduce The Risk of HIV Acquisition And Transmission Among Female Sex Workers In Zimbabwe: Study Protocol For The ‘AMETHIST’ Cluster Randomised Trial

2021 ◽  
Author(s):  
Frances Cowan ◽  
Fortunate Machingura ◽  
Sungai T Chabata ◽  
Sanni Ali ◽  
Joanna Busza ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Total N ◽  
Female Sex ◽  
Prevention And Treatment ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

Abstract Background: Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and are critical to engage in both HIV prevention and care. Here we describe our approach to evaluation of the AMETHIST intervention for FSW, adapted to the African context and set in Zimbabwe where there is a nationally-scaled programme for sex workers (Sisters). We hypothesise this intervention will raise uptake and adherence to prevention and treatment among FSW resulting in a reduction in their risk of HIV acquisition/transmission.Methods: The AMETHIST intervention (Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions) aims to provide risk differentiated prevention and care to FSW through microplanning and self help groups. Twenty two towns with the Sisters programme were randomised using restricted randomisation to either the Sisters programme or the Sister programme plus AMETHIST. The primary outcome is composite and is defined as the proportion of HIV positive FSW at risk of HIV transmission combined with the proportion of HIV negative FSW at risk of HIV acquisition. The outcome will be assessed after two years of intervention delivery in a respondent-driven sampling survey (total n=4400; n=200 FSW recruited at each site). Primary analysis will use the ‘RDS-2’ method to estimate cluster summaries and will adapt Hayes and Moulton’s ‘2-step’ method to adjust effect estimates for individual-level confounders and further adjust for cluster baseline prevalence. An in-depth process evaluation guided by our project trajectory will be undertaken.Discussion: Innovative pragmatic trials are needed to generate evidence on effectiveness of combination interventions in HIV prevention and treatment in different contexts. We describe the design and analysis of such a study.Trial Registration: The trial was registered at Pan African Clinical Trials Registry (PACTR202007818077777) on 2 July 2020.

How much do blood exposures contribute to HIV prevalence in female sex workers in sub-Saharan Africa, Thailand and India?

2007 ◽  
Vol 18 (9) ◽  
pp. 581-588 ◽  
Author(s):  
David Gisselquist
Keyword(s):  
Health Care ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Indirect Evidence ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Hepatitis C Infection ◽  
Female Sex ◽  
Sub Saharan ◽  
Hiv Acquisition

Female sex workers (FSWs) are subject to frequent invasive procedures in health care and cosmetic services. When infection control is deficient, these procedures not only put FSWs at risk to acquire HIV, but are also risks for FSWs to transmit HIV to the general population. Direct information about blood exposures other than injection drug use as risks for HIV infection in FSWs has been too limited to test the hypothesis that unsterile health-care procedures have infected large numbers of FSWs in sub-Saharan Africa and Asia. However, indirect evidence suggests that blood exposures might account for an important proportion of their HIV infections. This indirect evidence includes: higher prevalence of hepatitis C infection among sex workers than among other women; continuing HIV acquisition among FSWs despite high rates of condom use and surprisingly high ratios of incidence of HIV compared with incidence of syphilis, gonorrhoea and chlamydia.

scholarly journals Perspectives of Brothel Leaders and HIV Prevention Experts on the Role of Gatekeepers on Improving Condom Use by Female Sex Workers in Abuja, Nigeria

2017 ◽  
Vol 9 (10) ◽  
pp. 183
Author(s):  
Uchenna O. Okafor ◽  
Rik Crutzen ◽  
Egbe A. Awo ◽  
Bart Van Den Borne
Keyword(s):  
Hiv Prevention ◽  
Condom Use ◽  
Sex Work ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Consistent Condom ◽  
Sociocultural Factors ◽  
Access To Health Services ◽  
Female Sex ◽  
Hiv Prevention Strategies

A qualitative study using in-depth interviews explored the perceptions and views of brothel leaders and HIV program experts on the acceptability and adoptability of using gatekeepers in interventions aimed at improving Female Sex Workers’ (FSWs) condom use in Nigeria. Brothel leaders are an influential group within the FSWs’ social and physical environment and their attitudes, beliefs and actions can influence the immediate brothel environment and the adoption of interventions within the brothel. HIV prevention experts make key decisions on the content and strategies adopted for HIV prevention efforts and also influence the design and implementation of HIV prevention strategies within programs. Four themes illustrating the benefits and barriers of the inclusion of gatekeepers within the immediate environment of the FSW were identified. Results show that brothel leadership inclusion in HIV prevention efforts could exert potential positive influence on the immediate brothel environment. Brothel leaders can support the institution of establishment policies supporting consistent condom use by the FSWs, promotion of HIV awareness, resolution of conflicts and harassments, support to new entrants into sex work and the reinforcement of protective behaviors among the FSWs. The decriminalization of sex work and the inclusion of gatekeepers support into country HIV program guidelines may contribute to mitigating prevalent sociocultural factors limiting FSWs’ rights as well as their access to health services. The present study provides insights into the potential positive roles of brothel leaders in improving condom use and other HIV/AIDs related interventions for brothel based FSWs in Abuja, Nigeria from the perspective of brothel leaders and HIV prevention experts.

scholarly journals Factors associated with retention in HIV prevention and treatment clinical services among female sex workers enrolled in a sex workers’ outreach program (SWOP) in Nairobi, Kenya.

2021 ◽  
Author(s):  
Patrick Eshikumo ◽  
Patrick Awuor ◽  
Natalia Blanco ◽  
Marie-Claude Lavoie ◽  
Anna Whittington ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Cohort Analysis ◽  
Outreach Program ◽  
Post Exposure Prophylaxis ◽  
Female Sex ◽  
Prevention And Treatment ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Abstract Female sex workers (FSWs) are among the key populations (KP) prioritized for comprehensive HIV programming in Kenya. Retention in the program is critical for prevention of HIV acquisition and transmission among FSWs and their sexual partners. We conducted a retrospective cohort analysis of data collected from FSWs enrolled between October 2016 and September 2017 at seven drop-in centers (DICs) in Nairobi, Kenya, to examine retention in HIV prevention and treatment services and identify the associated factors. We found a 3- and 12- month retention of 24% and 17%, respectively. FSWs aged 20-34 years old were less likely to be retained compared to those 50 years or older. FSWs enrolled in a DIC located in their sub-county of residence or reporting ever using HIV pre- or post-exposure prophylaxis were more likely to be retained. Identifying predictors of FSWs disengagement from HIV services can inform the design and implementation of retention-enabling interventions.

scholarly journals A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda Wilson ◽  
Yuan Yuan Wang ◽  
Runsen Chen ◽  
Ping Cen ◽  
Yuehui Wang ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Thematic Analysis ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Yunnan Province ◽  
Border Region ◽  
Tailored Interventions ◽  
Female Sex ◽  
Hiv Prevention Strategies

Abstract Background The Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. The objective of this study was to examine the experiences of FSWs in the Yunnan to better understand the risk of infection and the potential for transmission of HIV. Methods Semi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan Province, China. Thematic analysis was conducted to identify themes that highlighted increased exposure of FSWs to the risk of HIV infection and transmission. Results The findings showed that FSWs’ primary source for HIV information was gynecologists, with few visiting the local HIV charity Red Ribbon. FSWs reported infrequent visits for check-ups with some seeing a gynecologist once a year. FSWs felt that the onus was on them to prevent STI/HIV infection by using a condom during sex, regardless of their ability to negotiate use. FSWs were also reluctant to see a gynecologists for treatment. Instead, they resorted to douching as a way of preventing HIV/STIs and treating vaginal health problems, such as leucorrhea. Most FSWs worked without the influence of alcohol and drugs. A small number of FSWs reported heroin addiction and injecting drug use. Conclusion The findings suggest a need for innovative HIV prevention strategies among FSWs and their clients in the Chinese border region. Governmental agencies should continue to implement practical strategies in terms of HIV prevention education and condom use through tailored interventions that are localized. Such strategies should include localized tailored interventions that dispel myths about douching as a method of HIV/STI prevention and incorporate a mobile outreach approach, similar to the ‘roadside restaurant’ outreach that has been successful in rural China.

Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV

Sexual Health ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 251 ◽  
Author(s):  
Nienke J. Veldhuijzen ◽  
Chantal Ingabire ◽  
Stanley Luchters ◽  
Wilkister Bosire ◽  
Sarah Braunstein ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Anal Intercourse ◽  
Sub Saharan Africa ◽  
Risk Behaviours ◽  
Cross Sectional ◽  
The Past ◽  
Female Sex ◽  
Heterosexual Anal Intercourse

Introduction Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI. Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n = 800) and Mombasa, Kenya (n = 820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews. Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4–24.7); OR Mombasa 2.1 (1.1–4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5–12.4); OR Mombasa 2.2 (1.1–4.3)); alcohol use before sex (OR Kigali 2.8 (1.4–5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2–4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7–7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5–1.9); OR Mombasa 0.5 (0.2–1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews. Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.

scholarly journals Family planning use and correlates among female sex workers in a community empowerment HIV prevention intervention in Iringa, Tanzania: a case for tailored programming

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. Wilson Beckham ◽  
Melissa Stockton ◽  
Noya Galai ◽  
Wendy Davis ◽  
Jessie Mwambo ◽  
...  
Keyword(s):  
Family Planning ◽  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Unmet Need ◽  
Community Empowerment ◽  
Text Messages ◽  
Sub Saharan Africa ◽  
Adjusted Relative Risk ◽  
Female Sex

Abstract Background Female sex workers in sub-Saharan Africa face high unmet need for family planning and higher risk for unintended pregnancy. Community empowerment HIV prevention approaches have the potential to increase family planning uptake and present an opportunity to integrate HIV, reproductive health, and contraception. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use. Methods This study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.) Results Among the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02–1.56]) and 36% (aRR 1.36 [95%CI: 1.13–1.64) higher than among those who had not attended. Conclusion There is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.

scholarly journals Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

2017 ◽  
Vol 16 (3) ◽  
pp. 257-268 ◽  
Author(s):  
Uchenna O Okafor ◽  
Rik Crutzen ◽  
Yauri Aduak ◽  
Sylvia Adebajo ◽  
Hubertus W Van den Borne
Keyword(s):  
Systematic Review ◽  
Condom Use ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Behavioural Interventions ◽  
Female Sex ◽  
Sub Saharan
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