HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review

This study aims to describe the experience of female sex workers (FSWs) living with HIV in Indonesia during the care and treatment cascade, including the challenges and support associated with them. It was initiated by a trained community study team from OPSI, a national network for FSW community in the country. A mixed-method design was used, consisting of a cross-sectional survey and qualitative interviews conducted in four large cities in May and June 2019. Quantitative data were collected from 80 FSWs living with HIV, while qualitative interviews were conducted for 9 FSWs previously involved in the survey. Most of the FSWs were diagnosed with HIV at facility-based HIV testing services. While most FSWs delayed initiating their treatment, majority eventually commenced it. Overall treatment retention was fairly good, but some were being inconsistent or even stopped. However, individuals that have access to viral load test was low, leading to a small number of those confirming their viral suppression status. Conclusively, interventions directed to strengthen individuals’ literacy in HIV treatment and stigma management is recommended, as well as identification of maximum potential support systems around the FSWs.

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Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-011-9985-z ◽

2011 ◽

Vol 16 (4) ◽

pp. 920-933 ◽

Cited By ~ 129

Author(s):

Fiona Scorgie ◽

Matthew F. Chersich ◽

Innocent Ntaganira ◽

Antonio Gerbase ◽

Frank Lule ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Sex Workers ◽

Female Sex Workers ◽

Demographic Characteristics ◽

Sub Saharan Africa ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Female Sex ◽

Sub Saharan

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Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

BMC Public Health ◽

10.1186/s12889-018-6362-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 15

Author(s):

Soori Nnko ◽

Evodius Kuringe ◽

Daniel Nyato ◽

Mary Drake ◽

Caterina Casalini ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Sex Workers ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Female Sex ◽

Counselling Services ◽

Hiv Testing And Counselling ◽

Sub Saharan

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Facilitators and barriers to incorporating digital technologies into HIV care among cisgender female sex workers living with HIV in South Africa

mHealth ◽

10.21037/mhealth.2019.12.07 ◽

2020 ◽

Vol 6 ◽

pp. 15-15 ◽

Cited By ~ 1

Author(s):

William X. You ◽

Carly A. Comins ◽

Brooke A. Jarrett ◽

Katherine Young ◽

Vijayanand Guddera ◽

...

Keyword(s):

South Africa ◽

Sex Workers ◽

Female Sex Workers ◽

Digital Technologies ◽

Hiv Care ◽

Female Sex ◽

Facilitators And Barriers ◽

Living With Hiv

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

10.21203/rs.2.12428/v3 ◽

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.

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

10.21203/rs.2.12428/v2 ◽

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.

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Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

BMJ Open ◽

10.1136/bmjopen-2020-047205 ◽

2022 ◽

Vol 12 (1) ◽

pp. e047205

Author(s):

Fisaha Haile Tesfay ◽

Sara Javanparast ◽

Hailay Gesesew ◽

Lillian Mwanri ◽

Anna Ziersch

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Health Facilities ◽

Sub Saharan Africa ◽

Hiv Care ◽

People Living With Hiv ◽

Nutritional Recovery ◽

Sub Saharan ◽

Living With Hiv ◽

Nutritional Outcomes

ObjectivesAlthough some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.DesignSystematic review.Data sourcesWe searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.Eligibility criteriaStudies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.Data extraction and synthesisData were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.ResultsSixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.Conclusions and recommendationsNutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.PROSPERO registration numberCRD42020196827.

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

International Journal of STD & AIDS ◽

10.1258/095646207781568655 ◽

2007 ◽

Vol 18 (9) ◽

pp. 581-588 ◽

Cited By ~ 2

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.

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

10.21203/rs.2.12428/v1 ◽

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.

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