Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys

Budu, Eugene; Seidu, Abdul‐Aziz; Hagan, John Elvis; Agbaglo, Ebenezer; Hormenu, Thomas; Schack, Thomas; Yaya, Sanni

doi:10.1371/journal.pone.0236552

Cited by 10 publications

(6 citation statements)

References 55 publications

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“…Improving access to treatment for men who pay for sex is especially important as, from 2010 onwards, only 68% of men used a condom the last time they paid for sex. A recent analysis of 29 DHS surveys from 2010-2019 found that, among men who reported condom use at their last paid sex, 84% reported consistent condom use during paid sex [43], which is higher than our estimates. Since the survey instruments only asked about consistent condom use if men reported condom use at last paid sex, we would expect consistent condom use measures to be higher.…”

Section: Plos Medicinecontrasting

confidence: 96%

Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000–2020): A meta-analysis of 87 population-based surveys

et al. 2022

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Background Key populations, including sex workers, are at high risk of HIV acquisition and transmission. Men who pay for sex can contribute to HIV transmission through sexual relationships with both sex workers and their other partners. To characterize the population of men who pay for sex in sub-Saharan Africa (SSA), we analyzed population size, HIV prevalence, and use of HIV prevention and treatment. Methods and findings We performed random-effects meta-analyses of population-based surveys conducted in SSA from 2000 to 2020 with information on paid sex by men. We extracted population size, lifetime number of sexual partners, condom use, HIV prevalence, HIV testing, antiretroviral (ARV) use, and viral load suppression (VLS) among sexually active men. We pooled by regions and time periods, and assessed time trends using meta-regressions. We included 87 surveys, totaling over 368,000 male respondents (15–54 years old), from 35 countries representing 95% of men in SSA. Eight percent (95% CI 6%–10%; number of surveys [Ns] = 87) of sexually active men reported ever paying for sex. Condom use at last paid sex increased over time and was 68% (95% CI 64%–71%; Ns = 61) in surveys conducted from 2010 onwards. Men who paid for sex had higher HIV prevalence (prevalence ratio [PR] = 1.50; 95% CI 1.31–1.72; Ns = 52) and were more likely to have ever tested for HIV (PR = 1.14; 95% CI 1.06–1.24; Ns = 81) than men who had not paid for sex. Men living with HIV who paid for sex had similar levels of lifetime HIV testing (PR = 0.96; 95% CI 0.88–1.05; Ns = 18), ARV use (PR = 1.01; 95% CI 0.86–1.18; Ns = 8), and VLS (PR = 1.00; 95% CI 0.86–1.17; Ns = 9) as those living with HIV who did not pay for sex. Study limitations include a reliance on self-report of sensitive behaviors and the small number of surveys with information on ARV use and VLS. Conclusions Paying for sex is prevalent, and men who ever paid for sex were 50% more likely to be living with HIV compared to other men in these 35 countries. Further prevention efforts are needed for this vulnerable population, including improved access to HIV testing and condom use initiatives. Men who pay for sex should be recognized as a priority population for HIV prevention.

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Section: Plos Medicinecontrasting

confidence: 96%

Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000–2020): A meta-analysis of 87 population-based surveys

et al. 2022

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“…For sex workers that obtain an income and have control over that income, they can be considered financially autonomous. Yet their power to negotiate safer sex practices may vary and may be dependent upon client demographics such as age and wealth quintile (Ahinkorah et al, 2020). Further, it is not uncommon for sex workers to be subject to physical violence in Zambia (Malama et al, 2019), dismissing any ability to negotiate the terms of engagement.…”

Section: Discussionmentioning

confidence: 99%

Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia

Bermudez

Mulenga

Mathur

2021

Global Public Health

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Objectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15-24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability.

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“…(19) Additionally, a pooled analysis of Demographic and Health Survey data from 29 sub-Saharan African countries found that consistent condom use among men paying for sex was overall high, 84.0% (CI: 80.4-87.6), but varied by demographic characteristics. (20) High levels of condom use with sex workers may help to partially explain this unanticipated nding; however, additional research is needed to further explore this association in this setting.…”

Section: Discussionmentioning

confidence: 99%

Prospective Longitudinal Study of Men Who Have Sex With Men and Transgender Women To Determine HIV Incidence in Two Provinces in Thailand

Namwat¹,

Leela-Apiradee

Tiawilai³

et al. 2021

Preprint

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Background In Thailand, HIV transmission is well characterized in large urban centers such as Bangkok and Chiang Mai but less so outside of these areas. We assessed HIV incidence and associated risk factors in two other locations. Methods Participants assigned male sex at birth were enrolled in Nakhon Ratchasima and Ratchaburi. HIV and syphilis testing and sociobehavioral questionnaires occurred over 18 months. HIV incidence rates and 95% confidence intervals (CIs) were estimated using a Poisson distribution. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% CIs for associations between potential risk factors and HIV seroconversion. Results A total of 1003 participants were enrolled. Overall HIV incidence was 1.56 per 100 person-years (95% CI:1.02–2.44) and similar at both sites. In the fully adjusted model, receptive anal sex in the past 6 months was associated with seroconversion (aHR:3.05, 95% CI:1.00-9.32), while sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.11, 95% CI:0.01–0.80). In the parsimoniously adjusted model, receptive anal sex (aHR:3.35, 95% CI:1.30–8.63) and STI diagnosis in the past six months (aHR:3.39, 95% CI:1.11–10.29) were associated with seroconversion, while sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.12, 95% CI:0.02–0.70). Conclusions Recent receptive anal sex practices were associated with HIV acquisition in these populations, highlighting the continued need for interventions encouraging safer anal sex practices to reduce HIV incidence.

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Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys

Cited by 10 publications

References 55 publications

Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000–2020): A meta-analysis of 87 population-based surveys

Population sizes, HIV prevalence, and HIV prevention among men who paid for sex in sub-Saharan Africa (2000–2020): A meta-analysis of 87 population-based surveys

Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia

Prospective Longitudinal Study of Men Who Have Sex With Men and Transgender Women To Determine HIV Incidence in Two Provinces in Thailand

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