Engagement in HIV Care Among young female sex workers in Zimbabwe

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.