Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Wamoyi, Joyce; Stobeanau, Kirsten; Bobrova, Natalia; Abramsky, Tanya; Watts, Charlotte

doi:10.7448/ias.19.1.20992

Cited by 175 publications

(156 citation statements)

References 68 publications

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“…Age disparate relationships increase AGYW's susceptibility to HIV acquisition, because older men are more likely to be HIV positive [8,20,21], whilst these partnerships are also characterised by inconsistent condom use [22][23][24] and concurrent sexual partnering [25]. Relationships are also more likely to be transactional in nature [26], which has been demonstrated to also increase HIV acquisition [27]. In addition, AGYW are vulnerable to intimate partner violence (IPV) and dominant male partner behaviours, both of which increase their susceptibility to acquiring HIV [28].…”

Section: Introductionmentioning

confidence: 99%

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

et al. 2020

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Background: Young women in sub-Saharan Africa remain at the epicentre of the HIV epidemic, with surveillance data indicating persistent high levels of HIV incidence. In South Africa, adolescent girls and young women (AGYW) account for a quarter of all new HIV infections. Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy introduced by the United States President's Emergency Plan for AIDS Relief (PEPFAR) aimed at reducing HIV incidence among AGYW in 10 countries in sub-Saharan Africa by 25% in the programme's first year, and by 40% in the second year. This study will assess the change in HIV incidence and reduction in risk associated behaviours that can be attributed to the DREAMS initiative in South Africa, using a population-based cross-sectional survey.Methods: Data will be collected from a household-based representative sample of AGYW (between the ages 12-24 years) in four high prevalence districts (more than 10% of the population have HIV in these districts) in South Africa in which DREAMS has been implemented. A stratified cluster-based sampling approach will be used to select eligible participants for a cross-sectional survey with 18,500, to be conducted over 2017/2018. A questionnaire will be administered containing questions on sexual risk behaviour, selected academic and developmental milestones, prevalence of gender based violence, whilst examining exposure to DREAMS programmes. Biological samples, including two micro-containers of blood and self-collected vulvovaginal swab samples, are collected in each survey to test for HIV infection, HIV incidence, sexually transmitted infections (STIs) and pregnancy. This study will measure trends in population level HIV incidence using the Limiting antigen (LAg) Avidity Enzyme Immuno-Assay (EIA) and monitor changes in HIV incidence. Discussion: Ending the HIV/AIDS pandemic by 2030 requires the continual monitoring and evaluation of prevention programmes, with the aim of optimising efforts and ensuring the achievement of epidemic control. This study will determine the impact DREAMS interventions have had on HIV incidence among AGYW in a 'real world, non-trial setting'.

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Section: Introductionmentioning

confidence: 99%

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

et al. 2020

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“…Besides, exposure to transactional sex practice and engaging in commercial sex work in this study were the reported reproductive health effects of SH. Studies also revealed that there is an association between transactional sex and HIV/STIs [54][55][56][57][58][59]. Participants in this study also mentioned STIs as the effects of SH, and it could be due to the risky nature of this practice.…”

Section: Discussionmentioning

confidence: 57%

Perception, Experiences, Risks, and Effects of Sexual Harassment Among Women Working in Hospitality Workplaces of Bahir Dar City, Northwest Ethiopia: A Qualitative Study

Worke¹,

Debelew²,

Koricha³

2020

Preprint

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Background: Sexual harassment is a public health problem that depends on gender, context, and perceivers ideology. Though it grasped attention worldwide, the perception, experience, risk, and effects of sexual harassment on victims are still uncertain. Mainly, in hospitality workplaces, women employees are disproportionately victims of sexual harassment. However, the issue is at an early stage in low and middle-income countries and Ethiopia in particular. Thus, this study was aimed to explore the perception, experience, perceived risks, and effects of sexual harassment against women working in the hospitality workplaces.Methods: We conducted an exploratory qualitative study from January 1 to August 30, 2019. Data were collected from women employees, managers, cashiers, and customers. We applied a semi-structured focus group and in-depth interview discussion guides. Women employees were selected using the snowball method, and we recruited the key informants purposefully until the data theoretically saturated. Key informants who were supposed to give adequate information to study objectives were selected. The selection process of the key informants was based on their responsibility concerning women working in hospitality workplaces. Data were analyzed via the thematic analysis approach with the help of ATLAS ti version 8.4.24 software package. Results: Forty-five women, five managers, four cashiers, and four customers were included in the study. Perceptions, experiences, perceived risk factors, and consequences of workplace sexual harassment were identified. The majority of the participants lack awareness about workplace sexual harassment. The experiences were verbal, physical, visual, and gender-related forms of sexual harassment. The perceived risk factors of sexual harassment were organization related, customer-related, and victim-related. The consequences were work-related, health-related, and financial and family undermining.Conclusions: Sexual harassment is poorly understood but widely experienced by women working in hospitality workplaces. It was also caused by multiple factors and affected both organizations and individuals. Awareness creation campaigns, pre-service education, and in-service training, prevention, and rehabilitation of the victims are needed. Likewise, organizational policies and strategies should have to be developed and implemented.

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“…HO recommended use of tenofovir-based PrEP in individuals at substantial risk of HIV, e.g., female-sex workers (FSW), men-who-have-sex-with-men (MSM) and vulnerable populations such as adolescent girls and young women (AGYW), particularly those engaged in transactional sex (7)(8)(9), as part of a combination prevention strategy (10). The South African National Department of Health subsequently rolled-out oral PrEP to select FSW sites in 2016 and approved of PrEP and universal test and treat (UTT) for HIV prevention in MSM, serodiscordant couples and AGYW in 2017 (11).…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

Chimbindi

Mthiyane

Zuma

et al. 2020

Preprint

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Introduction: Pre-exposure prophylaxis (PrEP) has the potential to alter the HIV epidemic in South Africa. Between 2016 and 2018 PrEP was rolled-out for 18-24 year-old female-sex workers (FSW) in a rural KwaZulu-Natal subdistrict with very high HIV incidence among adolescent girls and young women (AGYW). Using a ‘framework of access’ model, we describe PrEP access, awareness and uptake for AGYW, including community members’ attitudes towards PrEP for young people.Methods: We enrolled a cohort of 2184 AGYW aged 13-22 living within the subdistrict and quantitatively measured their eligibility, awareness and uptake of PrEP and other HIV prevention interventions in 2017 and 2018. We supplemented this insight with in depth exploration by conducting 19 group discussions with young people and community members, nine stakeholder key informant interviews, 58 in-depth interviews with 15-24 year-olds and 33 with implementing partners, and participatory observations. All interviews were recorded, transcribed and analysed using thematic analysis.Results: PrEP awareness increased from 2% to 9% from 2017 to 2018. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4-15.7%) reported transactional sex and 10.6% (95%CI: 8.8-12.7%) sex for money. Of these latter 194 PrEP-eligible AGYW, 21 were aware of PrEP, but none had ever used it. Wider community members were generally unaware of PrEP but imagined it would benefit young people, HIV-serodiscordant couples and those in long-distance relationships. Youth saw PrEP as a positive alternative to condoms since it “will be in their system” and not get in the way of sex. Teachers and healthcare providers were more apprehensive: worrying that PrEP would lower personal responsibility for sexual health.Conclusions: Although PrEP awareness increased and it was generally acceptable, uptake was low even among eligible AGYW, i.e., who reported FSW activity. Condom use remained undesirable suggesting a need to include PrEP in offers of alternative HIV prevention technologies to comdoms. The targeted nature of public-sector PrEP for FSW may have limited the reach, and the future broader roll-out, of PrEP in this setting. Inclusive approaches to PrEP provision integrated with wider sexual healthmay help improve demand and access to PrEP.

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Transactional sex and risk for HIV infection in sub‐Saharan Africa: a systematic review and meta‐analysis

Cited by 175 publications

References 68 publications

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study

Perception, Experiences, Risks, and Effects of Sexual Harassment Among Women Working in Hospitality Workplaces of Bahir Dar City, Northwest Ethiopia: A Qualitative Study

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

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