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      Safer Conception Needs for HIV Prevention among Female Sex Workers in Burkina Faso and Togo

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          Abstract

          Background. Reproductive health programming for female sex workers (FSW) may include contraceptive services but rarely addresses safer pregnancy planning. Methods. Adult FSW were enrolled into a cross-sectional study across four sites in Burkina Faso and Togo using respondent-driven sampling. Sociobehavioral questionnaires and HIV counseling and testing were administered. Sample statistics and engagement in HIV treatment were described and compared using Chi-squared statistics. Results. 1,349 reproductive-aged FSW were enrolled from January to July 2013. Overall, 267 FSW (19.8%) were currently trying to conceive. FSW trying to conceive were more likely to test positive for HIV at enrollment as compared to women not trying to become pregnant (24.5% versus 17.7%, P < 0.01); however awareness of HIV status was similar across groups. Among FSW trying to conceive, 79.0% (211/267) had previously received HIV testing, yet only 33.8% (23/68) of HIV-infected FSW reported a previous HIV diagnosis. Overall 25.0% (17/68) of HIV-infected FSW trying to conceive were on antiretroviral therapy. Conclusion. FSW frequently desire children. However engagement in the HIV prevention and treatment cascade among FSW trying to conceive is poor potentiating periconception transmission risks to partners and infants. Programs to facilitate earlier HIV diagnosis for FSW and safer conception counseling are needed as components of effective combination HIV prevention services.

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          Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations

          Douglas D Heckathorn (1997)
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            "Life is still going on": reproductive intentions among HIV-positive women and men in South Africa.

            Landon Myer, Virginia Zweigenthal, Phyllis Orner … (2007)
            This article reports on qualitative research investigating HIV positive individuals' reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not receiving ART. Being HIV positive modified but did not remove reproductive desires, and diversity existed in reproductive intentions. Some HIV positive individuals wished to avoid pregnancy. Fears of partner and infant infection and having a previously infected baby were important factors deterring some individuals from considering having children. There was also strongly perceived community disapproval associated with HIV and reproduction. Strong desires to experience parenthood, mediated by prevailing social and cultural norms that encouraged childbearing in society more broadly, were reported by others. Motherhood was an important component of married women's identity and important for women's social status. Family, husbands' and societal expectations for childbearing were important influences on women's reproductive intentions, for some counterbalancing HIV as a factor discouraging reproduction. There was evidence that prevention of perinatal transmission programs in combination with ART may alter women and men's attitudes in favour of childbearing. Most HIV positive women had not discussed their reproductive desires and intentions with health care providers in HIV care or general health services because of anticipated negative reactions. The few who had done so perceived the counselling environment to be mostly unsupportive of open discussion on these issues. The findings highlight the need for explicit policies recognizing reproductive rights and choice. They support the need for health counselling and service interventions that advance safer and healthier reproductive options for HIV positive individuals in this region of the world which is experiencing a generalised and advanced HIV/AIDS pandemic.
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              Engagement with HIV Prevention Treatment and Care among Female Sex Workers in Zimbabwe: a Respondent Driven Sampling Survey

              Frances M. Cowan, Sibongile Mtetwa, Calum Davey … (2013)
              Objective(S) To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare. Design Respondent driven sampling (RDS) surveys conducted at each site. Methods Sex workers were recruited using respondent driven sampling with each respondent limited to recruiting 2 peers. Participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Statistical analysis took account of sampling method. Results 870 women were recruited from the three sites. HIV prevalence was between 50 and 70%. Around half of those confirmed HIV positive were aware of their HIV status and of those 50-70% reported being enrolled in HIV care programmes. Overall only 25-35% of those with laboratory-confirmed HIV were accessing antiretroviral therapy. Among those reporting they were HIV negative, 21-28% reported having an HIV test in the last 6 months. Of those tested HIV negative, most (65-82%) were unaware of their status. Around two-thirds of sex workers reported consistent condom use with their clients. As in other settings, sex workers reported high rates of gender based violence and police harassment. Conclusions This survey suggests that prevalence of HIV is high among sex workers in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal. Intensifying prevention and care interventions for sex workers has the potential to markedly reduce HIV and social risks for sex workers, their clients and the general population in Zimbabwe and elsewhere in the region.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Dis Obstet Gynecol
                Journal ID (iso-abbrev): Infect Dis Obstet Gynecol
                Journal ID (publisher-id): IDOG
                Title: Infectious Diseases in Obstetrics and Gynecology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1064-7449
                ISSN (Electronic): 1098-0997
                Publication date (Print): 2014
                Publication date (Electronic): 23 October 2014
                Volume: 2014
                Electronic Location Identifier: 296245
                Affiliations
                1Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7138, Baltimore, MD 21205, USA
                2Programme d'Appui au Monde Associatif et Communautaire (PAMAC), 11 BP 1023 Ouagadougou, Burkina Faso
                3Arc en Ciel, 80295 Lomé, Togo
                4Institut de Recherche en Sciences de la Santé (IRSS/CNRST), 03 BP 7192 Ouagadougou, Burkina Faso
                5Conseil National de Lutte contre le SIDA du Togo (National AIDS Council), Faculté des Sciences de la Santé, Université de Lomé, 01 BP 2237 Lomé, Togo
                Author notes
                *Sheree R. Schwartz: sschwartz@ 123456jhu.edu

                Academic Editor: Gregory T. Spear

                Author information
                http://orcid.org/0000-0001-5759-7125
                http://orcid.org/0000-0002-5482-2419
                Article
                DOI: 10.1155/2014/296245
                PMC ID: 4227409
                SO-VID: 3e396e20-3646-4623-bc10-ad01ca37618f
                Copyright © Copyright © 2014 Sheree R. Schwartz et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 June 2014
                Date revision received : 7 October 2014
                Date accepted : 8 October 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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