Prevalence and predictors of HIV and sexually transmitted infections among vulnerable women engaged in sex work: Findings from the Kyaterekera Project in Southern Uganda

Abstract

Introduction Women engaged in sex work (WESW) have an elevated risk of the human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Estimates are three times higher than the general population. Understanding the predictors of HIV and STI among WESW is crucial in developing more focused HIV and STI prevention interventions among this population. The study examined the prevalence and predictors of HIV and STI among WESW in the Southern part of Uganda. Methodology Baseline data from the Kyaterekera study involving 542 WESW (ages 18–55) recruited from 19 HIV hotspots in the greater Masaka region in Uganda was utilized. HIV and STI prevalence was estimated using blood and vaginal fluid samples bioassay. Hierarchical regression models were used to determine the predictors of HIV and STI among WESW. Results Of the total sample, 41% (n = 220) were found to be HIV positive; and 10.5% (n = 57) tested positive for at least one of the three STI (Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis) regardless of their HIV status. Older age (b = 0.09, 95%CI = 0.06, 0.13, p≤0.001), lower levels of education (b = -0.79, 95%CI = -1.46, -0.11, p≤0.05), fewer numbers of children in the household (b = -0.18, 95%CI = -0.36, -0.01), p≤0.05), location (i.e., fishing village (b = 0.51, 95%CI = 0.16, 0.85, p≤0.01) or small town (b = -0.60, 95%CI = -0.92, -0.28, p≤0.001)), drug use (b = 0.58, 95%CI = 0.076, 1.08, p≤0.05) and financial self-efficacy (b = 0.05, 95%CI = -0.10, 0.00, p≤0.05), were associated with the risk of HIV infections among WESW. Domestic violence attitudes (b = -0.24, 95%CI = -0.42, -0.07, p≤0.01) and financial distress (b = -0.07, 95%CI = -0.14, -0.004, p≤0.05) were associated with the risk of STI infection among WESW. Conclusion Study findings show a high prevalence of HIV among WESW compared to the general women population. Individual and family level, behavioural and economic factors were associated with increased HIV and STI infection among WESW. Therefore, there is a need for WESW focused HIV and STI risk reduction and economic empowerment interventions to reduce these burdens.

Investigating the effects of cytokine biomarkers on HIV incidence: a case study for individuals randomized to pre-exposure prophylaxis vs. control

“…Our analysis identified and reported several baseline predictors such as the age of the oldest sex partner, participant's age at enrollment, earning a salary or not, years with a stable partner, income source, whether the sex partner has other partners, and frequency of sex in the last 30 days as significantly associated with HIV incidence. These findings align with those of other research studies ( 47 – 55 ).…”

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“…Our analysis identified and reported several baseline predictors such as the age of the oldest sex partner, participant's age at enrollment, earning a salary or not, years with a stable partner, income source, whether the sex partner has other partners, and frequency of sex in the last 30 days as significantly associated with HIV incidence. These findings align with those of other research studies (47)(48)(49)(50)(51)(52)(53)(54)(55).…”

Crossroads of Choice: A qualitative study of the factors influencing decisions to transition from sex work among women engaged in sex work in Southern Uganda

“…high prevalence of sexually transmitted infections) ( Cimino, 2012 ; Mazeingia & Negesse, 2020 ), and structural-level challenges (e.g. poverty, stigma and discrimination, gender inequality, physical and sexual violence) ( Kiyingi et al, 2022 ) that exacerbate their risk to HIV infection and other sexually transmitted infections (STIs).…”

“…In Uganda, the focus of this study, sex work continues to be illegal and highly stigmatized ( Schulkind et al, 2016 ) compromising WESW’s ability to have access to resources they may need to successfully navigate the challenges associated with commercial sex work, including exiting sex work. Existing studies among WESW in Uganda primarily focus on HIV and STI prevalence and prevention, risk behaviors among this population, risk factors associated with sex work, and reasons for entry in sex work ( Bahar et al, 2023 ; Kiyingi et al, 2022 ; Nabayinda et al, 2022 , 2023 ). Yet, to our knowledge, no studies have examined the processes and factors related to sex work exit.…”