The HIV care continuum and HIV-1 drug resistance among female sex workers: a key population in Guinea-Bissau

Abstract

Introduction: Female sex workers (FSW) are considered a key group for HIV transmissions in sub-Saharan Africa. The HIV Care Continuum and HIV drug resistance (HIVDR) among FSW has not been well studied in most countries in West Africa. In the current study we describe the HIV Care continuum and prevalence of HIVDR among FSW in Guinea-Bissau. Methods: A venue-based recruitment and peer-referral of FSW was used in seven cities in Guinea-Bissau from October 2014 to September 2017. We administered a questionnaire, performed discriminatory HIV-testing and collected blood specimens for CD4 count, viral load and HIVDR genotyping. Results: The survey included 440 FSW. The overall HIV-prevalence among FSW was 26.8%. Of the HIV-1 (HIV-1 singleor dually HIV-1/HIV-2) infected FSW (N = 104), 58.7% were previously diagnosed with HIV-1 at enrolment and 41.4% reported taking antiretroviral therapy (ART) compared to 28.6% of the HIV-2 single-infected FSW (N = 14). Among HIV-1 infected FSW on ART (N = 43), 55.8% were virally suppressed (< 1000 copies/ml) and of all HIV-1 infected FSW, 29.8% were virally suppressed. Among ART experienced FSW (N = 22), 50.0% had HIVDR. HIVDR was also found in 9.4% of treatment naïve FSW (N = 53). Conclusion: The majority of FSW who knew their HIV status received ART, however a large proportion of FSW were not aware of their HIV positive status. This translated into a great majority of the HIV-infected FSW not being virally suppressed. Amongst treatment naïve FSW nearly a tenth had HIVDR, suggesting that sexual transmission of HIVDR is occurring in this at-risk-population.

High Level of HIV Drug Resistance and Virologic Nonsuppression Among Female Sex Workers in Ethiopia: A Nationwide Cross-Sectional Study

“…52 Consistent with our results, several studies in sub-Saharan Africa have shown high levels of VLN among FSWs. 28,[53][54][55][56] This might be due to multiple barriers, such as stigma related to HIV and sex work or high mobility, that prevent FSWs from accessing the HIV care continuum. 20 Moreover, FSWs are frequently exposed to violence, and women who report violence have poor ART adherence and viral suppression.…”

Sexual and reproductive health service needs associated with underage initiation of selling sex among adult female sex workers in Guinea-Bissau

“…Despite these limitations, this study contributes to the limited research on sex work in Guinea-Bissau. [18] Given the high prevalence of underage entry into selling sex and the suboptimal uptake of sexual and reproductive health services among this group, these findings underscore the need to prevent early initiation of selling sex and focus programmatic attention on overcoming barriers to care among those who previously or currently sell sex while underage to prevent HIV, STIs, unintended pregnancies, and negative maternal and child health outcomes.…”

“…[17] In one study, over one quarter of FSW in Guinea-Bissau were living with HIV, compared to about 3.8% among all reproductive-age women. [18] In the same study, FSW under the age of 30 had higher odds of undiagnosed HIV infection than those aged 30 or older. The objective of this research is to examine the prevalence of and factors associated with underage initiation of selling sex among adult FSW in Guinea-Bissau.…”

Trends of HIV Mortality between 2001 and 2018: An Observational Analysis

“…Data from several national surveys from low-income and middle-income countries have shown an increased prevalence of pretreatment HIV drug resistance to non-nucleoside reverse-transcriptase inhibitors. Drug resistance testing is largely not available in low-and middle-income countries and might be contributing to the high mortality despite good ART coverage [24]. Non-HIV-related conditions are also emerging as prominent health concerns in settings where ART is widely available.…”