Consistent Condom Use and Dual Protection Among Female Sex Workers: Surveillance Findings from a Large-Scale, Community-Based Combination HIV Prevention Program in Tanzania

Mbita, Gaspar; Mwanamsangu, Amasha; Plotkin, Marya; Casalini, Caterina; Shao, Amani; Lija, Gissenge; Boyee, Dorica; Ramadhan, Angella; Makyayo, Neema; Mlange, Ramadhani; Bandio, Raymond; Christofeld, Megan; Komba, Albert

doi:10.1007/s10461-019-02642-1

Cited by 27 publications

(35 citation statements)

References 22 publications

(36 reference statements)

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“…This study sought to explore the acceptability of HIVST among FSWs to inform the formulation of programmatic approaches in delivering HTS to FSWs in Tanzania. As part of a large scale comprehensive HIV combination prevention program in Tanzania (Sauti Project) [38], we conducted formative research documenting FSWs' views' on HIVST.…”

Section: Introductionmentioning

confidence: 99%

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Nnko

Nyato

Kuringe

et al. 2019

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Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania.Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software.Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST.Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants' support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants' perception that HIVST would be provided only through unassisted modality.Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available.Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

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Section: Introductionmentioning

confidence: 99%

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Nnko

Nyato

Kuringe

et al. 2019

Preprint

Self Cite

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“…On the other hand, condom use with regular (non-paying) partners was low in this study (9.3%), but comparable to that found in other studies of key populations in Tanzania. 26 Low perceived susceptibility and a sense of trusting a regular partner are factors that have been associated with condom-less sex. 27 28 Worth noting in this study is the finding that condom use with regular partners was significantly associated with HIV seropositivity.…”

Section: Discussionmentioning

confidence: 99%

HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

et al. 2020

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ObjectivesTo estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP).DesignA cross-sectional survey using respondent-driven sampling.SettingDar es Salaam, Tanzania’s largest city.ParticipantsMen who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study.Primary outcome measureHIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling.ResultsA total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%–10.9%) as compared with 22.3% (95% CI: 18.7%–26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15–19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8–12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4–7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7–3.6).ConclusionHIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.

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“…Targeted interventions on HIV prevalence between FSWs and elderly clients have a significant impact [14][15][16]. In recent years, utilization and advances in molecular epidemiology have corroborated critical aspects of the HIV epidemic [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological profile and molecular genetic characterization of HIV-1 among female sex workers and elderly male clients in Guangxi, China

Xiu

Qin

Chen

et al. 2021

Emerging Microbes & Infections

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The HIV/AIDS prevalence in female sex workers (FSWs) and elderly male clients is increasing in Guangxi, China, but the transmission relationship between them remains unclear. This study aims to illuminate the transmission network among FSWs and elderly male clients using molecular epidemiological analyses. Phylogenetic analysis was performed based on available HIV-1 pol sequences obtained from HIV-1 infected elderly male clients and FSWs. In both groups, CRF01_AE was the dominant strain, followed by CRF07_BC and CRF08_BC. Multivariate logistic regression analysis indicated that viral loads of 50 to 1000 copies/mL (OR: 2.958, 95% CI: 1.110-7.881), immunological treatment failure (OR: 2.171, 95% CI: 1.114-4.230) and CRF07_BC (OR: 2.320, 95% CI: 1.065-5.051) were risk factors for entering the transmission network. Transmission network analysis showed that 180 (56.3%) sequences were segregated into 43 networks, with sizes ranging between 2 and 20. CRF07_BC tended to form large clusters, whereas CRF01_AE tended to form multiple but small clusters. Two groups of 11 FSWs and 169 clients were intricately intertwined. Spatial analysis demonstrated the formation of hotspots and clusters of transmission sharing regional differences. In conclusion, our study provides direct genetic evidence of transmission linkages between FSWs and elderly male clients, indicating that FSWs are the drivers of HIV-1 spreading to the elderly male population. Although the CRF01_AE subtype was still the predominant subtype in the region, the higher degree and larger clusters found in CRF07_BC illustrate a rapid and intensive uptrend, which is expected to increase its prevalence in the region in the future.

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Consistent Condom Use and Dual Protection Among Female Sex Workers: Surveillance Findings from a Large-Scale, Community-Based Combination HIV Prevention Program in Tanzania

Cited by 27 publications

References 22 publications

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

Epidemiological profile and molecular genetic characterization of HIV-1 among female sex workers and elderly male clients in Guangxi, China

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