Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

Abstract

Background HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and marijuana use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. Methods From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and marijuana use and lack of HIV infection awareness. Results Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current marijuana use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). Conclusion Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.

Evidence of sociodemographic heterogeneity across the HIV treatment cascade and progress towards 90‐90‐90 in sub‐Saharan Africa – a systematic review and meta‐analysis

“…Contrary to the Botswana study, these results found married persons to be more likely than single persons to be aware of their status and found no statistically significant association across education or mobility. The third study was conducted exclusively among female sex workers in Malawi, and investigated associations between substance use and Awareness of HIV‐Positive Status , finding those with alcohol dependency had 2.4‐fold greater prevalence of being unaware of their HIV‐positive status compared to non‐harmful use (95% CI 1.0 to 5.6), but found no associations for other levels of alcohol consumption or marijuana use [28].…”

Achieving the first 90 for key populations in sub‐Saharan Africa through venue‐based outreach: challenges and opportunities for HIV prevention based on PLACE study findings from Malawi and Angola

“…These new diagnoses were made even though most participants reported having previously tested for HIV. These data align with recent evidence from Malawi where relatively few MSM and FSW living with HIV were previously aware of their HIV status . We estimate that over 2000 KPLHIV who do not currently know their status could be newly diagnosed if venue‐based HTS were expanded to all venues in the studied locales.…”

HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review

“…To date, there are few interventions focused on reducing substance use while improving ART uptake (Deering et al, 2009; Donastorg, Barrington, Perez, & Kerrigan, 2014), and none with FSW in sub-Saharan Africa. Substance use can impair cognitive functions, which in turn may adversely affect health seeking behaviour such as receiving and initiating HIV care and treatment (Chitwood, McBride, French, & Comerford, 1999; Tucker, Burnam, Sherbourne, Kung, & Gifford, 2003; Sohler et al, 2007; Simmonds & Coomber, 2009; Lancaster et al, 2016). Integrating substance use treatment with HIV care and treatment programmes, as resources allow, may reach FSW and improve HIV care and treatment outcomes.…”