War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda

Goldenberg, Shira M.; Muzaaya, Godfrey; Akello, Monica; Nguyen, Paul; Birungi, Josephine; Shannon, Kate

doi:10.1097/qai.0000000000001030

Cited by 15 publications

(32 citation statements)

References 47 publications

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“…Women who have a history of incarceration may be further marginalized and have reduced access to reproductive health services. Incarceration is hypothesized to be associated with HIV acquisition [2] , [13] . Pathways that lead from incarceration to increased HIV acquisition may be similar to those for pregnancy outcomes, and include marginalization and reduced access to healthcare.…”

Section: Discussionmentioning

confidence: 99%

Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Chanda¹,

Ortblad

Mwale³

et al. 2017

Contraception

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ObjectivesAccess to reproductive healthcare, including contraceptive services, is an essential component of comprehensive healthcare for female sex workers (FSW). Here, we evaluated the prevalence of and factors associated with contraceptive use, unplanned pregnancy, and pregnancy termination among FSW in three transit towns in Zambia.Study designData arose from the baseline quantitative survey from a randomized controlled trial of HIV self-testing among FSW. Eligible participants were 18 years of age or older, exchanged sex for money or goods at least once in the past month, and were HIV-uninfected or status unknown without recent HIV testing (<3 months). Logistic regression models were used to assess factors associated with contraceptive use and unplanned pregnancy.ResultsOf 946 women eligible for this analysis, 84.1% had been pregnant at least once, and among those 61.6% had an unplanned pregnancy, and 47.7% had a terminated pregnancy. Incarceration was associated with decreased odds of dual contraception use (aOR=0.46, 95% CI 0.32–0.67) and increased odds of unplanned pregnancy (aOR=1.75, 95% CI 1.56–1.97). Condom availability at work was associated with increased odds of using condoms only for contraception (aOR=1.74, 95% CI 1.21–2.51) and decreased odds of unplanned pregnancy (aOR=0.63, 95% CI 0.61–0.64).ConclusionsFSW in this setting have large unmet reproductive health needs. Structural interventions, such as increasing condom availability in workplaces, may be useful for reducing the burden of unplanned pregnancy.

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Section: Discussionmentioning

confidence: 99%

Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Chanda¹,

Ortblad

Mwale³

et al. 2017

Contraception

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“…2 Similarly, knowledge of status has been reported to be low in other regions of Sub-Saharan Africa among FSWs. 3,4 Interventions to improve HIV testing coverage for FSWs are warranted, the development of such interventions must include an understanding of existing barriers and facilitators to HIV testing from the perspective of this vulnerable community.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs

Chanda¹,

Perez-Brumer

Ortblad

et al. 2017

AIDS Patient Care and STDs

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Zambia has a generalized HIV epidemic, and HIV is concentrated along transit routes. Female sex workers (FSWs) are disproportionately affected by the epidemic. HIV testing is the crucial first step for engagement in HIV care and HIV prevention activities. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. FSW peer educators were recruited through existing sex worker organizations for participation in a trial related to HIV testing among FSWs. We conducted five focus groups with FSW peer educators (N = 40) in three transit towns in Zambia (Livingstone, Chirundu, and Kapiri Mposhi) to elicit community norms related to HIV testing. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier. Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.

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“…The economic, social and political instability of conflict and post-conflict environments, including social and physical displacement, loss of traditional economic options, cultural upheaval, family separation and increased women-headed households, often result in conditions that facilitate significant engagement in sex work as a source of income, particularly for women. Further, armed conflict and the highly policed and militarized environment characteristic of post conflict have been linked to widespread gender-based violence (including rape as a weapon of war; forced abductions), rights violations of women [ 3 , 11 – 17 ], and reduced access to, or the interruption of, HIV and sexual and reproductive health (SRH) programmes [ 4 , 18 – 21 ]. For example, previous research has shown that within conflict settings, the interruption of condom distribution, disruption of HIV diagnostic services, and shortages of HIV antiretroviral therapy (ART) may drastically impede diagnosis and care [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent global review identified a critical need for further studies examining structural HIV/STI risks or access to care for sex workers in the highest-HIV burden countries [ 9 ], to inform the design, adaptation and implementation of effective HIV/STI programmes, particularly needed within conflict-affected settings of sub-Saharan Africa. While sex workers are often highly marginalized even in non-conflict settings, in conflict-affected environments they may face elevated social and structural risks and barriers to care, including abuses of human rights by military and police, gender-based inequities, widespread violence, discrimination and stigma, social and physical isolation, breakdowns in health service delivery systems, and other structural risks that often accompany or follow a crisis [ 11 , 14 , 26 , 28 , 29 ]. Despite this, little is known about conflict-affected sex workers’ vulnerability to HIV/STIs or access to HIV and SRH services, or their social and structural drivers within conflict-affected settings.…”

Section: Introductionmentioning

confidence: 99%

A comprehensive review of HIV/STI prevention and sexual and reproductive health services among sex Workers in Conflict-Affected Settings: call for an evidence- and rights-based approach in the humanitarian response

et al. 2017

Self Cite

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BackgroundWhile the conditions in emergency humanitarian and conflict-affected settings often result in significant sex work economies, there is limited information on the social and structural conditions of sex work in these settings, and the impacts on HIV/STI prevention and access to sexual and reproductive health (SRH) services for sex workers. Our objective was to comprehensively review existing evidence on HIV/STI prevention and access to SRH services for sex workers in conflict-affected settings globally.MethodsWe conducted a comprehensive review of all peer review (both epidemiological and qualitative) and grey literature published in the last 15 years (2000–2015), focusing on 1) HIV/STI vulnerability or prevention, and/or 2) access to SRH services for sex workers in conflict-affected settings. Five databases were searched, using combinations of sex work, conflict/mobility, HIV/STI, and SRH service terms. Relevant peer-reviewed and grey literature were also hand-searched, and key papers were cross-referenced for additional material.ResultsFive hundred fifty one records were screened and 416 records reviewed. Of 33 records describing HIV/STI prevention and/or access to SRH services among sex workers in conflict-affected settings, 24 were from sub-Saharan Africa; 18 studies described the results of primary research (13 quantitative, 3 qualitative, 2 mixed-methods) and 15 were non-primary research (e.g., commentaries, policy reports, programmatic manuals). Available evidence indicated that within conflict-affected settings, SWs’ capacity to engage in HIV/STI prevention and access SRH services is severely undermined by social and structural determinants including widespread violence and human rights violations, the collapse of livelihoods and traditional social structures, high levels of displacement, and difficulties accessing already scant health services due to stigma, discrimination and criminalization.Discussion/ConclusionsThis review identified significant gaps in HIV/STI and SRH research, policy, and programming for conflict-affected sex workers, highlighting a critical gap in the humanitarian response. Sex worker-informed policies and interventions to promote HIV/STI prevention and access to HIV and SRH services using a rights-based approach are recommended, and further research on the degree to which conflict-affected sex workers are accessing HIV/STI and SRH services is recommended.A paradigm shift from the behavioural and biomedical approach to a human rights-based approach to HIV/STI prevention and SRH is strongly recommended.

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War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda

Cited by 15 publications

References 47 publications

Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Contraceptive use and unplanned pregnancy among female sex workers in Zambia

Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs

A comprehensive review of HIV/STI prevention and sexual and reproductive health services among sex Workers in Conflict-Affected Settings: call for an evidence- and rights-based approach in the humanitarian response

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