Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent-driven sampling surveys across Zimbabwe, 2013

Hargreaves, James; Busza, Joanna; Mushati, Phillis; Fearon, Elizabeth; Cowan, Frances M

doi:10.1080/09540121.2016.1268673

Cited by 48 publications

(49 citation statements)

References 35 publications

(34 reference statements)

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“…HIV prevalence among FSWs remains three to four times higher than that of women aged 15 to 49 in Zimbabwe's general female population, which was 17.7% in 2011 and 16.6% in 2015 . This is consistent with other studies showing HIV prevalence as high as 50% to 60% among FSWs . Observed changes in HIV prevalence, while adjusted for socio‐demographic differences of the samples in 2011 and 2015, could have been affected by changes in incidence and in the proportion successfully initiated and sustained on treatment, and subject to unmeasured confounding.…”

Section: Discussionsupporting

confidence: 91%

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Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015

et al. 2018

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Introduction‘Sisters with a Voice’, Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation.MethodsWe used mixed methods to collect data at three sites: in‐depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer‐administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS‐1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education.Results870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio‐demographic differences, we found higher estimates of the proportion of HIV‐positive FSWs and HIV‐positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV‐negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites.ConclusionsImprovements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90‐90‐90 targets.

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Section: Discussionsupporting

confidence: 91%

“…For these models, we dropped the seeds and weighted data by the inverse of reported network size, normalized by year so changes in differences in network size by year would not affect results. This approach is in line with other regression analyses using RDS data .…”

Section: Methodssupporting

confidence: 84%

Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015

et al. 2018

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“…5–8 For FSWs in particular, stigma may be a particularly salient barrier. 6,9,10 FSWs may experience both HIV-related and sex work-related stigma operating in tandem and/or cumulatively. 10–12 Stigma has been broadly defined as negative attitudes, relative powerlessness, and loss of status related to membership in a particular group or characteristic.…”

Section: Introductionmentioning

confidence: 99%

“…6,9,10 FSWs may experience both HIV-related and sex work-related stigma operating in tandem and/or cumulatively. 10–12 Stigma has been broadly defined as negative attitudes, relative powerlessness, and loss of status related to membership in a particular group or characteristic. Stigma can be experienced as enacted (explicit actions against an individual), perceived (such as the expectation that enacted stigma will occur), or internalized or self-stigma (the internalization of enacted and perceived stigma that results in negative attitudes about the self).…”

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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“…Participants described how fear of stigma and discrimination could act as a barrier to linkage to HIV care or lead to delays in deciding to visit an HIV care and treatment facility after an HIV diagnosis. FSWs often face multiple levels of stigma related to the social and structural context of sex work (19, 22, 23) or as a result of household illness (24). Thus, it is not surprising that stigma and discrimination continue and perhaps increasing among FSWs living with HIV.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

Nyato

Nnko

Komba³

et al. 2019

Preprint

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BackgroundHIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.MethodsWe conducted 21 focus group discussions (FGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.ResultsInfluences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.ConclusionFindings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

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Overlapping HIV and sex-work stigma among female sex workers recruited to 14 respondent-driven sampling surveys across Zimbabwe, 2013

Abstract: Hargreaves, J.R.; Busza, J.; Mushati, P.; Fearon, E.; Cowan, F.M. (2016)

Cited by 48 publications

References 35 publications

Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015

Changes in engagement in HIV prevention and care services among female sex workers during intensified community mobilization in 3 sites in Zimbabwe, 2011 to 2015

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

Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

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