Sustained Changes in Sexual Behavior by Female Sex Workers After Completion of a Randomized HIV Prevention Trial

Ngugi, Elizabeth; Chakkalackal, Michelle; Sharma, Anjali; Bukusi, Elizabeth A.; Njoroge, Betty; Kimani, Joshua; MacDonald, Kelly S.; Bwayo, Job J.; Cohen, Craig R.; Moses, Stephen; Kaul, Rupert

doi:10.1097/qai.0b013e3180f616db

Cited by 33 publications

(43 citation statements)

References 24 publications

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“…However, reported condom use was significantly lower with primary partners even though women were unlikely to know any partners' HIV status, suggesting that FSW were still unable to negotiate condom use with long-term partners or did not want to use condoms perhaps because these partners are considered less risky. 17 Such partner-specific condom use has been seen in other FSW and female cohorts in a variety of settings [18][19][20] and supports the concept that HIV prevention methods that are controlled by or can be detected by male partners may not be feasible for women in primary partnerships. Completely discrete intravaginal products, oral preexposure prophylaxis, or vaccines may be the only types of methods that can overcome this barrier.…”

Section: Discussionmentioning

confidence: 85%

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Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Priddy

Wakasiaka

Hoang

et al. 2011

AIDS Research and Human Retroviruses

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Multiple intravaginal HIV prevention methods, including microbicide gels, barriers, and intravaginal rings, are in clinical development in Africa. Development of intravaginal HIV prevention products requires an understanding of sexual behavior, sexually transmitted infection (STI), and vaginitis prevalences, and sexual and vaginal practices in potential target populations. We assessed these factors in a cohort of Kenyan female sex workers (FSW). Women who reported exchanging sex for money/gifts at least three times in the past month and who were HIV uninfected were enrolled and followed for 6 months. STI prevalence and HIV incidence were analyzed by multivariate logistic regression analysis, controlling for demographic and behavioral factors. Thirtyseven percent (74/200) reported having had anal sex. Frequency of anal sex was higher with regular and casual partners than with primary partners. Women were less likely to use condoms for anal sex than for vaginal sex with regular or casual partners. Vaginal washing was universal (100%). HIV incidence was 5.6 per 100 personyears (95% CI 1.62, 11.67). HIV incidence was not associated with any demographic or risk behavior. The relatively high rate of anal sex and universal vaginal washing may complicate both safety and efficacy evaluation of intravaginal products and should be taken into account in trial design. This FSW population had significant HIV incidence and needs continued HIV prevention interventions.

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Section: Discussionmentioning

confidence: 85%

“…14,20,22,24 However, the cohort described here is particularly relevant for biomedical HIV prevention trials because of the high HIV incidence observed. Recent studies of HIV incidence in FSW cohorts in other areas of Nairobi have found lower incidence rates that would not support participation in efficacy trials.…”

Section: Discussionmentioning

confidence: 99%

Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Priddy

Wakasiaka

Hoang

et al. 2011

AIDS Research and Human Retroviruses

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“…G. Williams et al, 2003) in consistent condom use. Increase in condom use for different FSW partner types was measured in some studies and consistent condom use was less with intimate partners of FSWs (boyfriends and non-paying regular partners) than with paying clients (Feldblum et al, 2005;Nagot et al, 2005;Ngugi et al, 2007;Odek et al, 2009;Raul et al, 2002;Ray et al, 2001;Steen et al, 2000;Thomsen et al, 2006;Wechsberg et al, 2006). Considerable loss to follow-up was reported in some of the studies with a few showing high attrition rates of greater than 50% (Feldblum et al, 2005;Ngugi et al, 2007;Ray et al, 2001;Walden et al, 1999;B.…”

Section: Effectivenessmentioning

confidence: 99%

“…Twelve studies combined various methods for the delivery of condom use messages (Asamoah-Adu et al, 1994;Carney, Petal, Petersen, & Parry, 2016;Feldblum et al, 2005;Ghys et al, 2002;Lutchters et al, 2008;Nagot et al, 2005;Ngugi et al, 2007;Ngugi, Wilson, Sebstad, Plummer, & Moses, 1996;Odek et al, 2009;Parcesepea et al, 2016;Pickering, Quigley, Pépin, Todd, & Wilkins, 1993 ;B. G. Williams et al, 2003;E.…”

Section: Effectivenessmentioning

confidence: 99%

Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

Okafor

Crutzen

Aduak

et al. 2017

African Journal of AIDS Research

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“…All studies report that sex workers who do use contraception resort most often to condoms yet the latter are not consistently used in all sex acts 3,[5][6][7][8][9] . FSWs may have difficulties in negotiating the consistent use of condoms with clients, and also may deliberately use condoms with some types of partners (such as casual clients) while deliberately not using condoms with other types of partners (such as emotional partners or regular clients) 10 . The consistency of condom use is a critical consideration when evaluating its role in reducing unmet need for contraception, not to mention HIV/ STI prevention.…”

Section: Introductionmentioning

confidence: 99%

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

Sutherland

Alaii²,

Tsui

et al. 2011

The European Journal of Contraception & Reproductive Health

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A B S T R A C TBackground and objectives Female sex workers (FSWs) are thought to be at heightened risk for unintended pregnancy, although sexual and reproductive health interventions reaching these populations are typically focused on the increased risk of sexually transmitted infections. The objective of this study of FSWs in Kenya is to document patterns of contraceptive use and unmet need for contraception. Methods This research surveys a large sample of female sex workers (N ¼ 597) and also uses qualitative data from focus group discussions. Results The reported level of modern contraceptives in our setting was very high. However, like in other studies, we found a great reliance on male condoms, coupled with inconsistent use at last sex, which resulted in a higher potential for unmet need for contraception than the elevated levels of modern contraceptives might suggest. Dual method use was also frequently encountered in this population and the benefits of this practice were clearly outlined by focus group participants. Conclusion These findings suggest that the promotion of dual methods among this population could help meet the broader reproductive health needs of FSWs. Furthermore, this research underscores the necessity of considering consistency of condom use when estimating the unmet or undermet contraceptive needs of this population.

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Sustained Changes in Sexual Behavior by Female Sex Workers After Completion of a Randomized HIV Prevention Trial

Abstract: Less intensive community-based risk reduction services after clinical trial termination may support ongoing reductions in STIs and HIV among high-risk FSWs.

Cited by 33 publications

References 24 publications

Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

Contraceptive needs of female sex workers in Kenya – A cross-sectional study

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