Examining HIV Knowledge and Sexually Risky Behaviors Among Female Sex Workers in Kampala, Uganda

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2024 Feb 24

PMID 38397654

Authors

Jude Ssenyonjo

Colleen Mistler

Tanya Adler

Roman Shrestha

Peter Kyambadde

Michael Copenhaver

Affiliations

Soon will be listed here.

Abstract

HIV incidence remains alarmingly high among female sex workers (FSWs) in Uganda, necessitating targeted interventions. This study aimed to identify individual and provider-level barriers and facilitators to primary HIV prevention among FSWs in an urban setting. Focus groups involving FSWs and healthcare providers (HCPs) were conducted to inform the development of tailored prevention interventions. Results revealed that all participants had mobile phones, recent sexual activity, and a history of HIV testing, with high rates of sexually transmitted infections and varying HIV test results. FSWs displayed a well-informed awareness of HIV transmission risks, emphasizing the threat for those not testing positive. They unanimously recognized the crucial role of HIV testing in informing, mitigating risks, promoting ART use, and endorsing consistent condom usage. Despite heightened awareness, HCPs noted potential underestimation of vulnerability. Various challenges, including inadequate condom usage, substance abuse, and client dynamics, underscored the complexity of safeguarding against HIV transmission among FSWs. Widespread alcohol and drug use, including marijuana, kuber, and khat, served as coping mechanisms and social facilitators. Some FSWs successfully reduced alcohol intake, highlighting challenges in addressing substance use. FSWs preferred group discussions in health education programs, emphasizing peer interactions and the effectiveness of visual aids in HIV prevention education. This study provides comprehensive insights to guide the development of targeted interventions addressing the multi-faceted challenges FSWs face in HIV prevention.

References

Mbonye M, Nakamanya S, Nalukenge W, King R, Vandepitte J, Seeley J . 'It is like a tomato stall where someone can pick what he likes': structure and practices of female sex work in Kampala, Uganda. BMC Public Health. 2013; 13:741. PMC: 3751244. DOI: 10.1186/1471-2458-13-741. View

Wang B, Li X, Stanton B, Zhang L, Fang X . Alcohol use, unprotected sex, and sexually transmitted infections among female sex workers in China. Sex Transm Dis. 2010; 37(10):629-36. PMC: 2943995. DOI: 10.1097/OLQ.0b013e3181e2118a. View

Rowily A, Aloudah N, Jalal Z, Abutaleb M, Paudyal V . Views, experiences and contributory factors related to medication errors associated with direct oral anticoagulants: a qualitative study with physicians and nurses. Int J Clin Pharm. 2022; 44(4):1057-1066. PMC: 9393124. DOI: 10.1007/s11096-022-01448-x. View

Wariki W, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K . Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev. 2012; (2):CD005272. PMC: 11345029. DOI: 10.1002/14651858.CD005272.pub3. View

Yeo E, Hlongwane K, Otwombe K, Hopkins K, Variava E, Martinson N . Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study. PLoS One. 2022; 17(1):e0261855. PMC: 8782394. DOI: 10.1371/journal.pone.0261855. View

Hladik W, Baughman A, Serwadda D, Tappero J, Kwezi R, Nakato N . Burden and characteristics of HIV infection among female sex workers in Kampala, Uganda - a respondent-driven sampling survey. BMC Public Health. 2017; 17(1):565. PMC: 5466716. DOI: 10.1186/s12889-017-4428-z. View

Chersich M, Luchters S, Ntaganira I, Gerbase A, Lo Y, Scorgie F . Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. J Int AIDS Soc. 2013; 16:17980. PMC: 3589546. DOI: 10.7448/IAS.16.1.17980. View

Matovu J, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J . Health providers' experiences, perceptions and readiness to provide HIV services to men who have sex with men and female sex workers in Uganda - a qualitative study. BMC Infect Dis. 2019; 19(1):214. PMC: 6400025. DOI: 10.1186/s12879-019-3713-0. View

Bazzi A, Yotebieng K, Otticha S, Rota G, Agot K, Ohaga S . PrEP and the syndemic of substance use, violence, and HIV among female and male sex workers: a qualitative study in Kisumu, Kenya. J Int AIDS Soc. 2019; 22(4):e25266. PMC: 6462807. DOI: 10.1002/jia2.25266. View

10.

Prakash R, Bhattacharjee P, Blanchard A, Musyoki H, Anthony J, Kimani J . Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya. Afr J AIDS Res. 2018; 17(2):99-108. DOI: 10.2989/16085906.2017.1377268. View

11.

Young J, Butt J, Hersi A, Tohow A, Mohamed D . Khat Dependence, Use Patterns, and Health Consequences in Australia: An Exploratory Study. J Stud Alcohol Drugs. 2016; 77(2):343-8. DOI: 10.15288/jsad.2016.77.343. View

12.

Silapaswan A, Krakower D, Mayer K . Pre-Exposure Prophylaxis: A Narrative Review of Provider Behavior and Interventions to Increase PrEP Implementation in Primary Care. J Gen Intern Med. 2016; 32(2):192-198. PMC: 5264683. DOI: 10.1007/s11606-016-3899-4. View

13.

Park J, Gaydos C, White R, Decker M, Footer K, Galai N . Incidence and Predictors of Chlamydia, Gonorrhea and Trichomonas Among a Prospective Cohort of Cisgender Female Sex Workers in Baltimore, Maryland. Sex Transm Dis. 2019; 46(12):788-794. PMC: 7132779. DOI: 10.1097/OLQ.0000000000001085. View

14.

Ma Q, Jiang J, Pan X, Cai G, Wang H, Zhou X . Consistent condom use and its correlates among female sex workers at hair salons: a cross-sectional study in Zhejiang province, China. BMC Public Health. 2017; 17(1):910. PMC: 5706376. DOI: 10.1186/s12889-017-4891-6. View

15.

Muldoon K . A systematic review of the clinical and social epidemiological research among sex workers in Uganda. BMC Public Health. 2015; 15:1226. PMC: 4674940. DOI: 10.1186/s12889-015-2553-0. View

16.

Oldenburg C, Perez-Brumer A, Hatzenbuehler M, Krakower D, Novak D, Mimiaga M . State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS. 2015; 29(7):837-45. PMC: 4439297. DOI: 10.1097/QAD.0000000000000622. View

17.

Shannon K, Crago A, Baral S, Bekker L, Kerrigan D, Decker M . The global response and unmet actions for HIV and sex workers. Lancet. 2018; 392(10148):698-710. PMC: 6384122. DOI: 10.1016/S0140-6736(18)31439-9. View

18.

Nabayinda J, Kizito S, Witte S, Nabunnya P, Kiyingi J, Namuwonge F . Factors Associated with Consistent Condom Use Among Women Engaged in Sex Work: Lessons From the Kyaterekera Study in Southwestern Uganda. AIDS Behav. 2022; 27(3):969-977. PMC: 9974574. DOI: 10.1007/s10461-022-03833-z. View

19.

Ongeri L, Kirui F, Muniu E, Manduku V, Kirumbi L, Atwoli L . Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey. BMC Psychiatry. 2019; 19(1):137. PMC: 6505064. DOI: 10.1186/s12888-019-2118-3. View

20.

Mbonye M, Nalukenge W, Nakamanya S, Nalusiba B, King R, Vandepitte J . Gender inequity in the lives of women involved in sex work in Kampala, Uganda. J Int AIDS Soc. 2012; 15 Suppl 1:1-9. PMC: 3499847. DOI: 10.7448/IAS.15.3.17365. View