Background Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. Methods We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. Results The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. Conclusions This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.

Background and Aims: Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. The study examined the prevalence and the associated factors of multiple indicators of violence against FSWs. Methods: The study utilized a cross-sectional secondary data from the 2015 Integrated Bio-Behavioral Surveillance Survey conducted among FSWs and their nonpaying partners by Ghana AIDS Commission. We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15. Results: Of the 4279 FSWs, 433 (10%) and 1059 (25%) suffered physical and sexual violence, respectively. The predictors of physical violence are being a seater

Background: Violence against female sex workers (FSWs) is a widespread phenomenon primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing services and heightens their risk of STIs including HIV infection. Consequently, it is expedient to understand the prevalence and the underlying factors that influence the multiple indicators of violence against FSWs to inform the design and implementation of effective remedial interventions.Objective: This study sought to assess the prevalence and associated factors of physical and sexual violence against FSWs in Ghana.Method: The study used secondary data from the 2015 Integrated Bio-Behavioural Surveillance Survey (IBBSS) among FSWs and their non-paying partners conducted by Ghana AIDS Commission (GAC). Bivariate, and multiple logistic regression analyses were done to establish factors associated with physical and sexual violence against FSWs. Statistical significance was set at a p-value<0.05.Results: The study established the prevalence of physical and sexual violence as 10.1% and 24.8% respectively. Physical violence was perpetrated mainly by first-time paying clients (50.6%) and regular paying clients (31.0%). A similar trend was reported for sexual violence. As established by the study, the predictors of physical violence are type of FSW (p-value<0.01), current age of FSW (p-value=0.02), (geographical) region of residence (p-value<0.01), whether FSW had ever used drugs in the past one year (<0.01) and whether FSW had ever used alcohol before sex in the past six months preceding the survey (p-value<0.01). Sexual violence on the other hand was predicted by current age of FSW (p-value=0.02), marital status (p-value<0.01), number of living children (p-value=0.04), where FSWs take clients for sex (p-value <0.01), (geographical) region of residence (p-value<0.01), history of drug use (p-value <0.01), and history of alcohol use (p-value<0.01). Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs.Conclusion: Physical and sexual violence against FSWs is pervasive in Ghana and it is influenced by many factors. There is the need for tailored interventions to address the menace in order to enhance FSWs’ ability to access health care services and to use condoms consistently.

Background and Aims:Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. The study examined the prevalence and the associated factors of multiple indicators of violence against FSWs. Methods: The study utilised a cross-sectional secondary data from the 2015 Integrated Bio-Behavioural Surveillance Survey (IBBSS) conducted among FSWs and their non-paying partners by Ghana AIDS Commission (GAC). We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15. Results: The prevalence of physical and sexual violence were 10% and 25% respectively. Physical violence was perpetrated mainly by first-time paying clients (51%) and regular paying clients (31%) with similar trend observed for sexual violence. The predictors of physical violence are being a seater (aOR=0.53, 95%CI: 0.36-0.74), aged ≥40 (aOR=0.23, 95%CI: 0.08-0.64), non-use of drugs (aOR=0.56, 95%CI: 0.44-0.70), and not using alcohol before sex (aOR=0.69, 95%CI: 0.56-0.86). Sexual violence was predicted by those aged age 31-40 (aOR=0.68, 95%CI: 0.49-0.94) and age≥40 (aOR=0.38, 95%CI: 0.22-0.66), currently married (aOR=0.42, 95%CI: 0.27-0.67), having no living children (aOR=0.69, 95%CI: 0.51-0.94), non-use of drugs (aOR=0.80, 95%CI: 0.68-0.94), and not using alcohol before sex (aOR=0.74, 95%CI: 0.63-0.86). Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs. Conclusion: Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace.

Background Violence against female sex workers (FSWs) is a widespread phenomenon, especially in African nations like Ghana where sex work is outlawed primarily because of the pervasive worldview that sex work is a contravention of morality. Violence against FSWs deters them from accessing critical health services and heightens their risk of STIs including HIV infection. To address this important issue, it is expedient to understand the prevalence and the associated factors of multiple indicators of violence against FSWs to inform evidence-based and urgent targeted public health policy and intervention strategies. Method The study utilised a cross-sectional secondary data from the 2015 Integrated Bio-Behavioural Surveillance Survey (IBBSS) conducted among FSWs and their non-paying partners by Ghana AIDS Commission (GAC). We analysed data on a total of 4279 participants. Bivariate, and multivariable logistic regression analyses were utilized to identify factors associated with physical and sexual violence against FSWs. Data were analysed using Stata version 15. Results The study found the prevalence of physical and sexual violence as 10.1% and 24.8% respectively. Physical violence was perpetrated mainly by first-time paying clients (50.6%) and regular paying clients (31.0%) with similar trend observed for sexual violence. The predictors of physical violence are being a seater (aOR=0.53, 95%CI: 0.36-0.74), aged ≥40 (aOR=0.23, 95%CI: 0.08-0.64), non-use of drugs (aOR=0.56, 95%CI: 0.44-0.70), and not using alcohol before sex (aOR=0.69, 95%CI: 0.56-0.86). Sexual violence was predicted by those aged age 31-40 (aOR=0.68, 95%CI: 0.49-0.94) and age≥40 (aOR=0.38, 95%CI: 0.22-0.66), currently married (aOR=0.42, 95%CI: 0.27-0.67), having no living children (aOR=0.69, 95%CI: 0.51-0.94), non-use of drugs (aOR=0.80, 95%CI: 0.68-0.94), and not using alcohol before sex (aOR=0.74, 95%CI: 0.63-0.86). Region and other source of income were associated with both physical and sexual violence. Both physical and sexual violence had negative consequences on consistency of condom use and condom failure among FSWs. Conclusion Physical and sexual violence against FSWs is pervasive, and a critical public health issue in Ghana. The identified associated factors could be considered as part of an overall strategy aimed at addressing the menace. Further studies are warranted to devise multisectoral approaches for appropriate policy and intervention strategies aimed at regulating the practice.