Factors associated with HIV and syphilis infection among female sex workers in three cities in Papua New Guinea: findings from Kauntim mi tu, a biobehavioral survey

Abstract

Background In this paper, factors associated with HIV and syphilis infection in three cities in Papua New Guinea are explored. Methods: Respondent-driven sampling surveys among FSW in Port Moresby, Lae, and Mt. Hagen (2016–17) were conducted. FSW who were aged ≥12 years, who were born female, who spoke English or Tok Pisin and who had sold or exchanged vaginal sex in the past 6 months were eligible to participate. Participants were interviewed face-to-face and offered rapid HIV and syphilis testing. Survey logistic procedures were used to identify factors associated with HIV and syphilis infection, including modern contraception use, physical violence and having a casual male partner. Weighted data analysis was conducted. Results: Overall, 2901 FSW (Port Moresby, 673; Lae, 709; and Mt. Hagen, 709) were enrolled in the study. HIV prevalence was 15.2% in Port Moresby, 11.9% in Lae and 19.6% in Mt. Hagen. Factors associated with HIV varied by city; for example, use of modern contraception in Port Moresby, experiences of physical violence in Lae and ever having tested for HIV in Mt. Hagen. No one variable was associated with HIV in all cities. Prevalence of syphilis infection was 7.1%, 7.0%, and 3.0% in Port Moresby, Lae, and Mt. Hagen, respectively. Factors associated with syphilis infection also varied by city and were only significant in Lae. Conclusion: The different factors associated with HIV and syphilis infection in each city highlight the complex HIV and syphilis epidemics among FSW and the importance of conducting surveys in multiple locations and developing local interventions.

A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea

“…HIV prevalence among MSM and TGW was 8.5% in Port Moresby and 6.9% in Lae [ 18 ]. These rates are significantly higher than the estimated adult prevalence of 0.9% [ 17 ]. For a detailed description of the methodology used, including reasons for combining MSM and TGW into a single survey, see the Kauntim mi tu study report [ 17 ].…”

“…In Papua New Guinea (PNG), sex work and male-to-male sex are illegal and highly stigmatised [ 16 ]. In this setting key populations including FSW, MSM and TGW are particularly vulnerable to HIV due to high prevalence of HIV-related risk behaviours, including concurrent sexual partnerships, low condom use and high prevalence of sexually transmissible infections [ 17 , 18 ]. Kauntim mi tu , a biobehavioural survey (BBS) among FSW, MSM and TGW in PNG undertaken in 2016–17 across three cities reported an HIV prevalence of 15.2% among FSW in Port Moresby, 11.9% in Lae, and 19.6% in Mount Hagen [ 19 ].…”

“…The PNG National STI and HIV Strategy 2018–2022 [ 20 ] calls for greater focus on key populations including community mobilisation and engagement; equitable and safe access to HIV prevention, care and support services; and peer-based outreach activities. Despite this, findings from Kauntim mi tu across the three sites show that PNG is falling short of reaching the UNAIDS 95–95-95 targets among these populations [ 16 , 17 ]. For example, less than half of HIV positive FSW in Port Moresby (39%) self-reported awareness of their HIV status (MSM/TGW, 24.4%); of these, 79.6% self-reported taking ART (MSM/TGW, 43.9%); and of these 54.1% were virally suppressed (MSM/TGW, 86.1%) [ 16 ].…”

Strategic options for syphilis control in Papua New Guinea– impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model

“…Prevalence data shown after adjustment for diagnostic test performance and endemic yaws (see Methods). In (c), the two data points for FSW in 2017 are from two sentinel cities (Lae, with higher prevalence, and Mount Hagen) ( Kelly-Hanku et al., 2020 ). PoM = Port Moresby, the capital.…”

“… a. Population sub-group sizes and their numbers of partners Group (15–49 years) Share of Population Married/with stable heterosexual partner Partners/year Sex acts/partner/year Source Not yet sexually active Women 14% NA 0 NA Demographic and Health Surveys (DHS) 2006 ( National Statistics Office of Papua New Guinea, 2009 ) and 2016–2018 ( National Statistics Office of Papua New Guinea, 2019 ) Low-Risk Women 51% 100% 1 100 DHS, community surveys ( Maibani-Michie et al., 2011 ; National AIDS Council Secretariat, 2012 ), studies in sexual health clinics ( Vallely et al., 2014 ) and model’s balancing of stable & casual partnerships between women and men Medium-Risk Women 33% 30% 3 casual 30 High-Risk Women/FSW 2.3% 12% 55 clients 5 National size estimations ( Hakim et al., 2019 ; Kelly-Hanku et al., 2018 ; Weikum et al., 2019 ); IBBS ( Hakim et al., 2019 ; Kelly-Hanku et al., 2018 , 2020 ; Millan et al., 2007 ); studies ( Family Health InternationalUSAID AsiaPapua New Guinea National AIDS Council, 2011 ; Maibani-Michie & Yeka, 2005 ; Maibani-Michie et al., 2007 ; Morineau, 2011 ; National AIDS Council Secretariat, 2012 ; Papua New Guinea National AIDS Council SecretariatPartners, 2008 ; Yeka et al., 2006 ), 2018 national HIV investment case ( Nation...…”