Characterizing Sociostructural Associations With New HIV Diagnoses Among Female Sex Workers in Cameroon

Abstract

Background: Female sex workers (FSW) are disproportionately affected by HIV in Cameroon, with an estimated 23.6% HIV prevalence. Given the unavailability of HIV incidence data, to better understand associations with acquiring HIV we assessed the prevalence and associations with new HIV diagnoses among FSW in Cameroon. Methods: In 2016, FSW were recruited through respondent-driven sampling from 5 cities for a biobehavioral survey. Participants self-reporting living with HIV or with an indeterminate test status were excluded from analysis. New diagnoses were defined as testing HIV-positive when participants self-reported HIV-negative or unknown status. A multivariable modified Poisson regression model was developed to assess determinants of new HIV diagnosis (referent group: HIV-negative) using key covariates; adjusted prevalence ratios (aPR) are reported if statistically significant (P < 0.05). Results: Overall 2255 FSW were recruited. Excluding participants who self-reported living with HIV (n = 297) and indeterminate test results (n = 7), 260/1951 (13.3%) FSW were newly diagnosed with HIV. Variables significantly associated with new HIV diagnosis were: no secondary/higher education [aPR: 1.56, 95% confidence interval (CI): 1.12 to 2.15], 5+ dependents compared with none (aPR: 2.11, 95% CI: 1.01 to 4.40), 5+ years involved in sex work compared with <1 year (aPR: 2.84, 95% CI: 1.26 to 6.42), history of incarceration (aPR: 2.13, 95% CI: 1.13 to 3.99), and low social capital (aPR: 1.53, 95% CI: 1.12 to 2.10). Higher monthly income (>250,000 FCFA vs. <50,000 FCFA) was associated with lower prevalence of new HIV diagnosis (aPR: 0.22, 95% CI: 0.05 to 0.86). Conclusions: There are significant sociostructural factors that seem to potentiate risk of HIV infection and delay diagnosis among FSW in Cameroon. Initiatives to build social capital and integrate services such as pre-exposure prophylaxis and HIV self-testing into HIV programs may reduce new infections and decrease time to diagnosis and treatment.

Caracterização de mulheres trabalhadoras do sexo em capitais brasileiras, 2016*

“…The high proportion of FSWs who worked in the street in Recife, São Paulo and Salvador reflects the development of recruitment networks in poorer areas of these cities. The high HIV prevalence rates found in very poor districts of these cities corroborates the evidence of studies conducted in other countries, such as in Ukraine in 2013-2014 22 and in the Republic of Cameroon in 2016, 23 where working on the streets is indicated as a variable associated with low schooling levels, starting sex work at an early age, greater exposure to risk behaviors and situations, and greater prevalence of sexually transmitted infections. 22,23 The proportion of participants who became sex workers in Recife and Salvador before they were 18 years old is alarming.…”

Unmet Need for Family Planning and Experience of Unintended Pregnancy Among Female Sex Workers in Urban Cameroon: Results From a National Cross-Sectional Study

“…Methods have been reported in more detail previously. 12,50 Briefly, 6 FSWs were purposively selected as "seeds" based on their peer networks. Seeds and subsequent participants were provided with referral coupons to recruit up to 3 other FSWs from their social network for participation.…”

“…11 However, extensive social and structural factors affect both condom use and condom failure among FSWs. [12][13][14][15] These factors include punitive laws and policies, local policing practices, economic insecurity, intersecting stigmas, physical and sexual violence, and drug and alcohol use during sex work. 16 Even in settings with high levels of consistent condom use with paying partners, condom use between FSWs and their nonpaying or emotional partners is low due to interpersonal barriers to condom use.…”

“…37,44 It is not clear whether postabortion care services routinely include family planning counseling and methods. 37 As of 2016, more than 1 in 4 sex workers in Cameroon are estimated to be living with HIV 12 compared to around 1 in 20 among all women aged 15-64 years. 45 Sex work is illegal in Cameroon, and arrests as well as police violence, raids, and extortion have been commonly reported.…”

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

“…(2) Although less is known about young women who sell sex (YSW), a growing body of literature from SSA suggests a high incidence and burden of HIV by age 24 among YSW stemming from early experience of sexual, structural, and reproductive health vulnerabilities. (3)(4)(5)(6)(7)(8) In Kenya, the median age of AGYW self-identifying as a sex worker or entering sex work ranges from 14 -18 years, which means the first years of formal sex work occur during adolescence. (9,10) Many sexual, structural, and reproductive health vulnerabilities reported by YSW in Kenya start as early as first sex and are often associated with entry into sex work at an earlier age (11)(12)(13)(14)(15).…”