scholarly journals “I Felt Very Small and Embarrassed by the Health Care Provider When I Requested to be Tested for Syphilis”: Barriers and Facilitators of Regular Syphilis and HIV Testing Among Female Sex Workers in Uganda

2021 ◽  
Author(s):  
Richard Muhindo ◽  
Andrew Mujugira ◽  
Barbara Castelnuovo ◽  
Nelson K. Sewankambo ◽  
Rosalind Parkes-Ratanshi ◽  
...  
Keyword(s):  
Health System ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Population Level ◽  
Barriers And Facilitators ◽  
System Level ◽  
Sex Worker ◽  
Female Sex ◽  
Syphilis Testing

Abstract Background: Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods: Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August-December 2018. We purposively selected FSW who tested for syphilis and HIV every 3-6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results: Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were: a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stock outs of test kits and high cost (health system). Facilitators were: c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were: a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual);: and d) availability of testing facilities (health system). Syphilis and HIV had some similar Ttesting barriers and facilitators. overlapped substantially for both infections.Conclusions: HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve the testing uptake for both infections at public health facilities and decrease population-level incidence.

scholarly journals “I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis”: barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard Muhindo ◽  
Andrew Mujugira ◽  
Barbara Castelnuovo ◽  
Nelson K. Sewankambo ◽  
Rosalind Parkes-Ratanshi ◽  
...  
Keyword(s):  
Health System ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Population Level ◽  
Barriers And Facilitators ◽  
System Level ◽  
Sex Worker ◽  
Female Sex ◽  
Syphilis Testing

Abstract Background Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators. Conclusions HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.

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 Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs

2017 ◽  
Vol 31 (7) ◽  
pp. 290-296 ◽  
Author(s):  
Michael M. Chanda ◽  
Amaya G. Perez-Brumer ◽  
Katrina F. Ortblad ◽  
Magdalene Mwale ◽  
Steven Chongo ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Barriers And Facilitators ◽  
Female Sex

scholarly journals Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

2020 ◽  
Author(s):  
Richard Muhindo ◽  
Barbara Castelnuovo ◽  
Andrew Mujugira ◽  
Nelson K. Sewankambo ◽  
Rosalind Parkes-Ratanshi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Self Efficacy ◽  
Female Sex Workers ◽  
Social Influences ◽  
Descriptive Norms ◽  
Female Sex ◽  
Syphilis Testing ◽  
Hiv Test ◽  
High Attitude

Abstract Background: Few studies have evaluated intentions to undergo periodic sexually transmitted infection (STI) and HIV testing among female sex workers (FSW) in Sub-Saharan Africa. We aimed to assess intention to seek periodic syphilis and HIV testing among FSW in Uganda. Methods: Between July and October 2018, we conducted a cross-sectional study among 441 FSW. Participants were recruited through peer referrals. Self-reported data on intention to take a syphilis test in the next 3 months and an HIV test in next 6 months were obtained using an interviewer-administered questionnaire. We used constructs of the Integrated Change Model to assess intentions, attitudes, norms, social influences and self-efficacy towards 3-monthly syphilis and 6-monthly HIV testing. Predictors of intention to seek testing were estimated using linear regression.Results: A total of 441 FSW were included in the analysis, and the median age was 26 years (interquartile range [IQR] 23–30). Most (66.9%) reported high intention to take an HIV test in the next 6 months, and 51.9% showed high intention to take a serological syphilis test in the next 3 months. In multivariable analysis, never testing for HIV was associated with low intention of testing (β=-0.15, p=0.001). Factors significantly associated with high intentions to test for HIV in the next 6 months were perceived influence of significant others (β=0.08, p=0.03), high self-efficacy (β=0.26, p=0.001) and high attitude scores (β=0.45, p=0.001). Similarly, high attitude (β=0.30, P=0.001) and descriptive norms (β=0.32, P=0.001) were associated with high intentions to test for syphilis in the next three months. Conclusion: These results suggest public health programs promoting routine HIV and syphilis testing should consider factors such as attitudes, descriptive norms, social influences, self-efficacy and past behaviours which inform intention to undergo STI testing.

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 The Female Sex Work Industry in a District of India in the Context of HIV Prevention

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Raluca Buzdugan ◽  
Shiva S. Halli ◽  
Jyoti M. Hiremath ◽  
Krishnamurthy Jayanna ◽  
T. Raghavendra ◽  
...  
Keyword(s):  
Sex Work ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Work Setting ◽  
Vulnerability Factors ◽  
Modes Of Operation ◽  
Sex Worker ◽  
Work Settings ◽  
Female Sex ◽  
Female Sex Work

HIV prevalence in India remains high among female sex workers. This paper presents the main findings of a qualitative study of the modes of operation of female sex work in Belgaum district, Karnataka, India, incorporating fifty interviews with sex workers. Thirteen sex work settings (distinguished by sex workers' main places of solicitation and sex) are identified. In addition to previously documented brothel, lodge, street,dhaba(highway restaurant), and highway-based sex workers, under-researched or newly emerging sex worker categories are identified, including phone-based sex workers, parlour girls, and agricultural workers. Women working in brothels, lodges,dhabas, and on highways describe factors that put them at high HIV risk. Of these,dhabaand highway-based sex workers are poorly covered by existing interventions. The paper examines the HIV-related vulnerability factors specific to each sex work setting. The modes of operation and HIV-vulnerabilities of sex work settings identified in this paper have important implications for the local programme.

scholarly journals Correlates of HIV Testing among Female Sex Workers in Iran: Findings of a National Bio-Behavioural Surveillance Survey

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0147587 ◽  
Author(s):  
Mostafa Shokoohi ◽  
Mohammad Karamouzian ◽  
Razieh Khajekazemi ◽  
Mehdi Osooli ◽  
Hamid Sharifi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Female Sex ◽  
Behavioural Surveillance

scholarly journals Adjustment among Homosexual in Gujarat

2014 ◽  
Vol 1 (4) ◽  
Author(s):  
Mukesh B Bhatt, ◽  
Dr. S. M. Makvana
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Total Sample ◽  
Statistical Technique ◽  
Female Sex Worker ◽  
Sex Worker ◽  
Female Sex ◽  
Significant Difference ◽  
Male Patients ◽  
Level Of Significance

The present Study of adjustment among Homosexual – female sex-worker, social men and women and AIDS patient from Gujarat. Total sample of 360 people was taken according to variables. In which, 180 male and 180 female were taken. In 180 male in 60 homosexual, 60 social men and 60 AIDS male patients and female in 60 female sex workers, 60 social woman and 60 AIDS female patients From Gujarat. The sample was selected randomly. Adjustment Questionnaire Developed by D. J. Bhatt (1994) used for data collection. The collected data were analyzed by F- test statistical technique at 0.01 level of significance and 2×3×2 factorial design used. Results revealed significant difference between the male and female. There was significant difference in adjustment level found among homosexual-female sex workers, social men – women and AIDS patients.

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