Engagement in HIV Care Among young female sex workers in Zimbabwe

Sue Napierala; Sungai Tafadzwa Chabata; Elizabeth Fearon; Calum Davey; James Hargreaves; Joanna Busza; Phillis Mushati; Sibongile Mtetwa; Tarisai Chiyaka; Owen Mugurungi; Dagmar Hanisch; Karin Hatzold; Andrew Phillips; Frances Cowan

doi:10.1097/qai.0000000000001815

Engagement in HIV Care Among young female sex workers in Zimbabwe

Sue Napierala, Sungai Tafadzwa Chabata, Elizabeth Fearon, Calum Davey, James Hargreaves, Joanna Busza, Phillis Mushati, Sibongile Mtetwa, Tarisai Chiyaka, Owen Mugurungi, Dagmar Hanisch, Karin Hatzold, Andrew Phillips, Frances Cowan

International Public Health

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

25 Citations (Scopus)

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.

Original language	English
Title of host publication	Journal of Acquired Immune Deficiency Syndromes
Publisher	Lippincott Williams and Wilkins
Pages	358-366
Number of pages	9
Volume	79
Edition	3
DOIs	https://doi.org/10.1097/qai.0000000000001815
Publication status	Published - 1 Nov 2018

Keywords

HIV care continuum
key and vulnerable populations
sex workers
young people
Zimbabwe

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/qai.0000000000001815Licence: CC BY-NC

Engagement in HIV Care Among young female sexAccepted author manuscript, 753 KB

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Napierala, S., Chabata, S. T., Fearon, E., Davey, C., Hargreaves, J., Busza, J., Mushati, P., Mtetwa, S., Chiyaka, T., Mugurungi, O., Hanisch, D., Hatzold, K., Phillips, A., & Cowan, F. (2018). Engagement in HIV Care Among young female sex workers in Zimbabwe. In Journal of Acquired Immune Deficiency Syndromes (3 ed., Vol. 79, pp. 358-366). Lippincott Williams and Wilkins. https://doi.org/10.1097/qai.0000000000001815

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title = "Engagement in HIV Care Among young female sex workers in Zimbabwe",

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{\textquoteright}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.",

keywords = "HIV care continuum, key and vulnerable populations, sex workers, young people, Zimbabwe",

author = "Sue Napierala and Chabata, \{Sungai Tafadzwa\} and Elizabeth Fearon and Calum Davey and James Hargreaves and Joanna Busza and Phillis Mushati and Sibongile Mtetwa and Tarisai Chiyaka and Owen Mugurungi and Dagmar Hanisch and Karin Hatzold and Andrew Phillips and Frances Cowan",

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booktitle = "Journal of Acquired Immune Deficiency Syndromes",

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Napierala, S, Chabata, ST, Fearon, E, Davey, C, Hargreaves, J, Busza, J, Mushati, P, Mtetwa, S, Chiyaka, T, Mugurungi, O, Hanisch, D, Hatzold, K, Phillips, A & Cowan, F 2018, Engagement in HIV Care Among young female sex workers in Zimbabwe. in Journal of Acquired Immune Deficiency Syndromes. 3 edn, vol. 79, Lippincott Williams and Wilkins, pp. 358-366. https://doi.org/10.1097/qai.0000000000001815

TY - GEN

T1 - Engagement in HIV Care Among young female sex workers in Zimbabwe

AU - Napierala, Sue

AU - Chabata, Sungai Tafadzwa

AU - Fearon, Elizabeth

AU - Davey, Calum

AU - Hargreaves, James

AU - Busza, Joanna

AU - Mushati, Phillis

AU - Mtetwa, Sibongile

AU - Chiyaka, Tarisai

AU - Mugurungi, Owen

AU - Hanisch, Dagmar

AU - Hatzold, Karin

AU - Phillips, Andrew

AU - Cowan, Frances

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

KW - HIV care continuum

KW - key and vulnerable populations

KW - sex workers

KW - young people

KW - Zimbabwe

U2 - 10.1097/qai.0000000000001815

DO - 10.1097/qai.0000000000001815

M3 - Conference contribution

VL - 79

SP - 358

EP - 366

BT - Journal of Acquired Immune Deficiency Syndromes

PB - Lippincott Williams and Wilkins

ER -

Engagement in HIV Care Among young female sex workers in Zimbabwe

Abstract

Keywords

UN SDGs

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