Sexual and reproductive health outcomes among female sex workers in Johannesburg and Pretoria, South Africa: Recommendations for public health programmes

Abstract

BackgroundThe sexual and reproductive health (SRH) status of female sex workers is influenced by a wide range of demographic, behavioural and structural factors. These factors vary considerably across and even within settings. Adopting an overly standardised approach to sex worker programmes may compromise its impact on some sub-groups in local areas.MethodsRecords of female sex workers attending clinic-, community-, or hotel-based health services in Johannesburg (n = 1422 women) and Pretoria (n = 408 women), South Africa were analysed. We describe the population’s characteristics and identified factors associated with sexual and reproductive health outcomes, namely HIV status; previous symptomatic sexually transmitted infection (STI); modern contraceptive use and number of child dependents.ResultsThe women in Johannesburg were less likely than those in Pretoria to have HIV (42.2% vs 52.9%), or previous symptomatic STIs (44.3% vs. 8.3%), and were 1.4 fold less likely to have child dependents (20.1% vs. 15.3%). About 43% of women in Johannesburg were Zimbabwean and 40% in Pretoria. Of concern, only about 15% of women in both sites were using modern contraceptives. Johannesburg women were also more likely to access health services at a hotel (85.0% vs. 80.6%) or clinic (5.7% vs. 0.5%), to have completed secondary education (57.1% vs. 36.0%), and moved house more than twice during the past year (19.6 vs. 2.0%). In both cities, risk of HIV rose rapidly with age (23.8%–58.2% vs. 22.0%–64.8%). Of interest, HIV prevalence was considerably higher in those with consistent condom use with one’s main partner than inconsistent users.ConclusionsSex worker populations are heterogeneous. Local health programmes must prioritise services that reflect the variety and complexity of sex worker needs and behaviours, and should be designed in consultation with sex workers. Segmenting sex worker populations according to age, country of origin and place of service delivery, and training healthcare providers accordingly, could help prevent new HIV infections, improve adherence to antiretroviral treatment and increase uptake of SRH services.

Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa

“…It should also be noted that many of the women in these FGDs declared not currently using contraception other than condoms. This is reflected in other studies conducted in the same area . This is largely due to the lack of availability of options outside of the Depo‐provera injection which was known in the population to have side effects (cramps, excessive bleeding, nausea) which negated the contraceptive benefit, especially in the context of the work environment.…”

“…These services include: HIV counselling and testing and condom distribution, NIMART (nurse‐initiated and managed antiretroviral treatment), tuberculosis screening, HPV screening, clinical services for minor ailments, psychosocial support, and referrals to both clinical and legal services. The clinics, services and programme are described in further detail in several other publications, including a detailed account of the formative research conducted during the design of the TAPS project .…”

Epidemiology of gonorrhoea: a global perspective

“…101,[111][112][113][114][115] The percentage of SWs reporting condomless sex with clients or difficulty using condoms with clients ranged from 2.1% among female SWs in South Africa to 70% among male SWs in India. 101,111,112,[114][115][116][117] Drug use has been commonly described, and has been associated with greater numbers of clients, forced sex and unstable housing. 118,119 Some cities have clinics dedicated to SW care; however, SWs who lack access to such clinics may face barriers to sexual health services due to lack of health insurance, mistrust of the healthcare system, local reliance on syndromic management and concern that positive tests may adversely affect their ability to work.…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[20] In many parts of sub-Saharan Africa, dedicated providers also deliver implant services through mobile outreaches, which can rapidly increase implant uptake. [8,21] Existing outreach services in SA, for example to schools and among groups such as female sex workers, [22] provide a solid platform for such services. Projects piloting provision of implants in outreach services and through dedicated providers are needed.…”