The HIV care cascade and antiretroviral therapy in female sex workers: implications for HIV prevention

AbstractBackgroundHIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.MethodsWe conducted 21 focus group discussions (FGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.ResultsInfluences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.ConclusionFindings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

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High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda

International Journal of STD & AIDS ◽

10.1177/0956462418804658 ◽

2018 ◽

Vol 30 (3) ◽

pp. 275-283 ◽

Cited By ~ 1

Author(s):

Shira M Goldenberg ◽

Godfrey Muzaaya ◽

Monica Akello ◽

Melissa Braschel ◽

Josephine Birungi ◽

...

Keyword(s):

Hiv Testing ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Infections ◽

Hiv Care ◽

Northern Uganda ◽

Negatively Associated ◽

Hiv Care Cascade ◽

Female Sex ◽

Cascade Of Care

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.

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Early antiretroviral therapy and daily pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: a prospective observational demonstration study

Journal of the International AIDS Society ◽

10.1002/jia2.25208 ◽

2018 ◽

Vol 21 (11) ◽

pp. e25208 ◽

Cited By ~ 15

Author(s):

Aminata Mboup ◽

Luc Béhanzin ◽

Fernand A Guédou ◽

Nassirou Geraldo ◽

Ella Goma-Matsétsé ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Prevention ◽

Sex Workers ◽

Female Sex Workers ◽

Female Sex ◽

Exposure Prophylaxis

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Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105947 ◽

2020 ◽

Vol 77 (2) ◽

pp. 100-106 ◽

Cited By ~ 2

Author(s):

Lauren E Parmley ◽

Carly A Comins ◽

Katherine Young ◽

Mfezi Mcingana ◽

Deliwe Rene Phetlhu ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Coping Strategies ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Disclosure ◽

Female Sex ◽

Adherence Support ◽

Wage Loss ◽

Living With Hiv

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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High Drop-off Along the HIV Care Continuum and ART Interruption Among Female Sex Workers in the Dominican Republic

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000590 ◽

2015 ◽

Vol 69 (2) ◽

pp. 216-222 ◽

Cited By ~ 32

Author(s):

Rose Zulliger ◽

Clare Barrington ◽

Yeycy Donastorg ◽

Martha Perez ◽

Deanna Kerrigan

Keyword(s):

Dominican Republic ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Female Sex

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

AIDS Education and Prevention ◽

10.1521/aeap.2019.31.5.421 ◽

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.

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