Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low‐ and Middle‐Income Countries: A Review of the Evidence

Abstract

S ex workers, injection drug users, men who have sex with men, and transgender individuals shoulder a disproportionate burden of HIV (Wheeler et al. 2015). UNAIDS (2014a) estimates that 40-50 percent of all new HIV infections among adults worldwide occur among these key populations. HIV among these key populations is driven by a myriad of behavioral and structural factors, including drug use, violence, sex with multiple and concurrent partners, inconsistent condom use, stigma and discrimination, and criminalization. Although these factors also increase the risk of poor reproductive health outcomes (WHO 2014), relatively little attention has been paid to the reproductive health needs of key populations.

Contraceptive Use Among Women Who Inject Drugs: Motivators, Barriers, and Unmet Needs

“…Our data corroborate findings from other studies regarding the importance of a range of barriers, such as the infertility beliefs mentioned above (White, Phillips, Mulleady, & Cupitt, 1993), contraception side effects (Harding & Ritchie, 2003), transport costs, experiences with health care provision (Armstrong, Kenen, & Samost, 1991), influence from intimate partners, forgetfulness, convenience (Egarter et al, 2013), influence from intimate partners, and difficulty negotiating condom use with sexual partners (Ippoliti et al, 2017;White et al, 1993). Most of these factors are not necessarily unique among women who inject drugs, as they are also observed among women who do not use drugs (Ippoliti et al, 2017;Peipert, Madden, Allsworth, & Secura, 2012;Wulifan, Brenner, Jahn, & De Allegri, 2016). However, some of these barriers may affect this population in a unique way.…”

“…At a micro level, understanding contraceptive needs, fertility-related behaviors, desired fertility, and other sexual and reproductive needs can inform women-centered services. The need for gender-sensitive services is currently gaining visibility, with calls to integrate interventions that address the unique needs and vulnerabilities of women in harm reduction services (Ayon et al, 2017;El-Bassel & Strathdee, 2015;Ippoliti, Nanda, & Wilcher, 2017;Iversen, Page, Madden, & Maher, 2015;Pinkham & Malinowska-Sempruch, 2008).…”

“…Ensuring that services are provided in spaces that women are familiar and comfortable with is particularly important given that attitudes of health providers affect women's access and uptake of sexual and reproductive health services (Armstrong et al, 1991;Ippoliti et al, 2017). In the areas where our study was conducted, Finally, the confluence of drug use and sex work interfered with consistent use of condoms, which suggests that skills for condom negotiation would be useful, and it is important to recognize that sex work can occur in intoxicated states or alongside drug injecting.…”

HIV pre‐exposure prophylaxis for female sex workers: ensuring women’s family planning needs are not left behind

“…Injections are the most commonly used and often the only available non‐barrier method in this population but are reported to have acceptability concerns among FSWs due to side effects which interfere with their ability to work . Additional barriers to access and uptake of contraception among FSWs include stigma or refusal of service due to sex work, young age or marital status, limited availability or choice of contraceptive methods, lack of health workers trained in LARC provision and limited knowledge of contraceptive methods .…”

The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services

“…). Integrated services also played a role in the prevention of mother‐to‐child transmission of HIV—specifically by promoting access to FP and by understanding key populations’ SRH needs (FHI360 ; Ippoliti in this issue).…”