Structural determinants of dual contraceptive use among female sex workers in Gulu, northern Uganda

Abstract

Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use

“…While just under half (46.7%) of participants indicated ever use of modern contraceptives (i.e., birth control pill, intrauterine devices, hormonal injections), the positive association between modern contraceptives and unintended pregnancy may be explained by poor/interrupted access and/or ineffective use of these contraceptives. Previous work from this cohort revealed poor or no access to contraceptives, with 50% experiencing barriers to accessing condoms or contraceptives 8 . Indeed, ineffective use, frequent discontinuation and method switching have been reported among sex workers in Madagascar and linked to unintended pregnancy 15 .…”

“…Despite reports suggesting a high unmet reproductive need in conflict-affected settings 5 , there remains limited peer-reviewed literature quantifying the need for reproductive health services in conflict and conflict affected settings 6 . Furthermore, despite the concomitant increase of transactional sex in conflict-affected regions 2,7 , there remains a limited understanding of sex workers' reproductive health needs and outcomes 8 . This is an important gap, given that sex workers globally are disproportionately affected by reproductive health inequities 9,12 .…”

“…There is a need for improved access to sex workerfriendly and integrated sex worker-tailored reproductive health services (including Prevention of Mother-to-Child Transmission services) especially for sex workers working in brothels and lodges. Previous research from Gulu found that access to integrated HIV services was independently associated with dual contraceptive use for pregnancy prevention, suggesting that increased access to integrated HIV/SRH services could help mitigate sex worker s' reproductive health inequities 8 . Sex worker -tailored and sex worker -led services that include peer-led and outreach components are pivotal to improving access to HIV/SRH services 41 .…”

“…Indeed, ineffective use, frequent discontinuation and method switching have been reported among sex workers in Madagascar and linked to unintended pregnancy 15 . Another possible explanation for the positive association between modern contraception and unintended pregnancy is that sex workers who ever had an unintended pregnancy began taking modern contraceptives to prevent future pregnancies 8 .…”

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting

“…When sex workers are more concerned about risk of violence, their ability to negotiate condom use is limited [1,8,10,11], as they must prioritize their immediate safety over risk for infectious disease acquisition [11][12][13]. Furthermore, police presence adds additional pressure for sex workers to rush client negotiations, which has been found to increase the odds of clientperpetrated violence [14][15][16]. Cumulatively, these factors impose barriers to sex worker's access to health and social services and ability to report client-perpetrated violence to the police [1-3, 6, 7].…”