Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV

Sexual Health ◽  
2011 ◽  
Vol 8 (2) ◽  
pp. 251 ◽  
Author(s):  
Nienke J. Veldhuijzen ◽  
Chantal Ingabire ◽  
Stanley Luchters ◽  
Wilkister Bosire ◽  
Sarah Braunstein ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Anal Intercourse ◽  
Sub Saharan Africa ◽  
Risk Behaviours ◽  
Cross Sectional ◽  
The Past ◽  
Female Sex ◽  
Heterosexual Anal Intercourse

Introduction Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI. Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n = 800) and Mombasa, Kenya (n = 820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews. Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4–24.7); OR Mombasa 2.1 (1.1–4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5–12.4); OR Mombasa 2.2 (1.1–4.3)); alcohol use before sex (OR Kigali 2.8 (1.4–5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2–4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7–7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5–1.9); OR Mombasa 0.5 (0.2–1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews. Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.

scholarly journals “The Drug Will Help Protect My Tomorrow”: Perceptions of Integrating PrEP into HIV Prevention Behaviors Among Female Sex Workers in Lilongwe, Malawi

2019 ◽  
Vol 31 (5) ◽  
pp. 421-432
Author(s):  
Jaclyn Shea ◽  
Agatha Bula ◽  
Wezzie Dunda ◽  
Mina C. Hosseinipour ◽  
Carol E. Golin ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Behaviors ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Economic Effects ◽  
Sub Saharan Africa ◽  
Prevention Strategies ◽  
Female Sex ◽  
Hiv Prevention Strategies ◽  
Hiv Acquisition

Female sex workers (FSW) are disproportionately at risk for HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, yet approaches for incorporating PrEP within prevention strategies used by FSW are lacking. Semistructured focus group discussions were conducted with 44 HIV-negative FSW in Lilongwe, Malawi to explore perceptions of PrEP: acceptability, integration within HIV prevention behaviors, and barriers to use. Acceptability of PrEP was high. Motivation to use PrEP was rooted in love for one's life, anticipated negative economic effects associated with HIV acquisition. PrEP was viewed as complementary to existing norms for engaging in healthy sexual behaviors. Many felt PrEP may provide extra protection from HIV, along with condoms and frequent STI testing. Unpredictable daily lives, stigma, and side effects were barriers that could affect PrEP use. Leveraging existing HIV prevention strategies and social norms surrounding HIV prevention behaviors may positively impact PrEP uptake among FSW in Malawi and sub-Saharan Africa.

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.

31. Lifetime prevalence of anal intercourse among sexually active female youth and young female sex workers: a comparative systematic review and meta-analysis

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 585
Author(s):  
Branwen Nia Owen ◽  
Paddy M. Brock ◽  
Zara Shubber ◽  
Rebecca F. Baggaley ◽  
Ailsa R. Butler ◽  
...  
Keyword(s):  
General Population ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Meta Analysis ◽  
Anal Intercourse ◽  
Young Female ◽  
Average Risk ◽  
Sexually Active ◽  
Female Sex ◽  
Heterosexual Anal Intercourse

Background Anal cancer incidence has increased over the past twenty years. Heterosexual anal intercourse (AI) is a risk factor for HPV and HIV infection but is under-researched and ill-understood. We compare AI practices among young, sexually active general population females and female sex workers (FSW). Methods: We searched PubMed for heterosexual AI studies among young females, including FSWs (mean age <25 years), to December 2012. Study estimates were pooled using a random-effects model. Results: Fifty-four studies (42 average-risk, 6 higher-risk, 6 FSWs) were included. Most studies among general population youth were conducted in North America using self-administered questionnaires. All FSW studies were conducted in Africa and Asia using face-to-face interviews (FTFI). Pooled estimates of lifetime AI prevalence were larger among average-risk (23.6%, 95% CI 20.4–26.7) and higher-risk youth (25.5%, 95% CI 11.7–39.2) than FSWs (12.8%, 95% CI 8.4–17.3), but highly heterogeneous (I2 >90%). However, pooled AI estimates by continent of average-risk youth (Asia = 13.9%, 95% CI = 1.7–29.5; Africa = 18.4%, 95% CI 0.9–35.8) were more similar to those of FSWs (Asia = 16.0%, 95% CI 10.3–21.6; Africa = 9.7%, 95% CI 3.8–15.7). Estimates of average-risk youth reporting via FTFI (12.1%, 95% CI 0.7–23.5) were likewise similar to those among FSWs (12.8%, 95% CI 8.4–17.3). Pooled AI prevalence estimates among FSWs were higher in studies conducted after 2001 than in earlier studies. Conclusions: AI is common among sexually active females and may be increasing; it could therefore be an important determinant of HPV transmission and anal cancers. AI is as or more common among the general population youth than young FSWs but this may be confounded by continent, interview method and other unmeasured variables.

Client-Initiated Violence Against Zambian Female Sex Workers: Prevalence and Associations With Behavior, Environment, and Sexual History

2019 ◽  
pp. 088626051986008 ◽  
Author(s):  
Kalonde Malama ◽  
Luis Sagaon-Teyssier ◽  
Rachel Parker ◽  
Amanda Tichacek ◽  
Tyronza Sharkey ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Physical Violence ◽  
Sexual Debut ◽  
Sexual History ◽  
Sub Saharan Africa ◽  
Gender Based Violence ◽  
Cross Sectional ◽  
Female Sex ◽  
Male Clients

Violence against women is a known risk factor for HIV and affects female sex workers (FSW) in sub-Saharan Africa. Little is known about the magnitude and determinants of violence against FSW in Zambia, where HIV and gender-based violence prevalence are high. We conducted a cross-sectional study, using multivariable logistic regression, to determine the prevalence and correlates of client-initiated physical violence among 419 FSW in Lusaka and Ndola. The prevalence of client-initiated physical violence was 39%. The odds of violence were higher for FSW who: lived in Lusaka, recruited clients from the street, serviced clients in the clients’ homes, had a physically forced sexual debut, and had a higher client volume. Our results call for safer working spaces for FSW and violence prevention interventions for their male clients.

scholarly journals Differentiated Prevention And Care To Reduce The Risk of HIV Acquisition And Transmission Among Female Sex Workers In Zimbabwe: Study Protocol For The ‘AMETHIST’ Cluster Randomised Trial

2021 ◽  
Author(s):  
Frances Cowan ◽  
Fortunate Machingura ◽  
Sungai T Chabata ◽  
Sanni Ali ◽  
Joanna Busza ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Prevention ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Total N ◽  
Female Sex ◽  
Prevention And Treatment ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

Abstract Background: Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and are critical to engage in both HIV prevention and care. Here we describe our approach to evaluation of the AMETHIST intervention for FSW, adapted to the African context and set in Zimbabwe where there is a nationally-scaled programme for sex workers (Sisters). We hypothesise this intervention will raise uptake and adherence to prevention and treatment among FSW resulting in a reduction in their risk of HIV acquisition/transmission.Methods: The AMETHIST intervention (Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions) aims to provide risk differentiated prevention and care to FSW through microplanning and self help groups. Twenty two towns with the Sisters programme were randomised using restricted randomisation to either the Sisters programme or the Sister programme plus AMETHIST. The primary outcome is composite and is defined as the proportion of HIV positive FSW at risk of HIV transmission combined with the proportion of HIV negative FSW at risk of HIV acquisition. The outcome will be assessed after two years of intervention delivery in a respondent-driven sampling survey (total n=4400; n=200 FSW recruited at each site). Primary analysis will use the ‘RDS-2’ method to estimate cluster summaries and will adapt Hayes and Moulton’s ‘2-step’ method to adjust effect estimates for individual-level confounders and further adjust for cluster baseline prevalence. An in-depth process evaluation guided by our project trajectory will be undertaken.Discussion: Innovative pragmatic trials are needed to generate evidence on effectiveness of combination interventions in HIV prevention and treatment in different contexts. We describe the design and analysis of such a study.Trial Registration: The trial was registered at Pan African Clinical Trials Registry (PACTR202007818077777) on 2 July 2020.

scholarly journals Dynamics of the HIV epidemic in southern China: sexual and drug-using behaviours among female sex workers and male clients in Yunnan

2012 ◽  
Vol 23 (9) ◽  
pp. 670-675 ◽  
Author(s):  
J J Xu ◽  
M K Smith ◽  
J Chu ◽  
G W Ding ◽  
D F Chang ◽  
...  
Keyword(s):  
Drug Use ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Southern China ◽  
Cross Sectional Study ◽  
Risk Behaviours ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Female Sex ◽  
Male Clients

To examine the HIV/sexually transmitted infection (STI)-related risk behaviours among community-based female sex workers (FSWs) and their clients in Yunnan Province, China, we performed a cross-sectional study of 705 FSWs and 100 male clients. We found that HIV seroprevalence among FSWs was 13.0% and the most prevalent STI was herpes simplex virus type 2 (HSV-2) (71.1%), followed by Chlamydia trachomatis (18.1%) and syphilis (8.8%). The 20% of FSWs who reported injection drug use also reported needle-sharing behaviours in the last three months. Drug-using FSWs had substantially higher HIV and HSV-2 prevalence, serviced more clients and had a longer history of sex work than non-using FSWs. In total, 57.0% of male clients did not consistently use condoms with FSWs, 2.0% reported illicit drug use and 17.0% had STI symptoms in the last year. The dual risk behaviours of drug-using FSWs and clients place them at greater risk of HIV infection. Intervention programmes must adopt comprehensive methods.

scholarly journals Correlates of Inconsistent Refusal of Unprotected Sex among Armenian Female Sex Workers

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Karine Markosyan ◽  
Delia L. Lang ◽  
Ralph J. DiClemente
Keyword(s):  
Sex Workers ◽  
Behavioral Interventions ◽  
Female Sex Workers ◽  
Cross Sectional Study ◽  
Unprotected Sex ◽  
Behavioral Characteristics ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
The Past ◽  
Female Sex

This cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs) in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs’ demographic, psychosocial, and behavioral characteristics. A total of 52.5% (n=62) of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants’ age and education revealed that perceiving more barriers toward condom use (AOR = 1.1;P<0.01), reporting more types of abuse (AOR = 2.1;P<0.01), and setting lower fees for service (AOR = 0.9;P=0.02) significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs) including HIV.

scholarly journals Uptake and correlates of chlamydia and gonorrhea testing among female sex workers in Southern China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pei Zhen Zhao ◽  
Ya Jie Wang ◽  
Huan Huan Cheng ◽  
Ye Zhang ◽  
Wei Ming Tang ◽  
...  
Keyword(s):  
Sexual Behaviors ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Southern China ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Past ◽  
Female Sex

Abstract Background Female sex workers (FSW) are highly susceptible to chlamydia and gonorrhea infection. However, there is limited literature examining their testing uptake to date. This study aimed to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China. Methods A cross-sectional study with convenience sampling was performed in five cities in Southern China. Data on socio-demographic characteristics, sexual behaviors, chlamydia and gonorrhea testing, and the utilization of health care services from participants were collected through face-to-face interviews. Univariate and multivariable logistic regressions were used to determine factors associated with chlamydia and gonorrhea testing, respectively. Results Overall, 1207 FSWs were recruited, with the mean age of 30.7 ± 6.8 years and an average number of clients of 7.0 (4.0–10.0) per week. 65.4% participants constantly used condoms with clients during the past month. Only 7.5 and 10.4% had been tested for chlamydia and gonorrhea in the last year, respectively. Multivariable analysis indicated that FSW who worked at low tiers (adjusted Odds Ratio (aOR) = 2.36, 95%CI:1.23–10.14), had more clients in the last month (aOR = 1.03, 95%CI:1.01–1.05), used condoms consistently (aOR = 1.79, 95%CI:1.12–2.86), had STD symptoms (aOR = 4.09,95%CI:2.62–6.40), had been tested for HIV (aOR = 5.16, 95%CI:3.21–8.30) or syphilis (aOR = 6.90, 95%CI:4.21–11.22) in the last year were more likely to have chlamydia testing. In addition, FSW who had more clients in the past month (aOR = 1.02,95%CI:1.00–1.04), had STD symptoms (aOR = 3.33, 95%CI:2.03–5.46), had been tested for HIV (aOR = 3.94, 95%CI:2.34–6.65) and syphilis (aOR = 3.27, 95%CI:1.96–5.46) in the last year were more likely to have gonorrhea testing. Conclusions The testing rates of chlamydia and gonorrhea are low among Chinese FSW. Integrating chlamydia and gonorrhea testing into HIV testing promotion programs may help bridge the gap among FSW.

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