HIV Epidemic in Tanzania: The Possible Role of the Key Populations

Mpondo, Bonaventura C. T.; Gunda, Daniel W.; Kilonzo, Semvua B.

doi:10.1155/2017/7089150

Cited by 32 publications

(32 citation statements)

References 36 publications

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“…Tanzania's adult HIV prevalence is 5.0%, with women bearing a disproportionate burden (6.5% among women compared to 3.5% among men) [45]. FSWs are particularly vulnerable, with a prevalence of 31.4% among women who sell sex in Dar es Salaam [46]. In addition to HIV, these women face substantial reproductive health needs.…”

Section: Background/rationalementioning

confidence: 99%

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Yam

Kahabuka²,

Mbita³

et al. 2020

PLoS ONE

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Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive womenincluding female sex workers-often plan to have children someday. Various "safer conception" strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego's Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was "too little." Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13-4.20) and having fewer children (AOR 0.65, 95% CI 0.48-0.87). Viral suppression was not associated with fertility desire.

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Section: Background/rationalementioning

confidence: 99%

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Yam

Kahabuka²,

Mbita³

et al. 2020

PLoS ONE

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“…These structural, interpersonal, psychosocial, and behavioral risk factors generate specific HIV prevention and treatment needs among key populations. In Sub-Saharan African countries facing generalized HIV epidemics, these needs are often overlooked, leaving members of key populations vulnerable to HIV acquisition and undermining national efforts to reduce HIV incidence (Djomand, Quaye, & Sullivan, 2014;Mpondo, Gunda, & Kilonzo, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Although similar to formal FSW in many respects, FBWs typically do not self-identify as sex workers, have fewer sexual partners, necessarily encounter partners in environments with alcohol consumption, and exchange sex for material goods and other benefits, blurring the line between commercial sex work and non-commercial transactional sex (Dambach et al, 2018;Harcourt and Donovan, 2005;Stoebenau, Heise, Wamoyi, & Bobrova, 2016). Tanzanian policy is to prioritize HIV prevention and treatment among FSW and other key populations (Ministry of Health, Community Development, Gender, Elderly and Children [MoHCDGEC] and National AIDS Control Programme [NACP], 2017); however, criminalization of sex work limits the scope and number of HIV prevention and treatment interventions targeted at FSW (Mpondo, et al, 2017). To our knowledge, no HIV programs are currently targeting FBWs.…”

Section: Introductionmentioning

confidence: 99%

Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania

et al. 2019

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In sub-Saharan Africa where sex work is often criminalized and highly stigmatized, female bar workers (FBWs) often serve as informal sex workers. However, little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of these risk factors and the prevalence of HIV among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents using data from the Tanzanian 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. We found that, compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors, often substantially so. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and frequent high alcohol consumption (behavioral). However, the HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher-but still sub-optimal-engagement with HIV prevention strategies including condom use and HIV testing. FBWs' elevated exposure to structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition but low HIV prevalence suggests that economic, psychosocial, and biomedical interventions to prevent HIV acquisition among FBWs in DSM are warranted.

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“…GBV is a concern for FSWs in Iringa, with a recent behavioural survey finding that 52% of FSWs reported experiencing physical violence in the past 6 months. 33 As in other settings in sub-Saharan Africa, 34 35 sex work is criminalised in Tanzania, 36 and stigma, discrimination and harassment of FSWs are common. 37 Such stigma has been found to affect FSWs’ access to and utilisation of services.…”

Section: Introductionmentioning

confidence: 99%

Work-related mobility and experiences of gender-based violence among female sex workers in Iringa, Tanzania: a cross-sectional analysis of baseline data from Project Shikamana

et al. 2018

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ObjectivesTo examine how work-related mobility among female sex workers (FSWs) is associated with gender-based violence (GBV) in Iringa, Tanzania.DesignCross-sectional analyses were conducted on baseline data gathered between October 2015 and April 2016 from FSWs participating in Project Shikamana, a community empowerment-based combination HIV prevention intervention.SettingParticipants were recruited for the baseline study using venue-based time-location sampling in two communities in Iringa, Tanzania.ParticipantsFSWs were eligible for participation if they were 18 years or older and had exchanged sex for money within the past month. Four-hundred ninety-six FSWs participated in the baseline survey.Primary and secondary outcome measuresAny recent experience of GBV was examined by recent work-related mobility among FSWs. Any recent experience of GBV was also disaggregated by severity for analyses. All bivariate and multivariate binary and multinomial logistic regressions adjusted for intraclass correlations among women recruited from the same venues.ResultsForty per cent of participants experienced recent physical or sexual violence, and 30% recently experienced severe physical or sexual violence. Thirty-three per cent of participants recently exchanged sex for money outside of their district or region, and 12% were both intraregionally and inter-regionally mobile for sex work. Intraregionally and inter-regionally mobile FSWs had 1.9 times greater odds of reporting recent GBV (adjusted OR: 1.89; 95% CI: 1.06 to 3.38; p=0.031) compared with non-mobile FSWs and a 2.5 times higher relative risk for recent experience of severe GBV relative to no recent GBV (relative risk ratio: 2.51; 95% CI: 1.33 to 4.74; p=0.005).ConclusionsMobility for sex work may increase FSWs’ exposure to GBV, particularly more severe GBV. The vulnerability of mobile FSWs to violence, particularly severe forms, demands inclusive services that are accessible to mobile FSWs.

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HIV Epidemic in Tanzania: The Possible Role of the Key Populations

Cited by 32 publications

References 36 publications

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania

Work-related mobility and experiences of gender-based violence among female sex workers in Iringa, Tanzania: a cross-sectional analysis of baseline data from Project Shikamana

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