Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

Abstract

BackgroundHIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs’ access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services.MethodsA systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported.Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203.ResultsThis review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work.ConclusionsFSWs’ access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6362-0) contains supplementary material, which is available to authorized users.

A systematic review and meta-analysis of the prevalence, trends and spatiotemporal distribution of HIV/AIDS infection in Northern African countries.

“…However, the HIV epidemic is currently concentrated in injection drug users and female sex workers particularly in Morocco, Egypt, Tunisia and Algeria .Although it was less in in Libya,, Mauritania and Sudan where Prisoners is the main factor. This demographic variability is similar to other nations such as Sub-Saharan Countries [57,58]. These ndings indicated that injection drug use might be the major risk factor for HIV transmission in the region.…”

Women’s healthcare decision-making capacity and HIV testing in sub-Saharan Africa: a multi-country analysis of demographic and health surveys

“…Active community engagement geared towards women empowerment especially in the areas of decisionmaking, therefore, needs to be prioritised. A recent systematic review indicated that encouragement from peers could enhance ability of women to undergo HIV test [27] and this is a key community-level strategy.…”

Intention to Seek Regular HIV and Syphilis Testing and Associated Factors Among Female Sex Workers in Uganda

“…The high proportion of negative attitudes we observed could be due to lack of comprehensive knowledge about the benefits of periodic STI screening or barriers to testing including fear, stigma and discrimination of sex workers. Lack of knowledge and perceived negative consequences are barriers to testing, whereas knowledge of the benefits of STI testing and past testing behaviours facilitate testing uptake [45,46]. Awareness of the testing behaviour of fellow FSW appears to be an important factor in normalizing periodic testing behaviours [28,43].…”