High HIV and syphilis prevalence among female sex workers in Juba, South Sudan

Abstract

HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country's epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged �15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7-6.1) or Kenya (aOR: 4.3, 95% CI: 1.5-13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan's HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.

Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa

“…In South Sudan, an estimated prevalence of HIV in the adult (15-49 years old) population is 2.7% (26), and in some locations, the rate is as high as 6.8% (27). The prevalence of HIV among pregnant women in Sudan was 0.4% compared to 1.0% in the general population (28).…”

Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan

“…But HIV prevalence by country was second highest among FSW in South Sudan (17.3% [95% CI: 8.7-28.1%]) after Djibouti (17.9%). FSW in Juba, the capital of South Sudan had high HIV prevalence of 37.8% [7].…”

“…The FSW in Juba were diverse in nationality [7], including Ugandans (39.8%), South Sudanese (34.8%), Congolese (20.7%), and Kenyans (4.4%). The median age of FSW in Juba was 29 years (interquartile range [IQR], 25-34 years) [7].…”

“…The FSW in Juba were diverse in nationality [7], including Ugandans (39.8%), South Sudanese (34.8%), Congolese (20.7%), and Kenyans (4.4%). The median age of FSW in Juba was 29 years (interquartile range [IQR], 25-34 years) [7]. The HIV prevalence in FSW and sexually exploited adolescents compared to female adolescents and women aged 15-49 years in the general population was 14.0 times higher in Juba and 13.5 times higher in Sub-Saharan Africa [8].…”

“…Empowering FSW with knowledge about HIV and explaining their high risk of HIV acquisition can motivate FSW to test for HIV [11]. However, only 12.5% (95% CI: 10.1-14.9%) of FSW in Juba had comprehensive knowledge of HIV [7] compared to 53.2% (95% CI: 49.6-56.5%) of FSW in Rwanda [17]. Although about three-quarters (78.8%) of FSW in Juba reported having tested for HIV, only 63.2% of 333 HIV-positive FSW knew their HIV status [7].…”