Trends in Transactional Sex Among Women at Risk for HIV in Rural Kenya During the First Year of the COVID-19 Pandemic

Richterman, Aaron; Bosire, Risper; Marcus, Noora; Bair, Elizabeth F.; Agot, Kawango; Thirumurthy, Harsha

doi:10.1001/jamanetworkopen.2022.20981

Cited by 5 publications

(6 citation statements)

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“…While this has been associated with decreased interest and willingness to use PrEP as well as general PrEP adherence in other studies ( 25 , 26 ), we found little change in HIV prevention interest likely due to the nature of participation in the studies. Economic strains increased frequency of sex work for a few participants, though the total number of transactional sex partners reported decreased overall as found in similar studies among women at risk for HIV ( 27 ). AGYW also mentioned decreases in alcohol use since bars were closed and large groups were not able to gather due to COVID-19 restrictions.…”

Section: Discussionsupporting

confidence: 68%

The impact of COVID-19 on sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors among trial participants in Malawi, South Africa, Uganda, and Zimbabwe

Mancuso,

Mathebula,

Chitukuta

et al. 2023

Front. Reprod. Health

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IntroductionThe COVID-19 pandemic greatly impacted HIV prevention and care globally. The pandemic also had disproportionate impacts on the financial, emotional, and physical wellbeing of women and girls in East and Southern Africa, who were already at increased HIV vulnerability. This study aimed to understand how the COVID-19 pandemic and its response efforts impacted the sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors of women and girls in HIV prevention studies.MethodsUsing the socio-ecological model (SEM), an explanatory sequential mixed-methods analysis was performed with data from four Microbicide Trial Network (MTN) studies on different populations—adolescent girls and young women (AGYW), pregnant persons, breastfeeding persons, and couples—in Malawi, South Africa, Uganda, and Zimbabwe. Descriptive statistics for outcomes of interest were calculated within each study separately and Chi-squared tests of independence were performed to evaluate associations between study population and outcomes. Excerpts from study qualitative interviews were stratified into code reports which were then summarized into memos with key themes and considerations of the SEM framework to provide context to quantitative findings.ResultsFew participants (8/731) had known or suspected COVID-19 infection. Sexual frequency and alcohol use decreased most often among AGYW compared to pregnant or breastfeeding women and couples (p-value < 0.001). The pandemic had little impact on changes in reported HIV prevention interest or access to HIV prevention study products. Healthcare access was impacted for everyone, with couples most likely to report decreases in access (p-value < 0.001). From qualitative interviews, economic instability, adverse mental health, and increased violence due to COVID-19 caused increased strain on other factors related to HIV vulnerability.ConclusionsWhile interest in HIV prevention did not change and a few HIV risks decreased for most women and girls, other vulnerabilities to HIV increased due to the COVID-19 pandemic, highlighting the importance of continued access to HIV prevention for women and girls. More research is needed to better understand the long-term impact of COVID-19 on HIV prevention and vulnerability in community populations.

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Section: Discussionsupporting

confidence: 68%

The impact of COVID-19 on sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors among trial participants in Malawi, South Africa, Uganda, and Zimbabwe

Mancuso,

Mathebula,

Chitukuta

et al. 2023

Front. Reprod. Health

View full text Add to dashboard Cite

show abstract

“…In our context, we found that many women experienced abandonment by men (partners), which increased the burden of work and compounded the toll of economic hardships on women's mental and physical well-being. Some women, grappling with severe nancial di culties and food insecurity, turned to short-term sexual survival strategies (22,33). Long before the pandemic, several studies have highlighted the complex and intersectional relationship between socioeconomic status and sexual health outcomes, including HIV and unwanted pregnancies, within informal settlements in Uganda and other sub-Saharan African countries (22,(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

“…Some women, grappling with severe nancial di culties and food insecurity, turned to short-term sexual survival strategies (22,33). Long before the pandemic, several studies have highlighted the complex and intersectional relationship between socioeconomic status and sexual health outcomes, including HIV and unwanted pregnancies, within informal settlements in Uganda and other sub-Saharan African countries (22,(33)(34)(35). Engagement in transactional sex and longer-term relationships for economic support illuminates the compromises impoverished women must make, even as it places them at heightened risk of HIV infection.…”

Section: Discussionmentioning

confidence: 99%

“…Women engaged in precarious work in informal sectors encounter exacerbated hardships, re ecting broader discussions on the vulnerability of women in informal economies not just in Uganda but in most low-and-middle-income countries (9). Such vulnerabilities are only made worse in pandemic situations in which women are required to bear the burden of increased child and general household care (45), thereby exposing them to worsening mental health conditions and susceptibility to unsafe means of survival (22,29,33,46). Ogando, Rogan and Moussie describe how, in some low-and middle-income countries, women's share of the care work can be as much as 75 to 90% higher than men's and that the COVID-19 crisis has intensi ed this inequality(18).…”

Section: Discussionmentioning

confidence: 99%

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The Impact of COVID-19 Restrictions on the Health and Well-being of Women Living in Informal Settlements in Uganda.

Tetui,

Lee,

Alhafi

et al. 2024

Preprint

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Background: The COVID-19 pandemic significantly impacted Uganda, with the first case reported in March 2020, resulting in extensive public health restrictions, including a lockdown, curfew, and closure of schools and workplaces. Urban residents, particularly those living in poverty in informal settlements, faced heightened challenges due to inadequate access to basic services, financial hardships, and increased caregiving responsibilities, especially for women. Women faced heightened risks of gender-based violence and engaged in transactional sex as coping mechanisms. This study explored the strategies used by women in Kampala and Mbale cities to meet basic needs during the pandemic and their implications for HIV infection vulnerability. Methods: Researchers conducted in-depth discussions with 282 women from various age groups in Kampala and Mbale's largest informal settlements, gathering insights into their pandemic experiences. These discussions, held in local languages, explored women's social, family, and financial challenges, as well as their perceptions of HIV risks. Transcripts were translated by local language experts before analysis. The team analyzed the transcripts using NVivo version 14 software, identifying patterns and themes that revealed survival strategies employed by women. Results: The study identified three interconnected themes that capture the complex strategies and challenges faced by women in informal settlements in Kampala and Mbale during the COVID-19 pandemic. Women struggled to cope with financial hardships and increased caregiving responsibilities, often resorting to desperate measures like transactional sex to survive, despite their resilience. The pandemic exacerbated vulnerabilities, heightening risks of HIV transmission and mental health issues, particularly among women living in poverty. While support networks provided some relief, they often fell short of meeting the diverse needs of women in these communities. Conclusions: The study shows that women in Uganda's informal settlements demonstrated resilience by taking on new roles and engaging in trading, but their reliance on transactional sex revealed stark power imbalances, increasing their vulnerability to gender-based violence, unintended pregnancies, and HIV infection. This highlights the urgent need for targeted interventions that address the complex challenges women face in crisis situations, which could enhance their resilience and alleviate their multiple struggles, with valuable lessons for similar contexts in low- and middle-income countries.

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“…Nearly all studies across the world reported on the reduction in work and income for individuals involved in sex work during the COVID-19 pandemic (Aantjes et al, 2023;Azam et al, 2021;Burgos & Del Pino, 2021;Cabras & Ingrasci, 2022;Callander et al, 2022;Chakrapani et al, 2022;Fedorkó et al, 2022;Gbagbo, 2020;Hassan et al, 2023;Judge & Jackson, 2023;Kahambing, 2021;Kavanagh et al, 2021;Laikram & Pathak, 2021;Leyva-Moral et al, 2023;Lamontagne et al, 2022;Machingura et al, 2021;Magnani et al, 2022;Mantell et al, 2021;Matambanadzo et al, 2021;Mlambo & Masuku, 2022;Moura et al, 2022;Museva et al, 2021;Nyabeze et al, 2022;Pearson et al, 2022;Pereira, 2021;Pollard et al, 2021;Richterman et al, 2022;Santos et al, 2022;Shankar et al, 2022;Shekhar, 2023;Singer et al, 2020;Su & Valiquette, 2022;Tan et al, 2021aTan et al, , 2021bTran et al, 2022;Wang et al, 2022;Wirawan et al, 2022).…”

Section: Reduction In Work and Incomementioning

confidence: 99%

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic

2023

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The COVID-19 pandemic profoundly affected physical, mental, and economic well-being across the globe and has disproportionately affected certain vulnerable groups. This paper provides a scoping review of literature on the impact of the COVID-19 pandemic on sex workers, published between December 2019 and December 2022. Six databases were systematically searched, identifying 1009 citations; 63 studies were included in the review. Thematic analysis revealed eight main themes: financial issues; exposure to harm; alternate ways of working; COVID-19 knowledge, protective behaviors, fear, and risk; well-being, mental health, and coping; access to support; access to health care; and the impact of COVID-19 on research with sex workers. COVID-associated restrictions led to reduced work and income, leaving many sex workers struggling to cover basic needs; additionally, government protections excluded those working in the informal economy. Fearing the loss of their already reduced number of clients, many felt compelled to compromise both prices and protective measures. Although some engaged in online sex work, this raised concerns about visibility and was impossible for those without technological access or skills. Many feared COVID-19, but felt pressure to continue working, often with clients who refused to wear masks or share exposure history. Other negative impacts on well-being related to the pandemic included reduced access to financial support or health care. Marginalized populations (and especially those in professions which require close contact like sex workers) need further support and capacity-building within the community to recover from the impact of COVID-19.

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Trends in Transactional Sex Among Women at Risk for HIV in Rural Kenya During the First Year of the COVID-19 Pandemic

Cited by 5 publications

References 5 publications

The impact of COVID-19 on sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors among trial participants in Malawi, South Africa, Uganda, and Zimbabwe

The impact of COVID-19 on sexual behavior, HIV prevention interest, general healthcare access, and other HIV risk factors among trial participants in Malawi, South Africa, Uganda, and Zimbabwe

The Impact of COVID-19 Restrictions on the Health and Well-being of Women Living in Informal Settlements in Uganda.

Struggling, Forgotten, and Under Pressure: A Scoping Review of Experiences of Sex Workers During the COVID-19 Pandemic

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