HIV testing behaviour and HIV prevalence among female sex workers in Ukraine: findings from an Integrated Bio-Behavioural Survey, 2013–2014

Abstract

ObjectivesUkraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.MethodsWe used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013–2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.ResultsRecent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).ConclusionHIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one’s status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs.

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.…”

Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: coverage, barriers and facilitators

“…The facilitating effect that street- and highway soliciting had upon access to the PP in the Ukrainian context may be attributed to the successful employment of mobile clinics, an intervention conducted by Alliance to ease access to HIV prevention services, specifically targeting these vulnerable subgroups [34]. Affluent-based FSWs may be less likely to disclose their HIV status due to fear of being associated with HIV and being banned from a venue, resulting in loss of income [21, 39, 73, 74] . Furthermore, affluent-based FSWs may be less interested in accessing the basic PP, as they are able to afford these services.…”

“…Geographical sampling of cities included in the IBBS may have also influenced the level of coverage. As in other studies that utilised IBBS data [74, 76-78], we did not weight for sampling and therefore, our results are to be interpreted with this in account. Only in 2017 and 2015 was a question on gender included in the IBBS and although only a small proportion of SWs were male or transgender, limitations caused by the misclassification need to be considered.…”

Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: Coverage, barriers and facilitators

“…The facilitating effect that street-and highway soliciting had upon access to the PP in the Ukrainian context may be attributed to the successful employment of mobile clinics, an intervention conducted by Alliance to ease access to HIV prevention services, specifically targeting these vulnerable subgroups [34]. Affluent-based FSWs may be less likely to disclose their HIV status due to fear of being associated with HIV and being banned from a venue, resulting in loss of income [2,21,39,73]. Furthermore, affluent-based FSWs may be less interested in accessing the basic PP, as they are able to afford these services.…”

“…As in most countries, the HIV epidemic in Ukraine is concentrated amongst populations that are at heightened risk of contraction, designated 'key populations'. These include people who inject drugs, men who have sex with men, transgender people, incarcerated persons and sex workers (SWs) [2][3][4].…”