HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing

Abstract

Objective: To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya. Design: Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14–24 years in Mombasa, Kenya. Method: Dried blood spot specimens were collected from study participants ( n = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool ( https://hiv.biozentrum.unibas.ch/ETI/ ), and data on self-reported events were obtained from the survey. Results: The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7–88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker. Conclusions: Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course.

HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis

“…Studies among women linked to targeted programmes or clinics may have recruited women at lower risk of HIV acquisition, who may be older or had sold sex for longer durations, potentially missing younger women, those yet to identify as selling sex and in the highest risk period immediately following sex work initiation. 33 Preliminary findings from South Africa suggest that sex work dynamics are changing with the mean age of sex workers increasing and longer durations at-risk, 34 whilst young WESW remain at highest incidence risk. 35 Different sampling and recruitment approaches were also likely to identify different women for study inclusion.…”

Understanding Health Risk Assessment in Female Sex Workers (FSW) and Its Relationship With the Frequency of Sexual Transactions

“…Older women tend to engage in more sexual transactions than younger women with an average age of 35 years and a median age of 23 years. 24 Female sex workers of productive age have a 30 times greater risk of contracting HIV compared to women of productive age who are not sex workers, 26 while previous research findings reveal that there are more female sex workers in the 18-24 year age group compared to the [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] March 2024 41 year age group. 27 This research proves that the length of time you have been female sex workers a FSW is associated with health risks such as contracting HIV.…”

Understanding Health Risk Assessment in Female Sex Workers (FSW) and Its Relationship With the Frequency of Sexual Transactions

“…This was also discovered when conducting seroconversion examinations where female sexual workers who had been around for a long time had higher seroconversion compared to new female sexual workers. 28,29 The potential for information bias may occur in this research because at the beginning of the interview the respondent did not openly want to answer the questions. To control bias, researchers try to explain the research objectives and the benefits of this research for society, especially key populations.…”