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      HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique

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          Summary

          Background

          HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country.

          Methods

          This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity.

          Findings

          The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6).

          Interpretation

          One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030.

          Funding

          The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.

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          Most cited references59

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

          Douglas D Heckathorn (1997)
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            The role of sexually transmitted diseases in HIV transmission.

            Shannon Galvin, Myron S Cohen (2004)
            More than 42 million people worldwide are now infected with HIV, in spite of sustained prevention activities. Although the spread of HIV has been primarily sexual, epidemiological studies have indicated that the efficiency of the spread of HIV is poor, perhaps as infrequently as 1 in every 1,000 episodes of sexual intercourse. However, sexually transmitted diseases (STDs) that cause ulcers or inflammation greatly increase the efficiency of HIV transmission--by increasing both the infectiousness of, and the susceptibility to HIV infection. STDs might be particularly important in the early stages of a localized HIV epidemic, when people with risky sexual behaviour are most likely to become infected. In China, eastern Europe and Russia, there has been a remarkable increase in the incidence of STDs in recent years, and this is reflected in the rapid increase in the spread of HIV in these areas. Targeted STD detection and treatment should have a central role in HIV prevention in these emerging epidemics.
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              Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

              Julia L. Marcus, Wendy A Leyden, Stacey E. Alexeeff … (2020)
              This cohort study compares overall life expectancy and comorbidity-free life expectancy by HIV status for insured adults with and without HIV infection from 2000 to 2016 in the US. Question Is antiretroviral therapy associated with improved survival among individuals with HIV infection? Findings In this cohort study of 39 000 adults with HIV infection and 387 785 adults without HIV infection in the US, individuals with HIV infection lived 6.8 fewer years overall and 9.5 fewer years without major chronic comorbidities, even after initiation of antiretroviral therapy at high CD4 cell counts. Meaning The results suggest that life expectancy of adults with HIV infection may be near that of life expectancy of individuals without HIV infection, but greater attention is needed to prevention of comorbidities among individuals with HIV infection. Importance Antiretroviral therapy (ART) has improved life expectancy for individuals with HIV infection, but recent data comparing life span and comorbidity-free years by HIV status are lacking. Objective To quantify the gap in life span and comorbidity-free years by HIV status among adults with access to care. Design, Setting, and Participants This matched cohort study used data from insured adults with and without HIV infection (aged ≥21 years) matched 1:10 at medical centers of Kaiser Permanente in northern and southern California and the mid-Atlantic states of Washington DC, Maryland, and Virginia from January 1, 2000, through December 31, 2016. Data were analyzed from September 1, 2019, through March 31, 2020. Exposures HIV status and, for individuals with HIV infection, ART initiation at a CD4 cell count of 500/μL or greater. Main Outcomes and Measures Overall life expectancy and expected years free of major chronic comorbidities, including chronic liver disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and cardiovascular disease. Results Of 39 000 individuals with HIV infection and 387 785 matched uninfected adults, 374 421 (87.7%) were male, with a mean (SD) age of 41.4 (10.8) years. Among 359 244 individuals with known race/ethnicity, 90 177 (25.1%) were non-Hispanic black and 87 191 (24.3%) were Hispanic. From 2000 to 2003, overall life expectancy at age 21 years of age was 37.6 years among individuals with HIV infection and 59.7 years among uninfected adults, (difference, 22.1 years; 95% CI, 20.2-24.0 years). From 2014 to 2016, overall life expectancy at 21 years of age among individuals with HIV infection increased to 56.0 years compared with 65.1 years among uninfected adults (difference, 9.1 years; 95% CI, 7.9-10.2 years). During 2011 to 2016, individuals with HIV infection who initiated ART with a CD4 cell count of 500/μL or greater had a life expectancy at 21 years of age of 57.4 years compared with 64.2 years among uninfected adults (difference, 6.8 years; 95% CI, 5.0-8.5 years). From 2000 to 2003, the expected number of comorbidity-free years remaining at 21 years of age was 11.3 for individuals with HIV infection and 26.6 years for uninfected adults (difference, 15.3 years; 95% CI, 13.9-16.6 years). This difference in comorbidity-free years persisted over time but decreased to 9.5 years (95% CI, 7.7-11.2 years) for individuals with HIV infection who initiated ART at a CD4 cell count of 500/μL or greater. Conclusions and Relevance The results suggest that life expectancy of adults with HIV infection may be near that of life expectancy of individuals without HIV infection, but greater attention is needed to prevention of comorbidities among individuals with HIV infection.
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                Author and article information

                Contributors
                Saro Abdella
                Journal
                Journal ID (nlm-ta): eClinicalMedicine
                Journal ID (iso-abbrev): EClinicalMedicine
                Title: eClinicalMedicine
                Publisher: Elsevier
                ISSN (Electronic): 2589-5370
                Publication date PMC-release: 01 July 2022
                Publication date Collection: September 2022
                Publication date (Electronic): 01 July 2022
                Volume: 51
                Electronic Location Identifier: 101540
                Affiliations
                [a ]HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
                [b ]School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
                [c ]Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
                [d ]School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
                [e ]Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
                Author notes
                [* ]Corresponding author. helen_saro@ 123456yahoo.com
                Article
                Publisher Item ID: S2589-5370(22)00270-X Publisher ID: 101540
                DOI: 10.1016/j.eclinm.2022.101540
                PMC ID: 9256839
                PubMed ID: 35813094
                SO-VID: 8e67a275-d7ee-4f83-b415-0b607744a27b
                Copyright © © 2022 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 4 March 2022
                Date revision received : 9 June 2022
                Date accepted : 13 June 2022
                Categories
                Subject: Articles

                Keywords: hiv prevalence,associated factors,fsw
                Data availability:
                Keywords: hiv prevalence, associated factors, fsw

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