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Introduction: HIV transmission among Indonesian female sex workers (FSW) remains a concern. The pre-exposure prophylaxis (PrEP) as one of the HIV transmission prevention methods was limited in urban areas. The issue about PrEP will be available in rural areas of Jember, Indonesia. The related sector needs more preparation to respond to it. This study aims to determine the intention toward PrEP use among FSWs and its influencing factors (sociodemographic, PrEP-related knowledge, motivation, and self-efficacy) in rural areas. Materials and methods: This study used a cross-sectional approach. One hundred thirty-eight (138) FSWs were involved and were reached using purposive sampling. Data was collected using close-ended questionnaires and analysed using the Spearman bivariate correlation. Results: This study showed that only 31.2% of respondents intend to use PrEP. Several sociodemographic factors are significantly related to the intention to use PrEP among FSW, including age (p=0.013), recent education (p<0.001), length of time serving commercial sex (p=0.003), history of receiving PrEP information/education (p=0.027), and PrEP-related self-efficacy (p<0.001). Therefore, the factors of marital status (p=0.261), the experience of HIV testing (p=0.232), knowledge of PrEP (p=0.127), and motivation related to PrEP (p=0.093) were not significantly related to the intention to use PrEP. Conclusion: The intention toward PrEP use among FSWs is still low and significantly influenced by their self-efficacy. Efforts are needed to optimise the intention of FSW to use PrEP, such as increasing awareness of the dangers of HIV, socialising the importance of using PrEP when it is available, giving information about PrEP, and providing support so the motivation increases. [ABSTRACT FROM AUTHOR]

This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting.

BackgroundGlobally, female sex workers (FSWs) face high risk of HIV, particularly in regions like sub-Saharan Africa. In Ethiopia and Addis Ababa, the impact is significant. Implementing WHO-recommended measures, such as pre-exposure prophylaxis (PrEP), is crucial to reducing new HIV infections and addressing service access disparities among FSWs. Thus this study aimed to assess the acceptance of Pre-Exposure Prophylaxis (PrEP) among commercial female sex workers in selected sub-cities of Addis Ababa, Ethiopia, 2022.MethodInstitution-based cross-sectional study design was conducted on three randomly selected sub-cities of Addis Ababa from June 20 to July 30, 2022. All (358) commercial sex workers available during the study period were included. A structured, pretested, and interviewer-administered questionnaire was used to collect the data. Logistic regression was used to identify factors associated with acceptance of pre-exposure prophylaxis and statistical significance was determined at p-value

BackgroundThe COVID-19 pandemic has intensified global mental health challenges, particularly for vulnerable groups like female entertainment workers (FEWs), a critical HIV-affected population in Cambodia. Already facing pre-existing inequalities, FEWs encountered heightened difficulties due to the pandemic’s disruption of their livelihoods. Their susceptibility to mental health problems is exacerbated by poverty and the occupational stressors they regularly endure. This study aims to identify COVID-19-related factors adversely impacting the mental well-being of FEWs in Cambodia and explore potential interventions to mitigate these effects.MethodsIn December 2021, we conducted a two-day workshop in Phnom Penh using a group model-building approach with stakeholders from diverse backgrounds to gather collective insights. We employed the qualitative system dynamics method of causal loop diagram mapping to visualize the factors affecting FEWs’ mental health. Based on participants’ perceptions and experiences, we constructed a causal loop diagram to develop a comprehensive systems perspective.ResultsThe workshop involved 27 stakeholders, including representatives from national institutions (n = 3), local NGOs (n = 17), an international NGO (n = 1), and the FEW community (n = 6). Our analysis identified 13 feedback loops highlighting key factors influencing the mental well-being of FEWs during the pandemic. These factors included the loss of family members, financial instability, fear of COVID-19 infection, the pressure of children’s homeschooling due to school closures, and food insecurity. In response, stakeholders proposed a range of interventions, including alternative vocational training, increased awareness of mental health issues, access to mental health services, and programs targeting gender-based violence within FEW communities.ConclusionA collaborative, multi-sectoral approach is crucial to addressing the mental health challenges of FEWs in Cambodia. Prioritizing the establishment of accessible, affordable, and high-quality mental health services, alongside the implementation of targeted interventions, is essential to mitigate the negative mental health impacts of the pandemic and enhance the overall well-being of FEWs.

Poverty and economic insecurity are driving forces in entering sex work among women in low resource areas. This increases their risk for HIV by influencing the decision-making process for high-risk behaviors. Few studies have examined the financial behaviors and capacities of women engaged in sex work (WESW). This paper describes the methodology used in a financial diary study aimed at characterizing women's spending patterns within a larger prevention intervention trial among WESW in Uganda. From June 2019 to March 2020, a subsample of 150 women randomized to the combination HIV prevention and economic empowerment treatment was asked to complete financial diaries to monitor daily expenditures in real time. Two hundred and forty financial diaries were distributed to study participants during the financial literacy sessions at eight sites. A total of 26,919 expense entries were recorded over 6 months. Sex-work-related expenses comprised approximately 20.01% of the total. The process of obtaining quality and consistent data was challenging due to the transient and stigmatized nature of sex work coupled with women's varying levels of education. Frequent check-ins, using peer support, code word or visuals, and a shorter time frame would allow for a more accurate collection of high-frequency data. Moreover, the ability of women to complete the financial diaries despite numerous challenges speaks to their potential value as a data collection tool, and also as an organizing tool for finances. [ABSTRACT FROM AUTHOR]

Little is known about service utilization among female entertainment workers (FEWs) after experiencing gender-based violence (GBV). This study explored factors associated with post-GBV service utilization among FEWs in Cambodia. We included 299 FEWs, who experienced any forms of GBV in the past 12 months. This study highlights low access (14.05%) to post-GBV services among FEWs. Factors associated with post-GBV services utilization were marital status, living conditions, mental health, and types of entertainment venues. To improve post-GBV services utilization, ensuring quality, and availability of services are required. Further research is needed to develop pathways toward a supportive environment for FEWs to access these services. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSWs) have a high risk of human immunodeficiency virus (HIV) infection. In spite of the alarming fact that a large proportion of FSWs does not have adequate HIV knowledge, the association between sociodemographic factors and HIV knowledge among FSWs have yet to be thoroughly explored in the context of Malaysia. The aims of this study are the following: i) to determine HIV knowledge and ii) to examine the associated factors of HIV knowledge. Methods: An observational cross-sectional study was conducted. Data from the Integrated Biological and Behavioral Surveillance Survey (IBBS) 2017 (n = 630) were used. The survey was carried out in all states in Malaysia and its duration was 4 months (from March 2017 to June 2017). Ordered probit regressions were utilised to shed light on the association between sociodemographic variables and levels of HIV knowledge. Results: A large proportion of FSWs had middle-level HIV knowledge (44.1%). FSWs with tertiary-level education were 19.5% more likely to have high-level HIV knowledge compared to those without formal education. The probability of having low-level HIV knowledge was 6.8% lower among FSWs with monthly incomes of RM1,500--RM1,999 than those having incomes of ≤ RM499. Being single instead of married was associated with 7.6%--8% lower probabilities of having low- and middle-level HIV knowledge. Conclusion: Public health interventions to improve FSWs' HIV knowledge need to take into consideration the role of sociodemographic factors. [ABSTRACT FROM AUTHOR]

Abstract Background In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribution to FSW by peer distributors than after facility-based HIV testing and whether FSW regretted HIVST use or experienced associated relationship problems. Methods Peer HIVST distributors, who were FSW, were recruited in Blantyre district, Malawi between February and July 2017. Among HIVST recipients a prospective cohort was recruited. Interviews were conducted at baseline and at end-line, 3 months later. Participants completed daily sexual activity diaries. End-line data were analysed using logistic regression to assess whether regret or relationship problems were associated with HIVST use. Sexual activity data were analysed using Generalised Estimating Equations to assess whether HIVST use was temporally associated with an increase in social harms. Results Of 265 FSW recruited and offered HIVST, 131 completed both interviews. Of these, 31/131(23.7%) reported initial regret after HIVST use, this reduced to 23/131(17.6%) at the 3-month follow-up. Relationship problems were reported by 12/131(9.2%). Regret about HIVST use was less commonly reported in those aged 26–35 years compared to those aged 16–25 years (OR immediate regret—0.40 95% CI 0.16–1.01) (OR current regret—0.22 95% CI 0.07 – 0.71) and was not associated with the HIVST result. There was limited evidence that reports of verbal abuse perpetrated by clients in the week following HIVST use were greater than when there was no testing in the preceding week. There was no evidence for increases in any other social harms. There was some evidence of coercion to test, most commonly initiated by the peer distributor. Conclusions Little evidence was found that the peer distribution model was associated with increased levels of social harms, however programmes aimed at reaching FSW need to carefully consider possible unintended consequences of their service delivery approaches, including the potential for peer distributors to coerce individuals to test or disclose their test results and alternative distribution models may need to be considered.

Abstract Objective Understanding HPV vaccination willingness and its influencing factors among female sex workers (FSWs) in entertainment venues in an urban area of Guangxi, China. Methods From 15 August to 15 October 2022, FSWs in entertainment venues with commercial sex trade in an urban area of Guangxi were selected as the study subjects for the questionnaire survey using the method of intentional sampling. The questionnaire based on the information-motivation-behavior (IMB) skills model was used to collect the basic characteristics, HPV and HPV vaccine-related information and cognition, motivation to vaccinate, behavioral skills and willingness to vaccinate from the research targets. A multifactor logistic regression model was used to analyze the factors influencing the research targets' willingness to receive HPV vaccination. Results Of the 921 research targets, 712 (77.31%) were willing to receive HPV vaccination. The higher the level of knowledge regarding HPV and HPV vaccine-related information, the higher the motivation for HPV vaccination. In addition, the higher the behavioral skills score, the higher the willingness of FSWs in entertainment venues to receive HPV vaccination (P

Background: In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribution to FSW by peer distributors than after facility-based HIV testing and whether FSW regretted HIVST use or experienced associated relationship problems. Methods: Peer HIVST distributors, who were FSW, were recruited in Blantyre district, Malawi between February and July 2017. Among HIVST recipients a prospective cohort was recruited. Interviews were conducted at baseline and at end-line, 3 months later. Participants completed daily sexual activity diaries. End-line data were analysed using logistic regression to assess whether regret or relationship problems were associated with HIVST use. Sexual activity data were analysed using Generalised Estimating Equations to assess whether HIVST use was temporally associated with an increase in social harms. Results: Of 265 FSW recruited and offered HIVST, 131 completed both interviews. Of these, 31/131(23.7%) reported initial regret after HIVST use, this reduced to 23/131(17.6%) at the 3-month follow-up. Relationship problems were reported by 12/131(9.2%). Regret about HIVST use was less commonly reported in those aged 26–35 years compared to those aged 16–25 years (OR immediate regret—0.40 95% CI 0.16–1.01) (OR current regret—0.22 95% CI 0.07 – 0.71) and was not associated with the HIVST result. There was limited evidence that reports of verbal abuse perpetrated by clients in the week following HIVST use were greater than when there was no testing in the preceding week. There was no evidence for increases in any other social harms. There was some evidence of coercion to test, most commonly initiated by the peer distributor. Conclusions: Little evidence was found that the peer distribution model was associated with increased levels of social harms, however programmes aimed at reaching FSW need to carefully consider possible unintended consequences of their service delivery approaches, including the potential for peer distributors to coerce individuals to test or disclose their test results and alternative distribution models may need to be considered. [ABSTRACT FROM AUTHOR]

Abstract Background The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor in HIV transmission in the community. However, it has long been known that using condoms correctly and consistently is an extremely cost-effective global method for preventing HIV infection, but inconsistent condom use (ICU) would pose the greatest proximal risk of HIV acquisition and transmission. Understanding the prevalence and associated risk factors of inconsistence condom use among FSWs would inform policymakers to design programmatic interventions in the context of Ethiopia. Methods This analysis used data from the ‘National HIV and STIs Bio-behavioral Survey (NHSBS)’, which was conducted between December 2019 up to May 2020 by using a respondent-driven sampling (RDS) technique among FSWs aged 15 years and older who were selling sex in selected major cities and towns in Ethiopia. A multi-level logistic regression model was fitted to assess town and individual-level variations simultaneously to adjust hierarchical variations. Statistical significance was determined by using a P-value less than 0.05 with a 95% confidence interval (CI) not including one. Results Overall, 6,085 FSWs from 16 cities and towns participated in the study. The prevalence of inconsistent condom use across the 16 cities and towns was 17.1% [95% CI (16.5, 17.8)]. Inconsistent condom use was significantly higher among FSWs who had depression compared to those without depression [AOR = 1.43; 95% CI (1.13,1.82)], used any drug [AOR = 1.43; 95% CI (1.14–1.79)], had history of sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], changed sex selling location [AOR = 1.27; 95% CI (1.06, 1.51)], longer period of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], ever had anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], had ≥ 2 non-paying sexual partner [AOR = 2.99; 95% CI(2.26, 3.95)], selling sex `in more than two cities [AOR = 3.01;95% CI (2.27, 3.99)], who lacked access to condom [AOR = 2.1; 95% CI (1.69, 2.67)], and did not have HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)]. Conclusion Inconsistent condom use among FSWs is prevalent in Ethiopia and is associated with marital status, education status, depression, alcohol drinking, drug use, sexual violence, being raped, lack of knowledge about HIV, practising anal sex, selling sex in different locations, having more than two non-paying sexual partners, working in more than two cities, and lack of access to condom at the workplace. Programme interventions to enhance consistent condoms use among FSWs need to take these factors into consideration.

Abstract Background Pre-exposure prophylaxis is the use of antiretroviral medications by HIV-negative individuals to prevent infection before exposure. Ethiopia has made progress in reducing new HIV infections, but the burden remains high with ongoing challenges in prevention uptake. This study examined the utilization and factors associated with pre-exposure prophylaxis among female sex workers. Methods A community-based cross-sectional study design was conducted in Bahir Dar city administration among female sexual workers in 2022. The results were collected using a pre-tested and structured questionnaire. Epi data for data entry and social package for social science for analysis were used. Result Overall, 15.9% (CI: 12.0-21.1) of female sexual workers received pre-exposure prophylaxis. Parents’ living condition (only father alive [AOR = 0.23, 95% CI, 0.02–0.64], only mother alive [AOR = 0.31, 95% CI, 0.02–0.74]), marital status being single (AOR = 0.27, 95% CI, 0.06–0.94), having history of STI (AOR = 2.82, 95% CI, 1.60–4.77) were associated with pre-exposure prophylaxis uptake. Conclusion This study showed low pre-exposure prophylaxis uptake. The study identified a history of sexually transmitted infections, marital status, and parent living conditions as significant factors. To increase pre-exposure prophylaxis uptake and reduce HIV incidence, an awareness campaign, tailored support, targeted interventions, and addressing concerns of high-risk groups are needed.

Introduction: Adolescent female sex workers are at high risk of acquiring human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection. There was paucity of information regarding their sexual practices. The main objective of this study was to study the sexual behavior, condom use practices, and physical and sexual violence experienced by adolescent female sex workers (FSWs). Materials and Methods: This study was a secondary data analysis of the data collected during the nationwide IBBS 2014–15 survey. All adolescent FSWs aged 15 to 19 years were included in the analysis. The primary outcome variable was HIV serostatus, and independent variables included sexual behavior and condom use practices and socio-demographic variables. Descriptive analyses were performed to estimate the prevalence of independent variables. Ethical approval of the original IBBS study was obtained by the Ethics Committee of National AIDS Control Organization. Results: A total of 948 adolescent FSWs were included in the final analysis. The prevalence of HIV in adolescent FSWs was 1.2% [95% confidence interval, 0.1–1.9%]. The mean age [standard deviation (SD)] of FSWs was 18.2 (0.9) years. The mean (SD) age at first sexual intercourse was 15.6 (1.7) years, and the mean (SD) age of starting sex work was 16.6 (1.5) years. The majority of the FSWs (94%) had used condom during the last sexual intercourse with a commercial partner, and about one-thirds (66%) had consistently used condom with a commercial partner. About a quarter (26%) of the FSWs had anal intercourse with a commercial partner in the last 1 month. About one in five FSWs (21%) had experienced physical violence in the last 1 year. Conclusion: Almost one-third of FSWs had high-risk sexual behavior like multiple clients, anal intercourse, inconsistent condom use, and so on. These behaviors in turn increase their vulnerability to HIV infection.

Abstract Background While self-rated health (SRH) and quality of life (QoL) has been associated with substance use disorders (SUDs) in sex-working populations, little is known about this association in Iran. This study aimed to assess QoL and SRH in Iranian female sex workers (FSWs) in Tehran. Method FSWs were recruited using convenience sampling methods from substance abuse treatment centers in Tehran that exclusively provided services for women. Participants completed an interviewer-administered demographic questionnaire in Persian and the Iranian version of the Short Form Health Survey (SF-36). Descriptive analyses, means and standard deviations; frequency and percentages, t-test and one-way ANOVA, and Chi-square tests were utilized to analyze the data. Results The mean age among 161 participants clinically diagnosed with SUD was 34.09 years (SD 7.97; range: 18–57). The total mean QoL score was 41.03 (SD: 12.92). The highest and lowest mean scores were observed in the physical functioning (52.23) and role emotional (26.64) dimensions, respectively. Significant differences (p

This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting. [ABSTRACT FROM AUTHOR]

Background: The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor in HIV transmission in the community. However, it has long been known that using condoms correctly and consistently is an extremely cost-effective global method for preventing HIV infection, but inconsistent condom use (ICU) would pose the greatest proximal risk of HIV acquisition and transmission. Understanding the prevalence and associated risk factors of inconsistence condom use among FSWs would inform policymakers to design programmatic interventions in the context of Ethiopia. Methods: This analysis used data from the 'National HIV and STIs Bio-behavioral Survey (NHSBS)', which was conducted between December 2019 up to May 2020 by using a respondent-driven sampling (RDS) technique among FSWs aged 15 years and older who were selling sex in selected major cities and towns in Ethiopia. A multi-level logistic regression model was fitted to assess town and individual-level variations simultaneously to adjust hierarchical variations. Statistical significance was determined by using a P-value less than 0.05 with a 95% confidence interval (CI) not including one. Results: Overall, 6,085 FSWs from 16 cities and towns participated in the study. The prevalence of inconsistent condom use across the 16 cities and towns was 17.1% [95% CI (16.5, 17.8)]. Inconsistent condom use was significantly higher among FSWs who had depression compared to those without depression [AOR = 1.43; 95% CI (1.13,1.82)], used any drug [AOR = 1.43; 95% CI (1.14–1.79)], had history of sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], changed sex selling location [AOR = 1.27; 95% CI (1.06, 1.51)], longer period of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], ever had anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], had ≥ 2 non-paying sexual partner [AOR = 2.99; 95% CI(2.26, 3.95)], selling sex 'in more than two cities [AOR = 3.01;95% CI (2.27, 3.99)], who lacked access to condom [AOR = 2.1; 95% CI (1.69, 2.67)], and did not have HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)]. Conclusion: Inconsistent condom use among FSWs is prevalent in Ethiopia and is associated with marital status, education status, depression, alcohol drinking, drug use, sexual violence, being raped, lack of knowledge about HIV, practising anal sex, selling sex in different locations, having more than two non-paying sexual partners, working in more than two cities, and lack of access to condom at the workplace. Programme interventions to enhance consistent condoms use among FSWs need to take these factors into consideration. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis is the use of antiretroviral medications by HIV-negative individuals to prevent infection before exposure. Ethiopia has made progress in reducing new HIV infections, but the burden remains high with ongoing challenges in prevention uptake. This study examined the utilization and factors associated with pre-exposure prophylaxis among female sex workers. Methods: A community-based cross-sectional study design was conducted in Bahir Dar city administration among female sexual workers in 2022. The results were collected using a pre-tested and structured questionnaire. Epi data for data entry and social package for social science for analysis were used. Result: Overall, 15.9% (CI: 12.0-21.1) of female sexual workers received pre-exposure prophylaxis. Parents' living condition (only father alive [AOR = 0.23, 95% CI, 0.02–0.64], only mother alive [AOR = 0.31, 95% CI, 0.02–0.74]), marital status being single (AOR = 0.27, 95% CI, 0.06–0.94), having history of STI (AOR = 2.82, 95% CI, 1.60–4.77) were associated with pre-exposure prophylaxis uptake. Conclusion: This study showed low pre-exposure prophylaxis uptake. The study identified a history of sexually transmitted infections, marital status, and parent living conditions as significant factors. To increase pre-exposure prophylaxis uptake and reduce HIV incidence, an awareness campaign, tailored support, targeted interventions, and addressing concerns of high-risk groups are needed. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent female sex workers are at high risk of acquiring human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection. There was paucity of information regarding their sexual practices. The main objective of this study was to study the sexual behavior, condom use practices, and physical and sexual violence experienced by adolescent female sex workers (FSWs). Materials and Methods: This study was a secondary data analysis of the data collected during the nationwide IBBS 2014–15 survey. All adolescent FSWs aged 15 to 19 years were included in the analysis. The primary outcome variable was HIV serostatus, and independent variables included sexual behavior and condom use practices and socio-demographic variables. Descriptive analyses were performed to estimate the prevalence of independent variables. Ethical approval of the original IBBS study was obtained by the Ethics Committee of National AIDS Control Organization. Results: A total of 948 adolescent FSWs were included in the final analysis. The prevalence of HIV in adolescent FSWs was 1.2% [95% confidence interval, 0.1–1.9%]. The mean age [standard deviation (SD)] of FSWs was 18.2 (0.9) years. The mean (SD) age at first sexual intercourse was 15.6 (1.7) years, and the mean (SD) age of starting sex work was 16.6 (1.5) years. The majority of the FSWs (94%) had used condom during the last sexual intercourse with a commercial partner, and about one-thirds (66%) had consistently used condom with a commercial partner. About a quarter (26%) of the FSWs had anal intercourse with a commercial partner in the last 1 month. About one in five FSWs (21%) had experienced physical violence in the last 1 year. Conclusion: Almost one-third of FSWs had high-risk sexual behavior like multiple clients, anal intercourse, inconsistent condom use, and so on. These behaviors in turn increase their vulnerability to HIV infection. [ABSTRACT FROM AUTHOR]

Baleh Nibret Eskezia,1 Yilkal Tafere,2 Abiot Aschale,2 Nurilign Abebe Moges2 1Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia; 2Department of Public Health College of Health Sciences, Debre Markos University, Debre Markos, EthiopiaCorrespondence: Abiot Aschale, Email abioaschale@gmail.comBackground: Human immunodeficiency virus self-testing (HIVST) is universally accepted as an HIV testing option to achieve the United Nations Agency for International Development first 95 goal by 2030. HIV testing coverage through voluntary counseling and testing and provider initiated testing and counseling is low among female sex workers (FSWs). However, there is no evidence on the level of HIVST among FSWs in the study area.Objective: To assess the uptake of HIVST and associated factors among FSWs at non-governmental facilities in Debre Markos and Bahir Dar towns, Northwest Ethiopia, 2022.Methods: An institution-based cross-sectional study design was employed. A total of 423 study participants were selected by systematic random sampling technique. The data were collected using a structured and pre-tested questionnaire; entered into EpiData version 3.1 and exported to SPSS version 25 for analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated to assess the strength of association between independent variables and dependent variable. Bivariable logistic regression was done for each variable and those with a P-value of < 0.25% were selected for multivariable analysis. Finally, P-value < 0.05% was declared statistically significant.Results: The magnitude of HIVST uptake among FSWs was 59.3%. Time since engagement of sex work > 5 years [AOR 2.16 (95% CI: 1.158– 4.013)], age of first sexual debut > 19 years [AOR 3.23 (95% CI: 2.045– 5.093)], previous urban residence [AOR 3.99 (95% CI: 2.58– 6.18)], good knowledge towards HIVST [AOR 1.78 (95% CI: 1.066– 2.964)], education status being college and above [AOR 5.6 (95% CI: 3.12– 9.30)] were significantly associated factors.Conclusion: HIVST uptake among FSWs was 59.3% which is lower than expected at national level. Educational status, age at first sexual debut, knowledge towards HIVST, and time since engagement in sex work were significantly associated with HIVST uptake.Keywords: HIV self-testing, female sex worker, Ethiopia

We conducted a comparative cross-sectional study to compare the prevalence of exposure to workplace violence and intimate partner violence (IPV) in 125 female sex workers (FSWs) and 125 age-matched control women working in other professions (non-FSWs) and their children in El Alto, Bolivia. Violence exposure was assessed using the Demographic Health Survey Domestic Violence Module. To determine associations between work type and violence exposure, we conducted multivariate logistic regression. One-third of working mothers experienced sexual IPV, regardless of their profession. FSWs experienced higher rates of severe physical IPV and workplace violence. Children of FSWs were approximately three times more likely to be exposed to violence in the workplace. In Bolivia, strategies to reduce exposure to violence within the home and in FSW workplaces are paramount to minimizing negative impacts on women and their children. These findings have implications for policies to improve education, living wages, and social interventions to prevent and mitigate violence against women and children. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted or more commonly known to people as venereal disease is called the Sexually Transmitted Disease (STD). Female Sexual Workers (FSW) of childbearing age are a group at risk of STD because of their sexual behavior but lack special government attention. Purpose: Analyze the relationship between knowledge, selftransparency, and friend support of the FSW with STD prevention behavior. Methods: The study is a library search, using Google scholar search applications, published and other electronic journals with key words of sexually transmitted infection and sexual working women, full text, quantitative and woritative research methods, and research articles published in Indonesian and English over the last five years (2017 to 2021) are the inklational criteria for the review of the research journal election. Results: There is a significant link between knowledge and priesthood prevention behavior, self-defining acy with ims prevention behavior, and social support friends with STD prevention behaviors. Conclusion: There is a significant link between knowledge, self-temperance, and social support in women with STD prevention behaviors, followed by research on the FSW with variables - variables that fit the true state of Semarang. It is hoped that the Semarang city government will set out a policy specifically for the FSW regarding STD. [ABSTRACT FROM AUTHOR]

Background: While self-rated health (SRH) and quality of life (QoL) has been associated with substance use disorders (SUDs) in sex-working populations, little is known about this association in Iran. This study aimed to assess QoL and SRH in Iranian female sex workers (FSWs) in Tehran. Method: FSWs were recruited using convenience sampling methods from substance abuse treatment centers in Tehran that exclusively provided services for women. Participants completed an interviewer-administered demographic questionnaire in Persian and the Iranian version of the Short Form Health Survey (SF-36). Descriptive analyses, means and standard deviations; frequency and percentages, t-test and one-way ANOVA, and Chi-square tests were utilized to analyze the data. Results: The mean age among 161 participants clinically diagnosed with SUD was 34.09 years (SD 7.97; range: 18–57). The total mean QoL score was 41.03 (SD: 12.92). The highest and lowest mean scores were observed in the physical functioning (52.23) and role emotional (26.64) dimensions, respectively. Significant differences (p < 0.05) in QoL were observed according to education and marital status, and the average QoL score was lower in women who reported permanent marriages and women who were illiterate. The average score of QoL was significantly higher in employed women. Overall, 51.6% of the women rated their health as sub-optimal, with divorced participants and women who were illiterate more likely to rate their health as sub-optimal (p < 0.05). Conclusion: Results emphasize the need for mental, physical, and sexual health screening and gender-specific interventions to improve QoL in this population. Further investigation may elucidate the consequences of poor SRH and QoL on SUD treatment adherence, sexual risk behavior, and morbidity and mortality in FSWs. [ABSTRACT FROM AUTHOR]

Stressors that arise in parenting are likely to have an adverse impact on the psychological well-being of female sex workers (FSWs), particularly in low- to middle-income countries (LMIC). This study examined the association between maternal role strain and depressive symptoms among 426 FSW mothers with dependent-age children (aged < 18 years) in Tijuana and Cd. Juarez, Mexico (2016-2017). Four dimensions of maternal role strain (e.g., child emotional and behavioral problems) were examined in relation to maternal depressive symptoms. We also investigated whether the relationship between maternal role strain and depressive symptoms was modified by venue of sex work. Compared to indoor/establishment-based FSWs, street-based FSWs reported significantly more child-related financial strain. In multiple regression analysis, having more depressive symptoms was associated with identifying as a street-based FSW, greater use of drugs, lower emotional support, more child-related financial strain and more emotional and behavioral problems in children. A significant interaction was identified such that the association between maternal role strain and depressive symptoms was stronger for indoor/establishment-based compared to street-based FSWs. These findings suggest the need to address parenting strain and type of sex work venue in the development of counseling programs to improve the mental health of FSWs in LMIC.

Abstract Background Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. Methods EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020–April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. Results Among 173 respondents, median age was 34 [IQR 27–42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. Conclusions FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.

Objective: To assess the uptake of HIVST and associated factors among FSWs at non-governmental facilities in Debre Markos and Bahir Dar towns, Northwest Ethiopia, 2022. Methods: An institution-based cross-sectional study design was employed. A total of 423 study participants were selected by systematic random sampling technique. The data were collected using a structured and pre-tested questionnaire; entered into EpiData version 3.1 and exported to SPSS version 25 for analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated to assess the strength of association between independent variables and dependent variable. Bivariable logistic regression was done for each variable and those with a P-value of < 0.25% were selected for multivariable analysis. Finally, P-value < 0.05% was declared statistically significant. Results: The magnitude of HIVST uptake among FSWs was 59.3%. Time since engagement of sex work > 5 years [AOR 2.16 (95% CI: 1.158– 4.013)], age of first sexual debut > 19 years [AOR 3.23 (95% CI: 2.045– 5.093)], previous urban residence [AOR 3.99 (95% CI: 2.58– 6.18)], good knowledge towards HIVST [AOR 1.78 (95% CI: 1.066– 2.964)], education status being college and above [AOR 5.6 (95% CI: 3.12– 9.30)] were significantly associated factors. Conclusion: HIVST uptake among FSWs was 59.3% which is lower than expected at national level. Educational status, age at first sexual debut, knowledge towards HIVST, and time since engagement in sex work were significantly associated with HIVST uptake. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to summarize 15 years of intervention science in combination HIV prevention and microfinance among women engaged in sex work (WESW) in Central Asia, identifying gaps in our understanding and recommendations for future studies. We begin by describing the emergence of HIV/STI risk among WESW in the Central Asia region, specifically Mongolia and Kazakhstan, and bridge to the formative stages of our methodology as well as completed prevention intervention studies. We describe the development of combining HIV prevention with asset-based microfinance interventions, lessons learned, and contributions these studies make to HIV prevention, intervention science, and practice. We end by recommending next steps to move prevention science forward in this area and among this key population, which continues to be underserved in HIV prevention science worldwide. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to evaluate the feasibility of using the HIV self-test in high-risk Iranian groups (MSM, FSWs, and TGs). Methods This study was a mixed study designed as a quantitative–qualitative study conducted between October 1, 2020, and June 22, 2021, in Tehran and Karaj, Iran. The sample size needed for this study generally was 1000 people, including FSWs, MSM, and transgender individuals. Convenience and snowball sampling methods were used to collect the samples. Results A total of 930 eligible respondents were enrolled in the study, of whom 456 (49%) were female and 49 (5.3%) were transgender (98% of TGs were male to female), and their mean age was 33.63 years (10.54 SD). The feasibility of using HIV self-tests in Iranian high-risk groups was significantly high. The majority of participants (97%) did not have any confidentiality problems while preparing or performing the test. In general, feasibility was assessed based on five questions. The overall feasibility score was 6.33 (0.824 SD). Taking tests, reading HIV test results, finding a safe place to do the test, and accessing HIV self-tests showed a high average. Conclusion HIV self-testing was highly acceptable and feasible among high-risk populations, so routine HIV testing was efficiently possible.

Abstract Background HIV testing is a primary prevention strategy against the HIV epidemic and an entry point for HIV/AIDS-related care, prevention and treatment. This study aimed to estimate the uptake of HIV testing among Sino-Vietnam female sex workers (FSWs) in Guangxi, China, from 2016 to 2018, and to identify the factors influencing HIV testing uptake. Methods A cross-sectional survey was conducted among FSWs in two Sino-Vietnam border cities of Guangxi, China. The survey was conducted through face-to-face interview, the data were collected by a structured questionnaire, and HIV-1 infection was detected simultaneously. Logistic regression analysis was used to determine the factors associated with uptake of HIV testing. Results In total, 4565 Chinese local FSWs (CL-FSWs) and 636 cross-border migrant Vietnamese FSWs (CMV-FSWs) were recruited into this study. HIV-1 prevalence in CL-FSWs and CMV-FSWs was 0.70% and 3.14%, respectively. The rate of self-reported uptake of HIV testing in CL-FSWs and CMV-FSWs was 54.56% and 45.44%, respectively. The rates of self-reported uptake of HIV testing declined in both groups from 2016 to 2018. Logistic regression analysis indicated that a number of factors, including socio-demographic characteristics (age

Abstract Background Female sex workers (FSWs) have tightly connected peer networks and remain at high risk of HIV acquisition. Peer delivery of HIV prevention interventions, such as HIV self-testing (HIVST), is a recommended implementation strategy for increasing intervention uptake and continuation among FSWs. We analyzed qualitative data from a peer-delivered HIVST intervention among FSWs in urban Uganda to understand the ways social support within this peer network can motivate or discourage the uptake of peer-delivered HIVST. Methods Between February and April 2017, we conducted in-depth interviews (IDIs) with FSWs (n = 30) and focus group discussions (FGDs) with FSW peer educators (PEs, n = 5) finishing participation in a four-month randomized implementation trial testing models of peer-delivered HIVST in Kampala. FSW participants were ≥ 18 years old, self-reported exchanging sex for money or goods (past month) and had not recently tested for HIV (past 3 months). FSW PEs either directly distributed HIVST kits to participants or provided coupons exchangeable for HIVST kits from specified healthcare facilities. In the IDIs and FGDs, we asked participants to share their experiences receiving or delivering peer-delivered HIVST, respectively. Using a hybrid deductive and inductive coding approach, we arranged findings along the dimensions of an established social support theory: informational, instrumental, and emotional support. Results The median age of participants was 30 years (IQR: 27–33) and PEs was 33 years (IQR: 29–37). We found that social support within FSW peer networks both motivated and discouraged uptake of peer-delivered HIVST. For example, sharing positive HIVST experiences (informational support), directly delivering HIVST kits (instrumental support), and encouraging linkage to care (emotional support) motivated HIVST uptake among FSWs. Conversely, the spread of misinformation (informational support), limited HIVST kit availability fostering mistrust of PEs (instrumental support), and fear of social exclusion following HIV status disclosure (emotional support) discouraged HIVST uptake among FSWs. Conclusions In Uganda, social support (e.g., informational, instrumental, and emotional support) among FSW peers can work in ways that both motivate and discourage peer-delivered intervention uptake. Future FSW peer-delivered HIV prevention interventions should be designed around the dimensions of social support within FSW peer networks to maximize initial and repeat intervention delivery and uptake.

Background: Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. Methods: EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020–April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. Results: Among 173 respondents, median age was 34 [IQR 27–42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. Conclusions: FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination. [ABSTRACT FROM AUTHOR]

Oral fluid-based HIV self-testing (HIVST) has emerged as a promising approach to increasing HIV testing coverage, particularly among high-risk populations. Understanding the experiences of women using self-tests and offering them to their sexual partners (secondary distribution) is crucial for determining the potential of HIVST. Qualitative in-depth interviews were conducted among 32 women at high risk of HIV infection, including women who engage in transactional sex, who participated in a cluster randomised trial of a secondary distribution strategy in western Kenya. Interviews explored how women used self-tests within relationships and how this affected their sexual decision-making. Three key themes emerged: women used HIVST to assess risk prior to engaging in sex with partners; HIVST provided women with increased agency to engage in or end relationships; and women appreciated these benefits and urged expanded access to self-tests. HIVST has the potential to support HIV prevention objectives in settings with high prevalence of HIV. Trial registration: ClinicalTrials.gov identifier: NCT03135067. [ABSTRACT FROM AUTHOR]

Background: Globally, female sex workers (FSWs) face high risk of HIV, particularly in regions like sub-Saharan Africa. In Ethiopia and Addis Ababa, the impact is significant. Implementing WHO-recommended measures, such as pre-exposure prophylaxis (PrEP), is crucial to reducing new HIV infections and addressing service access disparities among FSWs. Thus this study aimed to assess the acceptance of Pre-Exposure Prophylaxis (PrEP) among commercial female sex workers in selected sub-cities of Addis Ababa, Ethiopia, 2022., Method: Institution-based cross-sectional study design was conducted on three randomly selected sub-cities of Addis Ababa from June 20 to July 30, 2022. All (358) commercial sex workers available during the study period were included. A structured, pretested, and interviewer-administered questionnaire was used to collect the data. Logistic regression was used to identify factors associated with acceptance of pre-exposure prophylaxis and statistical significance was determined at p -value <0.05. An odds ratio with a 95% confidence interval was used to measure association estimates., Result: A total of 358 female sex workers responded, 67.9% (95% CI: 63.7, 73.2%) were willing to take pre-exposure prophylaxis. Acceptability of pre-exposure prophylaxis was significantly associated with the accessibility of pre-exposure prophylaxis at easily reachable areas (AOR3.786; 95%CI: 1.449, 9.894) and knowledge about pre-exposure prophylaxis (AOR 3.270; 95%CI: 1.336, 8.001)., Conclusion: Acceptability of pre-exposure prophylaxis among female sex workers was 67.9% which is low. Accessibility of pre-exposure prophylaxis is an easily reachable area and knowledge of about it could significantly affect its acceptability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Berhe, Asfaw and Tedla.)

Background: The COVID-19 pandemic has intensified global mental health challenges, particularly for vulnerable groups like female entertainment workers (FEWs), a critical HIV-affected population in Cambodia. Already facing pre-existing inequalities, FEWs encountered heightened difficulties due to the pandemic's disruption of their livelihoods. Their susceptibility to mental health problems is exacerbated by poverty and the occupational stressors they regularly endure. This study aims to identify COVID-19-related factors adversely impacting the mental well-being of FEWs in Cambodia and explore potential interventions to mitigate these effects., Methods: In December 2021, we conducted a two-day workshop in Phnom Penh using a group model-building approach with stakeholders from diverse backgrounds to gather collective insights. We employed the qualitative system dynamics method of causal loop diagram mapping to visualize the factors affecting FEWs' mental health. Based on participants' perceptions and experiences, we constructed a causal loop diagram to develop a comprehensive systems perspective., Results: The workshop involved 27 stakeholders, including representatives from national institutions ( n  = 3), local NGOs ( n  = 17), an international NGO ( n  = 1), and the FEW community ( n  = 6). Our analysis identified 13 feedback loops highlighting key factors influencing the mental well-being of FEWs during the pandemic. These factors included the loss of family members, financial instability, fear of COVID-19 infection, the pressure of children's homeschooling due to school closures, and food insecurity. In response, stakeholders proposed a range of interventions, including alternative vocational training, increased awareness of mental health issues, access to mental health services, and programs targeting gender-based violence within FEW communities., Conclusion: A collaborative, multi-sectoral approach is crucial to addressing the mental health challenges of FEWs in Cambodia. Prioritizing the establishment of accessible, affordable, and high-quality mental health services, alongside the implementation of targeted interventions, is essential to mitigate the negative mental health impacts of the pandemic and enhance the overall well-being of FEWs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chua, Ansah, Tep, Oy, Ung and Yi.)

Background and aims: Female sex workers (FSWs) play an essential role in the transmission of HIV and are considered critical groups compared to the public groups of society and their customers. Therefore, this study was conducted to investigate the status of sexual intercourse among prostitutes in Shiraz in 2015-2016. Methods: This is a cross-sectional study conducted on 162 prostitutes referred to Shiraz transitional damage reduction centers and the information was gathered through a checklist. Results: The results showed that the mean age at the first vaginal intercourse was 16.57±3.65. In 62.3% of people, the main reason for prostitution was the need for money to help the family. It was also found that 39.5% of prostitutes had anal sex, and more than 95% of them did not use condoms during sex. There was also a statistically significant relationship (P

We use data collected from a sample of 400 male clients of female sex workers (FSW) to examine their HIV testing behavior. We present frequencies of HIV testing and used bivariate and multivariable analyses to assess its socio-demographic, behavioral, and psychosocial correlates. We found that the majority (55 %) of male clients of FSW in Tijuana, Mexico had never had an HIV test and the prevalence of HIV testing within the past year was low (9 %). In multivariable analyses, significant correlates of having ever tested for HIV were higher age, higher HIV knowledge score, lower sexual compulsiveness score, lower misogynistic attitudes score, having a condom break during sex with a FSW, and higher frequency of sex with a FSW while she was high. Our findings represent an important starting point for developing effective interventions to address the need to promote HIV testing among this population.

BackgroundFemale sex workers (FSWs) are considered highly vulnerable to sexually transmitted infections (STIs), but available data on the prevalence of STIs among FSWs in China is limited at a provincial level. This study aimed to evaluate the prevalence of STIs and risk factors among FSWs in Jiangsu, China.MethodsWe conducted a multicenter cross-sectional study in seven cities of Jiangsu to investigate the prevalence and risk factors associated with HIV and other STIs. Blood and urine were collected to test for HIV, syphilis, Hepatitis C (HCV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.ResultsWe enrolled 3,580 FSWs. The overall prevalence of bacterial STIs was 6.2% (5.4%−7.0%). The prevalence of HIV, syphilis infection, HCV, NG and CT were 0.1% (95%CI, 0.0–0.2), 1.8% (95%CI, 1.4–2.3), 0.3% (95%CI, 0.1–0.5), 0.3% (95%CI, 0.2–0.5) and 4.3% (95%CI, 3.6–5.0), respectively. Most FSWs (85.6%) reported consistent condom use with clients in the past month. Only 10.6% of FSWs reported group sex, and 68.3% self–reported HIV testing in the previous year. According to the multivariable model, having group sex in the past year (aOR, 2.521, 95%CI: 1.366–4.651) and HIV infection (aOR, 26.260, 95%CI: 2.432–283.563) were associated with a higher risk of syphilis infection. Migrants (aOR, 1.669, 95%CI: 1.163–2.395), having a history of STIs in the past year (aOR, 4.601, 95%CI: 1.003–21.118), and NG infection (aOR, 38.549, 95%CI: 11.214–132.514) were associated with a higher risk of CT infection. On the contrary, FSWs aged older than 25 were associated with lower risk of syphilis infection (25–34: aOR, 0.339, 95%CI: 0.151–0.763) and CT infection (25–34: aOR, 0.503, 95%CI: 0.316–0.802; ≥35: aOR, 0.578, 95%CI: 0.362–0.925).ConclusionThis study's prevalence rates of syphilis and CT infections show the need to promote comprehensive STIs control and prevention strategies, including behavioral intervention and STIs screening, especially in younger high–risk populations. With the increasing coverage of HIV testing, integrating other STIs screening with HIV testing may be a reasonable way to implement comprehensive STIs control and prevention.

Background: HIV testing is a primary prevention strategy against the HIV epidemic and an entry point for HIV/AIDS-related care, prevention and treatment. This study aimed to estimate the uptake of HIV testing among Sino-Vietnam female sex workers (FSWs) in Guangxi, China, from 2016 to 2018, and to identify the factors influencing HIV testing uptake. Methods: A cross-sectional survey was conducted among FSWs in two Sino-Vietnam border cities of Guangxi, China. The survey was conducted through face-to-face interview, the data were collected by a structured questionnaire, and HIV-1 infection was detected simultaneously. Logistic regression analysis was used to determine the factors associated with uptake of HIV testing. Results: In total, 4565 Chinese local FSWs (CL-FSWs) and 636 cross-border migrant Vietnamese FSWs (CMV-FSWs) were recruited into this study. HIV-1 prevalence in CL-FSWs and CMV-FSWs was 0.70% and 3.14%, respectively. The rate of self-reported uptake of HIV testing in CL-FSWs and CMV-FSWs was 54.56% and 45.44%, respectively. The rates of self-reported uptake of HIV testing declined in both groups from 2016 to 2018. Logistic regression analysis indicated that a number of factors, including socio-demographic characteristics (age < 35 years, higher education, location in Chongzuo City), behaviour factors (having received free AIDS education, condom distribution services and peer education services, high risk sexual behaviours such as inconsistent condom use, having regular commercial sexual partners, etc.), psychological factors (perception of vulnerability to HIV/STIs, perception of risk for HIV infection) were the factors significantly related to uptake of HIV testing. Conclusion: In recent years, the rate of HIV testing uptake among Sino-Vietnam border FSWs in Guangxi, China was low, which may be an important reason for the high HIV-1 prevalence among FSWs in the region. A number of factors were identified to be associated with HIV-1 testing uptake, suggesting that HIV testing prevention strategies in this region could include accelerating AIDS education training, raising personal awareness of HIV testing, and improving accessibility of HIV testing. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the feasibility of using the HIV self-test in high-risk Iranian groups (MSM, FSWs, and TGs). Methods: This study was a mixed study designed as a quantitative–qualitative study conducted between October 1, 2020, and June 22, 2021, in Tehran and Karaj, Iran. The sample size needed for this study generally was 1000 people, including FSWs, MSM, and transgender individuals. Convenience and snowball sampling methods were used to collect the samples. Results: A total of 930 eligible respondents were enrolled in the study, of whom 456 (49%) were female and 49 (5.3%) were transgender (98% of TGs were male to female), and their mean age was 33.63 years (10.54 SD). The feasibility of using HIV self-tests in Iranian high-risk groups was significantly high. The majority of participants (97%) did not have any confidentiality problems while preparing or performing the test. In general, feasibility was assessed based on five questions. The overall feasibility score was 6.33 (0.824 SD). Taking tests, reading HIV test results, finding a safe place to do the test, and accessing HIV self-tests showed a high average. Conclusion: HIV self-testing was highly acceptable and feasible among high-risk populations, so routine HIV testing was efficiently possible. [ABSTRACT FROM AUTHOR]

Sex work is considered one of the oldest professions in the world. In India, selling sex in private is legal, while all other activities related to sex work, such as pimping, brothel-keeping, are considered to be illegal. Despite their vulnerability to HIV and other sexually transmitted infections, the research has been less focused on the other challenges faced by sex workers. This article aims to understand the major challenges faced by female commercial sex workers (CSWs) through a qualitative study covering 15 CSWs who work in Puducherry Union Territory in South India. The data were collected by using an in-depth interview guide, and the case study method. Thematic analysis was employed to analyse the data. The article discusses in detail the challenges CSWs face in terms of economical, psychological and social spheres of their lives. [ABSTRACT FROM AUTHOR]

Background: Substance abuse by female sex workers (FSWs) is particularly prevalent in the Northeastern states in India. It is important to understand how the FSWs actually function in different contexts. Objectives: The study aimed to describe various characteristics of substance abusing FSWs and to explore the changing trends in sex work dynamics in Imphal, Northeast India. Methods: This community-based, mixed-method, cross-sectional study was conducted among FSWs in Imphal from May 2017 to August 2019. 288 FSWs were recruited using respondent-driven sampling method and were interviewed using a semistructured questionnaire after obtaining written informed consent. Focus group discussions and in-depth interviews were conducted with participants and key informants. Results: The mean ± standard deviation age of the respondents was 30.9 ± 6.1 years; 53.8% were Christian. Majority (98.3%) of the respondents reported sex work as their only source of income; drug use (41.3%) and poverty and debt (35%) were main reasons for involvement in sex work. The most common place of solicitation was lodge/hotel (72.9%); condom was not used during the last sexual act by 2.1%; and heroin was frequently used before having sex by 52.1% and 9.3% used mobile phones for soliciting clients. “Pimps helped in getting customers but want to avoid paying half to them.” “It's easy to contact customers on mobile phone. I have 10–12 regular customers contacting through mobile.” Conclusions: Substances abusing FSWs predominantly uses heroin before sexual act and continue to practice unprotected sex. Newer technology like mobile phones was used for soliciting clients.

Background: The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV. Methods: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes. Results: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges. Conclusions: FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being. [ABSTRACT FROM AUTHOR]

Objective: To determine viral load (VL) nonsuppression (VLN) rates, HIV drug resistance (HIVDR) prevalence, and associated factors among female sex workers (FSWs) in Ethiopia. Methods: A cross-sectional biobehavioral survey was conducted among FSWs in 11 cities in Ethiopia in 2014. Whole blood was collected, and HIVDR genotyping was performed. Logistic regression analysis was performed to identify factors associated with VLN and HIVDR. Results: Among 4900 participants, 1172 (23.9%) were HIV-positive and 1154 (98.5%) had a VL result. Participants were categorized into antiretroviral therapy (ART) (n = 239) and ART-naive (n = 915) groups based on self-report. From the 521 specimens (ART, 59; ART-naive, 462) with VL >=1000 copies/mL, genotyping was successful for 420 (80.6%) and 92 (21.9%) had drug resistance mutations (DRMs). Pretreatment drug resistance (PDR) was detected in 16.5% (63/381) of the ART-naive participants. Nucleoside reverse transcriptase inhibitor (NRTI), non-NRTIs (NNRTIs), and dual-class DRMs were detected in 40 (10.5%), 55 (14.4%), and 35 (9.2%) of the participants, respectively. Among 239 participants on ART, 59 (24.7%) had VLN. Genotyping was successfully performed for 39 (66.1%). DRMs were detected in 29 (74.4%). All 29 had NNRTI, 23 (79.3%) had NRTI or dual-class DRMs. VLN was associated with age 35 years or older, CD4+ T-cell count <350 cells/mm3, and being forced into selling sex. PDR and acquired drug resistance were associated with CD4+ T-cell count <350 cells/mm3 (P < 0.001). Conclusions: The high VLN and HIVDR rates among FSWs underscore the need for targeted interventions to improve ART access and virologic monitoring to maximize the benefit of ART and limit the spread of HIV and HIVDR. [ABSTRACT FROM AUTHOR]

Background Despite progress in improving antiretroviral therapy (ART) for people with HIV in Malawi, the burden of HIV infections and HIV treatment outcomes among key populations is suboptimal. Client-centered differentiated service delivery approaches may facilitate addressing HIV prevention and treatment needs of key populations in Malawi. Methods De-identified program data routinely collected as part of the LINKAGES project–Malawi were assembled from October 2017 to September 2019. HIV case finding was compared across different testing modalities for each population. Poisson regression was used to estimate the association between testing modalities and ART initiation. Results Of the 18 397 people included in analyses, 10 627 (58%) were female sex workers (FSWs), 2219 (12%) were men who have sex with men (MSM), and 4970 (27%) were clients of FSWs. HIV case finding varied by modality and population, with index testing and enhanced peer outreach demonstrating high yield despite reaching relatively few individuals. FSWs who tested positive through risk network referral testing were more likely to initiate ART within 30 days compared with those who tested positive through clinic-based testing (adjusted risk ratio [aRR], 1.50; 95% CI, 1.23–1.82). For MSM, index testing (aRR, 1.45; 95% CI, 1.06–2.00) and testing through a drop-in center (aRR, 1.82; 95% CI, 1.19–2.78) were associated with 30-day ART initiation. Conclusions These data suggest that differentiated HIV testing and outreach approaches tailored to the needs of different key populations may facilitate improved ART initiation in Malawi. Achieving 0 new infections by 2030 suggests the need to adapt treatment strategies given individual and structural barriers to treatment for key populations with HIV in high-prevalence settings. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSWs) have tightly connected peer networks and remain at high risk of HIV acquisition. Peer delivery of HIV prevention interventions, such as HIV self-testing (HIVST), is a recommended implementation strategy for increasing intervention uptake and continuation among FSWs. We analyzed qualitative data from a peer-delivered HIVST intervention among FSWs in urban Uganda to understand the ways social support within this peer network can motivate or discourage the uptake of peer-delivered HIVST.Methods: Between February and April 2017, we conducted in-depth interviews (IDIs) with FSWs (n = 30) and focus group discussions (FGDs) with FSW peer educators (PEs, n = 5) finishing participation in a four-month randomized implementation trial testing models of peer-delivered HIVST in Kampala. FSW participants were ≥ 18 years old, self-reported exchanging sex for money or goods (past month) and had not recently tested for HIV (past 3 months). FSW PEs either directly distributed HIVST kits to participants or provided coupons exchangeable for HIVST kits from specified healthcare facilities. In the IDIs and FGDs, we asked participants to share their experiences receiving or delivering peer-delivered HIVST, respectively. Using a hybrid deductive and inductive coding approach, we arranged findings along the dimensions of an established social support theory: informational, instrumental, and emotional support.Results: The median age of participants was 30 years (IQR: 27-33) and PEs was 33 years (IQR: 29-37). We found that social support within FSW peer networks both motivated and discouraged uptake of peer-delivered HIVST. For example, sharing positive HIVST experiences (informational support), directly delivering HIVST kits (instrumental support), and encouraging linkage to care (emotional support) motivated HIVST uptake among FSWs. Conversely, the spread of misinformation (informational support), limited HIVST kit availability fostering mistrust of PEs (instrumental support), and fear of social exclusion following HIV status disclosure (emotional support) discouraged HIVST uptake among FSWs.Conclusions: In Uganda, social support (e.g., informational, instrumental, and emotional support) among FSW peers can work in ways that both motivate and discourage peer-delivered intervention uptake. Future FSW peer-delivered HIV prevention interventions should be designed around the dimensions of social support within FSW peer networks to maximize initial and repeat intervention delivery and uptake. [ABSTRACT FROM AUTHOR]

Background & objectives: Female sex workers (FSWs) who inject drugs (FSW-IDs) have a higher risk of HIV infection and transmission. Understanding the socio-demographic characteristics and other risk behaviours among FSW-IDs will help in strengthening targeted interventions for HIV prevention and management. In the present study, the HIV prevalence, associated socio-demographic characteristics and risk behaviours among FSWs who injected drugs (FSW-IDs) and those who did not ID (FSW-NIDs) was determined in India. Methods: The national cross-sectional, community-based, integrated biological and behavioural surveillance was conducted in 2014-2015 at 73 randomly selected FSW domains across 28 States and Union Territories in India. The sample size was fixed at 400 for each domain, and a probability-based sampling method was followed. The data were analyzed by logistic regression methods. Results: Data from 27,007 FSWs were included in the analysis, of which 802 (3%) were FSW-IDs. HIV prevalence among FSW-IDs was significantly higher than that in FSW-NIDs (4.5 vs. 1.9%). Univariate analysis showed that factors significantly associated with higher HIV prevalence among FSW-IDs were older age, sex work as the only source of income, dissolved marriage, living with a sex worker, urban locality of sex work and consumption of alcohol or oral drugs. In multivariable analysis, factors such as older age of FSW-IDs (35 yr and above), having a dissolved marriage and sex work being the only source of income were observed to be independently and significantly associated with higher HIV prevalence. Interpretation & conclusions: Scaling up the HIV preventive interventions for FSW-IDs, such as facilitating awareness and improved access to needle and syringe exchange programme (NSEP) and opioid substitution therapy (OST), encouraging safe sex and injecting practices, educating on the harmful effects of alcohol and drugs and providing alternative vocation options to secure their financial needs are several strategies that may reduce HIV transmission among FSWs. [ABSTRACT FROM AUTHOR]

Introduction: Health‐related quality of life (HRQoL) is an important HIV outcome beyond viral suppression. However, there are limited data characterizing HRQoL of key populations, including female sex workers (FSW) living with HIV. Methods: We used baseline data (22 June 2018–23 March 2020) of FSW who were diagnosed with HIV and enrolled into a randomized trial in Durban, South Africa. HRQoL information was collected by a generic preference‐accompanied tool with five domains (EQ‐5D), and summarized into a single score (range 0–1), which represents health utility. We employed multivariable beta regression models to identify determinants of HRQoL and to estimate subgroup‐specific HRQoL score. Using external estimates of life expectancy and population size, we estimated the number of quality adjusted life years reduced among FSW living with HIV in South Africa associated with violence and drug use. Results: Of 1,363 individuals (mean age: 32.4 years; mean HRQoL score: 0.857) in our analysis, 62.6% used drugs, 61.3% experienced physical or sexual violence and 64.6% self‐reported taking antiretroviral treatment (ART). The following were associated with a reduction in the average marginal HRQoL score: older age (per decade: 0.018 [95% confidence interval (CI): 0.008, 0.027]), drug use (0.022 [0.007, 0.036]), experience of violence (0.024 [0.010, 0.038]) and moderate (vs. no) level of internalized stigma (0.023 [0.004, 0.041]). Current ART use was associated with a 0.015‐point (–0.001, 0.031) increase in the HRQoL score. The estimated mean (95% CI) HRQoL scores ranged from 0.838 (0.816, 0.860) for FSW who used drugs, experienced violence and were not on ART; to 0.899 (0.883, 0.916) for FSW who did not use drugs nor experience violence and were on ART. Our results can be translated into a reduction in 37,184 and 39,722 quality adjusted life years related to drug use and experience of violence, respectively, in South Africa. Conclusions: These results demonstrate the association of ART with higher HRQoL among FSW and the need to further address structural risks, including drug use, violence and stigma. Population‐specific estimates of HRQoL score can be further used to calculate quality‐adjusted life years in economic evaluations of individual and structural interventions addressing the needs of FSW living with HIV. Clinical Trial Registration: NCT03500172 (April 17, 2018). [ABSTRACT FROM AUTHOR]