Proximity to sex work sites is not associated with higher HIV prevalence in the general population in Zimbabwe

Abstract In Zimbabwe, as in other East and Southern African countries, HIV prevalence is largely geographically heterogeneous. We determined if, and to what extent, this heterogeneity is associated with proximity to sex work sites by type of site (city, economic growth point, international, seasonal, or transport), using Demographic and Health Surveys location-specific HIV prevalence data—including 16,121 individuals (aged 15-49 years) from 400 sample locations—and Centre for Sexual Health and HIV/AIDS Research data on locations of 56 sex work sites throughout Zimbabwe. We conducted univariate and multivariate multilevel logistic regression to determine the association between sex work proximity—calculated as the shortest distance by road from each survey sample location to the nearest sex work site—and HIV seropositivity. We found no association between locations of sex work and heterogeneity in HIV prevalence in the general population, possibly explained by the mobile nature of both female sex workers and their clients as individual-level indicators of sex work were still significantly associated with HIV.

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HIV and STI positivity rates among transgender people attending two large STI clinics in the Netherlands

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054875 ◽

2021 ◽

pp. sextrans-2020-054875

Author(s):

Susanne Drückler ◽

Ceranza Daans ◽

Elske Hoornenborg ◽

Henry De Vries ◽

Martin den Heijer ◽

...

Keyword(s):

The Netherlands ◽

Gender Identity ◽

Sex Work ◽

Sexual Behaviour ◽

Sex Workers ◽

Hiv Prevalence ◽

Hiv Positive ◽

Gender Identities ◽

Transgender People ◽

Sexually Transmitted

BackgroundGlobal data show that transgender people (TGP) are disproportionally affected by HIV and sexually transmitted infections (STIs); however, data are scarce for Western European countries. We assessed gender identities, sexual behaviour, HIV prevalence and STI positivity rates, and compared these outcomes between TGP who reported sex work and those who did not.MethodsWe retrospectively retrieved data from all TGP who were tested at the STI clinics of Amsterdam and The Hague, the Netherlands in 2017–2018. To identify one’s gender identity, a ‘two-step’ methodology was used assessing, first, the assigned gender at birth (assigned male at birth (AMAB)) or assigned female at birth), and second, clients were asked to select one gender identity that currently applies: (1) transgender man/transgender woman, (2) man and woman, (3) neither man nor woman, (4) other and (5) not known yet. HIV prevalence, bacterial STI (chlamydia, gonorrhoea and/or infectious syphilis) positivity rates and sexual behaviour were studied using descriptive statistics.ResultsTGP reported all five categories of gender identities. In total 273 transgender people assigned male at birth (TGP-AMAB) (83.0%) and 56 transgender people assigned female at birth (TGP-AFAB) (17.0%) attended the STI clinics. Of TGP-AMAB, 14,6% (39/267, 95% CI 10.6% to 19.4%) were HIV-positive, including two new diagnoses and bacterial STI positivity was 15.0% (40/267, 95% CI 10.9% to 19.8%). Among TGP-AFAB, bacterial STI positivity was 5.6% (3/54, 95% CI 1.2% to 15.4%) and none were HIV-positive. Sex work in the past 6 months was reported by 53.3% (137/257, 95% CI 47.0% to 59.5%) of TGP-AMAB and 6.1% (3/49, 95% CI 1.3% to 16.9%) of TGP-AFAB. HIV prevalence did not differ between sex workers and non-sex workers.ConclusionOf all TGP, the majority were TGP-AMAB of whom more than half engaged in sex work. HIV prevalence and STI positivity rates were substantial among TGP-AMAB and much lower among TGP-AFAB. Studies should be performed to provide insight into whether the larger population of TGP-AMAB and TGP-AFAB are at risk of HIV and STI.

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Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

International Journal of STD & AIDS ◽

10.1177/0956462418799018 ◽

2018 ◽

Vol 30 (2) ◽

pp. 120-130 ◽

Cited By ~ 1

Author(s):

Gunjika Misra ◽

Damodar Sahu ◽

Umenthala S Reddy ◽

Saritha Nair

Keyword(s):

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Uttar Pradesh ◽

Hiv Prevalence ◽

Indian States ◽

Factors Affecting ◽

East Indian ◽

Female Sex ◽

Behavioural Surveillance

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4–18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2–6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6–16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the ‘Sustainable Development Goals’ goal of ‘Ending the AIDS epidemic’ by 2030.

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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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HIV testing behaviour and HIV prevalence among female sex workers in Ukraine: findings from an Integrated Bio-Behavioural Survey, 2013–2014

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053684 ◽

2019 ◽

Vol 95 (3) ◽

pp. 193-200 ◽

Cited By ~ 1

Author(s):

Anna Tokar ◽

Iana Sazonova ◽

Sharmistha Mishra ◽

Pavlo Smyrnov ◽

Tetiana Saliuk ◽

...

Keyword(s):

Hiv Testing ◽

Sex Work ◽

Sex Workers ◽

Sexual Partner ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Factors Associated ◽

Female Sex ◽

Living With Hiv ◽

Test Result

ObjectivesUkraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.MethodsWe used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013–2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.ResultsRecent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).ConclusionHIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one’s status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs.

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Challenges in estimating HIV prevalence trends and geographical variation in HIV prevalence using antenatal data: Insights from mathematical modelling

PLoS ONE ◽

10.1371/journal.pone.0242595 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242595

Author(s):

Leigh F. Johnson ◽

Mmamapudi Kubjane ◽

Jeffrey W. Eaton

Keyword(s):

South Africa ◽

Pregnant Women ◽

Rural Areas ◽

Urban Areas ◽

Geographical Variation ◽

Sexual Experience ◽

Hiv Prevalence ◽

Hiv Incidence ◽

African Countries ◽

Prevalence Data

Background HIV prevalence data among pregnant women have been critical to estimating HIV trends and geographical patterns of HIV in many African countries. Although antenatal HIV prevalence data are known to be biased representations of HIV prevalence in the general population, mathematical models have made various adjustments to control for known sources of bias, including the effect of HIV on fertility, the age profile of pregnant women and sexual experience. Methods and findings We assessed whether assumptions about antenatal bias affect conclusions about trends and geographical variation in HIV prevalence, using simulated datasets generated by an agent-based model of HIV and fertility in South Africa. Results suggest that even when controlling for age and other previously-considered sources of bias, antenatal bias in South Africa has not been constant over time, and trends in bias differ substantially by age. Differences in the average duration of infection explain much of this variation. We propose an HIV duration-adjusted measure of antenatal bias that is more stable, which yields higher estimates of HIV incidence in recent years and at older ages. Simpler measures of antenatal bias, which are not age-adjusted, yield estimates of HIV prevalence and incidence that are too high in the early stages of the HIV epidemic, and that are less precise. Antenatal bias in South Africa is substantially greater in urban areas than in rural areas. Conclusions Age-standardized approaches to defining antenatal bias are likely to improve precision in model-based estimates, and further recency adjustments increase estimates of HIV incidence in recent years and at older ages. Incompletely adjusting for changing antenatal bias may explain why previous model estimates overstated the early HIV burden in South Africa. New assays to estimate the fraction of HIV-positive pregnant women who are recently infected could play an important role in better estimating antenatal bias.

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HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia

AIDS ◽

10.1097/01.aids.0000386735.87177.2a ◽

2010 ◽

Vol 24 (Suppl 2) ◽

pp. S61-S67 ◽

Cited By ~ 23

Author(s):

Kelsi Kriitmaa ◽

Adrienne Testa ◽

Mohamed Osman ◽

Ivana Bozicevic ◽

Gabriele Riedner ◽

...

Keyword(s):

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Female Sex

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Linguistic Fractionalization and Health Information in Sub-Saharan Africa

The World Bank Economic Review ◽

10.1093/wber/lhz009 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

pp. S20-S25 ◽

Cited By ~ 1

Author(s):

Joseph Flavian Gomes

Keyword(s):

Health Information ◽

Linguistic Diversity ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Oral Rehydration ◽

Individual Level ◽

Individual Woman ◽

Sub Saharan ◽

Linguistic Groups

Abstract This paper explores the relationship between linguistic diversity and the stock of health information in society. Information is measured using individual-level knowledge about the oral rehydration product for treating children with diarrhea. Exploiting an individual woman-level dataset from the Demographic and Health Surveys for 14 sub-Saharan African countries combined with a novel high-resolution dataset on the spatial distribution of linguistic groups at a 1 km × 1 km level, this study shows that linguistic diversity has an inverted U-shaped relationship with the stock of information in society.

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Commercial sex and HIV transmission in mature epidemics: a study of five African countries

International Journal of STD & AIDS ◽

10.1258/ijsa.2008.008099 ◽

2008 ◽

Vol 19 (10) ◽

pp. 660-664 ◽

Cited By ~ 14

Author(s):

P M Leclerc ◽

M Garenne

Keyword(s):

Sex Workers ◽

Health Surveys ◽

Hiv Transmission ◽

Univariate Analysis ◽

Minor Role ◽

Demographic And Health Surveys ◽

Commercial Sex ◽

African Countries ◽

Hiv Seroprevalence ◽

A Minor

The study compares the association between using the services of commercial sex workers and male HIV seroprevalence in five African countries: Ghana, Kenya, Lesotho, Malawi and Rwanda. The HIV seroprevalence among men who ‘ever paid for sex’ was compared with controls who ‘never paid for sex’. Results were based on 12,929 eligible men, aged 15–59 years, interviewed in Demographic and Health Surveys. The odds ratio of HIV seroprevalence associated with ever paying for sex was 1.89 (95% confidence interval = 1.57–2.28), with only minor differences by country. The results were stable in multivariate analysis after controlling for available potential cofactors (data on non-sexual routes of transmission were not available). Given the relatively small proportion of men involved, the risk attributable to ‘ever paying for sex’ remained low: 7.1% in univariate analysis and 4.4% after adjustment, and it varied among countries (range 1.3–9.4%). These results match previous observations that commercial sex seems to play a minor role in the spread of HIV in mature epidemics.

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The Plight of Female Cameroonian Migrant Sex Workers in N’Djamena, Chad: A Case of Intersectionality

Journal of Immigrant and Minority Health ◽

10.1007/s10903-021-01216-5 ◽

2021 ◽

Author(s):

Sianga Mutola ◽

Ngambouk Vitalis Pemunta ◽

Ngo Valery Ngo ◽

Ogem Irene Otang ◽

tabi-Chama James Tabenyang

Keyword(s):

Human Rights ◽

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Phenomenological Study ◽

Small Sample ◽

African Countries ◽

Human Rights Abuses ◽

Female Sex ◽

Legal Outcomes

AbstractIn most countries, sex-work is criminalized and frowned upon. This leads to human rights abuses, especially for migrant female sex workers. The burden is heavier on migrant female sex-workers whose gender and foreign citizenship intersect to produce a plethora of adverse health, social, and legal outcomes. This phenomenological study explores the intersectionality of individual factors leading to human rights abuses among migrant Cameroonian female sex workers in N’Djamena, Chad. Ten female sex workers and two key-informants were interviewed, and being a small sample, they gave detailed information about their experiences. The data was later analyzed using thematic analysis. Participants narrated experiences of social exclusion, exposure to diverse abuses, and health risks due to gender, immigrant status, and illegality of sex work. The experiences of female migrant sex workers, within contexts of sex work criminalization, are exacerbated by the intersectionality of these factors. Women endure several vulnerabilities in many African countries, more so when they have to survive on sex work as foreigners in a country where the act is illegal.

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Achieving improved health and human rights for street-based sex workers - an ethnographic exploration of factors that drive policing of cisgender female sex workers in a U.S. setting

10.21203/rs.2.12865/v1 ◽

2019 ◽

Author(s):

Katherine HA Footer ◽

Bradley E. Silberzahn ◽

Sahnah Lim ◽

Steven Huettner ◽

Victor A. Kumar ◽

...

Keyword(s):

Public Health ◽

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Crime Control ◽

Health Determinant ◽

Individual Level ◽

Attitudes And Practices ◽

Female Sex ◽

Police Practices

Abstract Background: Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods: Drawing on ethnographic methods, 280 hours of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature exploring the more explicitly spatial exercise of police discretion and structural forces operating on police decision making. Results: Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which police practices towards sex work operate. Conclusions: A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the needs of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.

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