scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Risk Perceptions ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background HIV testing is a gateway to HIV care and treatment for those testing positive, and can link those with negative reactive tests to HIV preventive services, including enrolment into pre exposure prophylaxis (PrEP). While benefits of HIV testing services (HTS) are known, uptake of HTS among female sex workers (FSWs) in Tanzania and across sub-Saharan Africa (SSA) remains suboptimal. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS, and contribute to greater linkage to care and prevention services. This study explored perspectives of FSWs towards HIVST, to inform a large-scale combination HIV prevention program addressing key populations (KPs) in Tanzania. Methods We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs. PGD collected normative data e.g. perceptions and attitudes towards HTS, whereas IDI collected personal information e.g. sexual practices and HIV risk perceptions. Study participants were recruited through snowball sampling. Data were thematically analysed using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with feasibility of scale up of HIVST. Results A total of 20 PGD sessions were conducted involving 227 participants. We also conducted IDIs with 21 FSWs. Study participants were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality were primary in participants’ support for the HIVST. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for the FSWs with reactive test – this was related to the lack of professional counselling support in the self-testing environment. Conclusions Increased confidentiality, reduced cost for care, and increased autonomy were among the leading motivations to use HIVST. Major concerns included fear of HIV positive results, and not trusting self-diagnoses. We underscore the importance of providing adequate support services in conjunction with HIVST, e.g. access to counselling and referral services, and user-accessible support to the interpretations of test results.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods:We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results:A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals HIV testing and its associated factors among street-based female sex workers in Iran: results of a national rapid assessment and response survey

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sina Ahmadi ◽  
Mehrdad Khezri ◽  
Payam Roshanfekr ◽  
Salah Eddin Karimi ◽  
Meroe Vameghi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Associated Factors ◽  
Female Sex Workers ◽  
Rapid Assessment ◽  
Evidence Based ◽  
Multivariable Model ◽  
Sexually Transmitted ◽  
Female Sex ◽  
Self Testing

Abstract Background Female sex workers (FSWs) are at a disproportionate risk of sexually transmitted infections and they may face significant barriers to HIV testing. This study aimed to examine HIV testing prevalence and its associated factors among street-based FSWs in Iran. Method A total of 898 FSWs were recruited from 414 venues across 19 major cities in Iran between October 2016 and March 2017. Eligible FSWs were women aged 18 years of age who had at least one commercial sexual intercourse in the previous year. HIV testing was defined as having tested for HIV in the lifetime. Bivariable and multivariable logistic regression were used to examine the correlates of HIV testing. We report adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Result Overall, 57.8% (95%CI: 20.0, 88.0) of participants reported having tested for HIV, and HIV prevalence among FSWs who tested for HIV was 10.3% (95%CI: 7.5, 13.0). The multivariable model showed that unstable housing (aOR: 8.86, 95%CI: 2.68, 29.32) and drug use (aOR: 3.47, 95%CI: 1.33, 9.06) were associated with increased likelihood of HIV testing. However, FSWs with a higher level of income were less likely to be tested for HIV (aOR: 0.09, 95%CI: 0.02, 0.43). Conclusion Almost one in ten street-based FSWs had never tested for HIV. These findings suggest the need for evidence-based strategies such as outreach support and HIV self-testing to improve HIV testing in this marginalized population.

scholarly journals A Randomized Controlled Trial to Increase HIV Testing Demand Among Female Sex Workers in Kenya Through Announcing the Availability of HIV Self-testing Via Text Message

2018 ◽  
Vol 23 (1) ◽  
pp. 116-125 ◽  
Author(s):  
Elizabeth A. Kelvin ◽  
Gavin George ◽  
Eva Mwai ◽  
Samuel Kinyanjui ◽  
Matthew L. Romo ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Controlled Trial ◽  
Text Message ◽  
Randomized Controlled ◽  
Female Sex ◽  
Self Testing

scholarly journals Psychosocial correlates of regular syphilis and HIV screening practices among female sex workers in Uganda: a cross-sectional survey

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Richard Muhindo ◽  
Barbara Castelnuovo ◽  
Andrew Mujugira ◽  
Rosalind Parkes-Ratanshi ◽  
Nelson K. Sewankambo ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Self Efficacy ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Hiv Screening ◽  
Cross Sectional ◽  
Psychosocial Correlates ◽  
Female Sex ◽  
Syphilis Testing

Abstract Background Limited data are available regarding correlates of regular sexually transmitted infections (STIs) and HIV screening among female sex workers (FSW) in Sub-Saharan Africa. In this study, we aimed to assess the frequency of regular syphilis and HIV screening and the psychosocial correlates associated with screening among FSW in Uganda. Methods This cross-sectional correlational study was conducted among 441 FSW, aged 17–49 years. We enrolled FSW through peer referrals and ascertained self-reported data on number of serological tests for HIV, syphilis and other STIs in the prior 12 months using an interviewer-administered questionnaire. In addition, we assessed attitudes, norms, social influences and self-efficacy towards 3-monthly Syphilis and 6-monthly HIV testing. We estimated the correlates of regular STI and HIV testing using negative binomial regression. Results Of the respondents 420 (95.2%) reported to have ever taken an HIV test with 297 (67.4%) testing two or more times in the prior 12 months. Over half of the respondents (59%) reported ever taking a syphilis test with only 62 (14.1%) reporting testing three or more times in the prior 12 months. After adjusting for socio-demographics, attitude and norms, high perceived self-efficacy was associated with a 33% increase in the likelihood of repeated HIV testing [prevalence ratio (PR), 1.33, 95% confidence interval (CI) 1.15–1.53] while low perceived confidence was associated with a 25% decrease in the likelihood of repeated HIV testing (PR, 0.75, 95% CI 0.63–0.89). Similarly low attitudes and norms were associated with a decrease of 52.6% (PR, 0.47, 95% CI 0.37–0.61) and 47% (PR, 0.53, 95% CI 0.41–0.69) in the likelihood of repeated syphilis testing respectively. Conclusion Compared to HIV, uptake of repeated syphilis testing was very low. Correlates of HIV testing include; perceived self-efficacy amidst barriers and perceived confidence for HIV and low attitudes and accepting norms for syphilis. Health campaigns should emphasize overcoming barriers to HIV testing while promoting attitudes and norms including integration of serological syphilis testing and other STIs into HIV services.

scholarly journals Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049248
Author(s):  
Moses K Kumwenda ◽  
Webster Mavhu ◽  
Wezzie S Lora ◽  
Richard Chilongosi ◽  
Simon Sikwese ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Peer Pressure ◽  
Distribution Model ◽  
Hiv Status ◽  
Female Sex ◽  
Care Services ◽  
Self Testing

ObjectivesHIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.DesignQualitative study.SettingMalawi.ParticipantsThirty-nine FSW who had obtained a HIVST kit and eight peer distributors.ResultsPeer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.ConclusionsThis study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: an exploratory study in Tanzania

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Female Sex ◽  
Self Testing

scholarly journals Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard Muhindo ◽  
Andrew Mujugira ◽  
Barbara Castelnuovo ◽  
Nelson K. Sewankambo ◽  
Rosalind Parkes-Ratanshi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Peer Education ◽  
Text Message ◽  
Sub Saharan Africa ◽  
World Health ◽  
Peer Educators ◽  
Female Sex ◽  
Quasi Experimental

Abstract Background Globally, female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). However, uptake of STI and HIV testing services among FSW in sub-Saharan Africa remains low. We aimed to assess the effect of FSW-led peer education and text message reminders on 3-monthly syphilis and HIV testing among FSW in Uganda. Methods Between September 2019 and February 2020, we implemented weekly peer education sessions and bi-monthly SMS reminders for FSW in Mbarara (intervention city). Peer education sessions were implemented by 20 FSW, who received five days of basic training as peer educators. We held monthly meetings with peer educators throughout the six-month implementation period. FSW in Mbale (control city) continued to receive standard of care consisting of HIV testing outreach campaigns, and facility-based testing. Using a quasi-experimental design in one intervention city, and one control city, we conducted pre- and post- questionnaire-based surveys on recent syphilis and HIV testing behavior among FSW in July-October 2018, and March 2020. We compared proportions and prevalence ratios at baseline and follow-up using chi-square tests and negative binomial regression. Results We conducted 436 interviews (200 before/236 after) with FSW. At baseline similar proportions reported taking an HIV test (57 % vs. 54 %; p = 0.72), and a syphilis serology test (35 % vs. 39 %; p = 0.67) in the intervention and control cities, respectively, in the prior three months. After the intervention, this proportion increased to 82 % (95 % confidence interval [CI] 74.0-88.2) for HIV, and 81 % (95 % CI: 73.0–87.0) for syphilis in the intervention city. Relative to baseline in the control city, the proportion testing for HIV was unchanged (52 %) but decreased for syphilis (26 %). Conclusions Bi-monthly text message reminders with weekly peer education sessions increased uptake of 3-monthly syphilis and HIV testing in a Ugandan female sex work population and could help increase sex worker engagement in HIV/STI services in line with World Health Organization recommendations.

scholarly journals P14.18 Understanding the intention to undergo regular hiv testing among female sex workers in benin: a key issue for entry into hiv care

2015 ◽  
Vol 91 (Suppl 2) ◽  
pp. A205.1-A205
Author(s):  
Batona Georges ◽  
Gagnon Marie-Pierre ◽  
Simonyan David ◽  
Guedou Fernand Aimé ◽  
Alary Michel
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Hiv Care ◽  
Female Sex

scholarly journals Web-based multifaceted approach in community-based screening in HIV self-testing: protocol for randomized community trial among female sex workers in Indonesia (Preprint)

2021 ◽  
Author(s):  
Jessie Olivia Yunus ◽  
Anak Agung Sagung Sawitri ◽  
Dewa Nyoman Wirawan ◽  
I Gusti Agung Agus Mahendra ◽  
Dewi Susanti ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Standard Of Care ◽  
Community Based ◽  
Web Based ◽  
Female Sex ◽  
Self Testing ◽  
High Satisfaction ◽  
Fluid Test

BACKGROUND The HIV epidemic in Indonesia continues to be concentrated among key populations including female sex workers (FSW). However, increasing HIV testing among this sub-population continues to be a challenge, necessitating exploration into alternatives testing modalities. OBJECTIVE The objective of this study was to test whether the addition of oral fluid test as an alternative testing modality will increase the number of FSW who receive HIV testing. METHODS We undertook a community-randomized trial in 23 national priority districts with existing package of HIV community outreach services. The trial consisted of 15 intervention districts and 8 control districts. In the control districts, implementing units of HIV program administered the standard of care while in the intervention districts, an additional HIV self-testing option using oral fluid test was given as a community-based screening. Participants with reactive screening results will be encouraged to undergo HIV testing at a health facility to confirm their diagnosis and subsequent antiretroviral treatment. Multiple means of recruitment were deployed including through outreach workers and social media campaign. Due in large part to the COVID-19 pandemic, most research activities were conducted online. RESULTS 17,962 FSWs were reached in the intervention sites, 45.5% (n=8,176/17,962) accepted testing, 18.9% of whom accepted OFT (n= 1,545/8,176). A total of 1.3% (n=106/8,176) participants were confirmed HIV positive. In the control districts, 7,653 FSWs were reached, 45.4% (n=3,471/7.653) received testing, 0.8% (n=29/3,471) were confirmed HIV positive. Post-test surveys for participants receiving OFT indicated overall high satisfaction and intention to use. Through the social media campaign, there were also people who registered independently for OFT but did not identify as FSW. They were eventually not eligible to participate but their interest point to the possibility of implementing HIV self-testing to general population. CONCLUSIONS The addition of HIV self-testing to standard of care supported by a web-based data collection system was able to result in higher HIV testing and higher case finding among female sex workers in Indonesia. High satisfaction of OFT users and the interest of general population towards this alternative testing modality are promising for scaling up this strategy nationally. CLINICALTRIAL ClinicalTrials.gov, number NCT04578145

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