Engagement in HIV Care Among young female sex workers in Zimbabwe

Napierala, Sue, Chabata, Sungai Tafadzwa, Fearon, Elizabeth, Davey, Calum, Hargreaves, James, Busza, Joanna, Mushati, Phillis, Mtetwa, Sibongile, Chiyaka, Tarisai, Mugurungi, Owen, Hanisch, Dagmar, Hatzold, Karin, Phillips, Andrew and Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422 (2018) 'Engagement in HIV Care Among young female sex workers in Zimbabwe'. JAIDS: Journal of Acquired Immune Deficiency Syndromes, Vol 79, Issue 3, pp. 358-366.

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Abstract

Introduction: Young female sex workers (FSW) are at greater HIV risk than their older counterparts. Yet the extent of their engagement with HIV services is largely unknown. We compared engagement among FSW aged 18-24 with those ≥25 years.

Methods: We used respondent-driven sampling to recruit FSW from 14 communities in Zimbabwe from November-December 2013. We collected data on demographics, behaviour, service uptake, and HIV and viral load testing. Data were pooled and weighted using RDS-2 estimation. We analyzed HIV care cascade variables by age group. To identify potential drivers of younger FSW service use, we explored factors associated with knowing one’s HIV status.

Results: Among 2617 participants, mean age was 31 years and 26% were 18-24. Over half initiated sex work before age 25. Overall HIV prevalence was 59%, but was lower among younger FSW (35% vs 67%, p<0.01). Younger HIV-infected FSW were significantly less engaged at each step of the care cascade. Among younger FSW reporting ART use, 62% had an undetectable viral load compared with 79% in older FSW. In multivariable regression, young FSW encouraged to have an HIV test by another FSW (AOR=2.54; 95% confidence interval [CI]:1.44-4.50), and those with no recent clients (AOR=4.31; 95%CI: 1.30-14.33) were more likely to report knowing their status.

Conclusions: The high proportion of FSW initiating sex work before age 25 and their lower engagement in HIV services highlights the importance of considering this vulnerable population in HIV programming. Implementing targeted services tailored to the unique needs of young FSW is a public health imperative.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1097/QAI.0000000000001815
Depositing User:	Stacy Murtagh
Date Deposited:	30 Jul 2018 14:16
Last Modified:	19 Jul 2019 01:02
URI:	https://archive.lstmed.ac.uk/id/eprint/8987

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