HIV testing and its associated factors among street-based female sex workers in Iran: results of a national rapid assessment and response survey

Ahmadi, Sina; Khezri, Mehrdad; Roshanfekr, Payam; Karimi, Salah Eddin; Vameghi, Meroe; Ali, Delaram; Ahounbar, Elahe; Noroozi, Mehdi; Shokoohi, Mostafa

doi:10.1186/s13011-021-00382-x

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…These findings align with results from studies conducted in Iran, China and Uganda where only 57.8%, 68.3% and 56% of FSWs had tested for HIV [15][16][17]. Furthermore, in Canada, approximately 57.9% of FSWs tested for HIV and /or STIs with 45.5% and 44.9% of FSWs reported HIV and STI testing respectively and only 32.6% reported screening for both [18].…”

Section: Discussionsupporting

confidence: 86%

“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda

Bongomin,

Kibone,

Pebolo

et al. 2023

Venereology

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Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging health-risk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility, empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population.

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Section: Discussionsupporting

confidence: 86%

“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda

Bongomin,

Kibone,

Pebolo

et al. 2023

Venereology

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“…We found that HIV testing dropped significantly among FSWs in 2020 compared to the 70.1% reported for 2015 [ 9 ]. The results of another study among FSWs in 2017 reported that about half of FSWs tested for HIV in a lifetime [ 10 ]. Some of these differences may be due to the different sampling methods for recruiting participants in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…There is a big gap between the current HIV diagnosis rates in Iran [4,9,10] and the UNAIDS 95-95-95 targets for HIV diagnosis [9]. HIV testing can be associated with HIV risk perception, awareness of HIV test, age at sex work initiation, receiving free-of-charge harm reduction services, unstable housing, drug use, the level of income, incarceration history, having paying and non-paying partners, and knowing an HIV testing site [4,[9][10][11]. The HIV testing uptake was 70.1% among (FSWs) in Iran in 2015.…”

Section: Introductionmentioning

confidence: 99%

HIV testing and its associated factors among female sex workers in Iran in 2020: Finding from a respondent-driven sampling survey

Tavakoli,

Moradi,

Mirzazadeh

et al. 2023

PLoS ONE

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HIV testing uptake was around 70% among female sex workers (FSWs) in Iran in 2015. Due to the recognized importance of HIV testing in prevention, care, and treatment among FSWs, this study aimed to provide an update and also an improvement as it uses respondent-driven sampling (RDS) for the frequency and the correlates of HIV testing among FSWs in Iran. A total of 1,515 FSWs were recruited from eight cities in Iran between 2019–2020 using RDS. Data were collected using face-to-face interviews. Also, rapid diagnostic tests (RDT) were used to determine HIV and syphilis status as per national guidelines. We used multivariable logistic regression to explore correlates of HIV testing in the last 12 months. Of 1,399 FSWs who had data for HIV testing, 44.7% (95% Confidence Intervals (CI): 40.7; 48.7) reported HIV testing in the last 12 months. The odds of HIV testing in the last 12 months was higher among FSWs who used a condom at last sex with a non-paying partner (Adjusted OR = 1.78; 95% CI: 1.39; 2.27), never used alcohol (Adjusted OR = 1.72; 95% CI: 1.33; 2.23), ever used drug (Adjusted OR = 1.60; 95% CI: 1.22; 2.08). HIV testing among FSWs in Iran is considerably low. It is necessary to know the barriers to HIV testing to improve the cascade of HIV treatment in the country.

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“…Their results showed that the prevalence of HIV-positive among FSWs in 50 low-income countries was 11.8%, which was higher than the prevalence found in the present study. In the study by Ahmadi et al, 57.8% (95% CI: 20–88) of participants reported being tested for HIV, and HIV prevalence among FSWs who were tested for HIV was 10.3% (95% CI: 7.5–13) [ 22 ]. In the Netherlands, an overall HIV prevalence of 3.8% was reported, but this was significantly higher among women with a history of injecting drug use (13.6%) than among women without drug use (1.5%) [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…They are highly vulnerable to HIV infection because they engage in risky behaviors such as multiple sexual partners, high prevalence of other sexually transmitted infections (STIs), high use of injectable or non-injectable drug use, inconsistent condom use, or non-use during sexual contact, etc. [ 4 , 5 ]. In a 2019 meta-analysis, 37 eligible original articles published between 2010 and 2017 reported HIV prevalence at 2.17% in 46,657 FSWs.…”

Section: Introductionmentioning

confidence: 99%

HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020

et al. 2022

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Despite the overall decline in human immunodeficiency virus (HIV) prevalence, it remains unacceptably high in key populations. This study aimed to estimate prevalence of HIV infection and high-risk behaviors among female sex workers (FSWs). This study was a cross-sectional survey of FSWs conducted between December 2019 and August 2020 in eight geographically diverse cities in Iran. After providing informed consent, participants completed a bio-behavioral questionnaire and after completion of the interview, rapid diagnostic tests (RDT) and dried blood spots (DBS) were collected to determine HIV and syphilis status as per national guidelines, if the women consented. All analyzes were based on RDS adjustment. Weighting was done according to Giles’SS estimator. Among the 1515 FSWs, the overall prevalence of HIV and syphilis were 1.6% (95% CI: 0.8–2.3) and zero, respectively. The highest HIV prevalence was observed in Shiraz (5.1%) and Khorramabad city (1.6%). In addition, HIV-positive FSWs had a higher mean age at first sexual contact than HIV-negative FSWs (21.4 ± 5.6 vs. 17.2 ± 4.2 years). Injection drug use and a history of arrest or incarceration were associated with an increased odds of HIV infection (OR = 6.25; 95% CI: 1.90-20.55 and OR = 4.57; 95% CI: 1.64–12.72, respectively). Based on the results, strategies to improve early HIV diagnosis, harm reduction, and use of testing and treatment strategies are needed to reduce and control HIV infections.

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HIV testing and its associated factors among street-based female sex workers in Iran: results of a national rapid assessment and response survey

Cited by 7 publications

References 29 publications

“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda

“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda

HIV testing and its associated factors among female sex workers in Iran in 2020: Finding from a respondent-driven sampling survey

HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020

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