Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

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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Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya

10.21203/rs.2.19715/v3 ◽

2020 ◽

Author(s):

Elizabeth Roberts ◽

Huiting Ma ◽

Parinita Bhattacharjee ◽

Helgar K Musyoki ◽

Peter Gichangi ◽

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Keyword(s):

Reproductive Health ◽

Condom Use ◽

Young Women ◽

Sex Workers ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Age Group ◽

Inconsistent Condom ◽

Female Sex ◽

Inconsistent Condom Use

Abstract Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14 – 24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW. Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14 – 24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14 – 18 years, N=117; 19 – 24 years, N=291) and by program contact (ever contacted by local program for sex workers). Results: 47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p=1.00) . Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9% and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14 – 18 years; and 15.8% of those aged 19 – 24 years, p=0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact. Conclusions: SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.

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A Systematic Review of Factors Influencing Condom Use among Female Sex Workers

International Journal of Social Science Studies ◽

10.11114/ijsss.v8i5.4902 ◽

2020 ◽

Vol 8 (5) ◽

Author(s):

Caitlin McLachlan ◽

Tinashe Dune

Keyword(s):

Systematic Review ◽

Condom Use ◽

Sex Workers ◽

Perceived Risk ◽

Female Sex Workers ◽

Future Research ◽

High Risk Population ◽

Sex Industry ◽

Female Sex ◽

Male Clients

A systematic review of research published in English was conducted across seven electronic databases in public health, social and psychological sciences. The aim was to ascertain the factors that influence condom use among female sex workers in the commercial sex industry globally. The perspectives and experiences of 29,112 female sex workers (FSWs) and 1,792 male clients of FSWs with regards to condom use are represented across the 47 studies included in this review. Key themes comprised of Perceived self-efficacy, Relationship Types, Condom use and Attitudes, Violence and Abuse, Location and Support, Knowledge and Perceived Risk, Perception and Perspectives of Male Clients, Drug and Alcohol use, Criminalisation and Price and Payment. Female sex workers are defined as a high-risk population for HIV/AIDS. Condoms were used less frequently in situations where structural and cultural determinants heavily impacted the experiences and decisions of FSWs. Cultural contextual factors also heavily impacted on the perspectives and perceptions of male clients and their attitudes towards condom use. Criminalization and anti-sex work legislation in many of the countries where these studies were conducted meant that FSWs were a socially marginalised and ostracized population. Recommendations are explored for theory, practice and education and future research.

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