Social Cohesion, Social Participation, and HIV Related Risk among Female Sex Workers in Swaziland

Institut Pluridisciplinaire Hubert Curien, France
PLoS ONE (Impact Factor: 3.23). 01/2014; 9(1):e87527. DOI: 10.1371/journal.pone.0087527
Source: PubMed


Social capital is important to disadvantaged groups, such as sex workers, as a means of facilitating internal group-related mutual aid and support as well as access to broader social and material resources. Studies among sex workers have linked higher social capital with protective HIV-related behaviors; however, few studies have examined social capital among sex workers in sub-Saharan Africa. This cross-sectional study examined relationships between two key social capital constructs, social cohesion among sex workers and social participation of sex workers in the larger community, and HIV-related risk in Swaziland using respondent-driven sampling. Relationships between social cohesion, social participation, and HIV-related risk factors were assessed using logistic regression. HIV prevalence among the sample was 70.4% (223/317). Social cohesion was associated with consistent condom use in the past week (adjusted odds ratio [AOR] = 2.25, 95% confidence interval [CI]: 1.30-3.90) and was associated with fewer reports of social discrimination, including denial of police protection. Social participation was associated with HIV testing (AOR = 2.39, 95% CI: 1.36-4.03) and using condoms with non-paying partners (AOR = 1.99, 95% CI: 1.13-3.51), and was inversely associated with reported verbal or physical harassment as a result of selling sex (AOR = 0.55, 95% CI: 0.33-0.91). Both social capital constructs were significantly associated with collective action, which involved participating in meetings to promote sex worker rights or attending HIV-related meetings/ talks with other sex workers. Social- and structural-level interventions focused on building social cohesion and social participation among sex workers could provide significant protection from HIV infection for female sex workers in Swaziland.

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    • "Social cohesion among FSW in Swaziland, including being able to count on FSW colleagues to support the use of condoms, was found to be positively related to consistent condom use with all clients and partners in the past week (Fonner et al., 2014). There is a need to better characterize prevention strategies among FSW to inform increasing investments in targeted HIV and STI prevention programs for the FSW population globally (Kerrigan et al., 2013). "
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    ABSTRACT: Objectives. This study examined correlates of condom use among 248 female sex workers (FSW) in The Gambia. Methods. Between July and August 2011, FSW in The Gambia who were older than 16 years of age, the age of consent in The Gambia, were recruited for the study using venue-based sampling and snowball sampling, beginning with seeds who were established clients with the Network of AIDS Services Organizations. To be eligible, FSW must have reported selling sex for money, favors, or goods in the past 12 months. Bivariate and multivariate logistic regressions were used to determine associations and the relative odds of the independent variables with condom use. Four different condom use dependent variables were used: consistent condom use in the past six months during vaginal or anal sex with all clients and partners; consistent condom use in the past month during vaginal sex with new clients; consistent condom use in the past month during vaginal sex with nonpaying partners (including boyfriends, husbands, or casual sexual partners); and condom use at last vaginal or anal sex with a nonpaying partner. Results. Many FSW (67.34%, n = 167) reported it was not at all difficult to negotiate condom use with clients in all applicable situations, and these FSW were more likely to report consistent condom use with all clients and partners in the past 6 months (aOR 3.47, 95% CI [1.70-7.07]) compared to those perceiving any difficulty in condom negotiation. In addition, FSW were more likely to report using condoms in the past month with new clients (aOR 8.04, 95% CI [2.11-30.65]) and in the past month with nonpaying partners (aOR 2.93, 95% CI [1.09-7.89]) if they had been tested for HIV in the past year. Women who bought all their condoms were less likely than those who received all of their condoms for free (aOR 0.38, 95% CI [0.15-0.97]) to have used a condom at last vaginal or anal sex with a nonpaying partner. Conclusions. HIV and sexually transmitted infection (STI) prevention interventions for FSW should aim to improve condom negotiation self-efficacy since women who report less difficulty negotiating condom use are more likely to use condoms with clients. Interventions should also be aimed at structural issues such as increasing access to free condoms and HIV testing since these were positively associated with condom use among FSW.
    PeerJ 08/2015; 3(2):e1076. DOI:10.7717/peerj.1076 · 2.11 Impact Factor
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    • "Through building dense networks of relationships (bonding social capital) among sex workers and bridging and linking social capital with elites within the community and outside it, sex workers have engaged in collective action, strengthening their social and political position and reducing HIV risk (Ghose, Swendeman, George & Chowdhury, 2008). Research in Swaziland mapping the relationship between sex workers' HIV-related risk and social capital suggested that sex workers with stronger social capital had reduced HIV-risk behaviours and more engagement in local community action and supportive networks (Fonner et al., 2014). Much research on social capital, HIV and community action emphasises social capital as the property of an individual without exploring the social processes for generating and maintaining it. "
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    ABSTRACT: Social capital is increasingly conceptualised in academic and policy literature as a panacea for a range of health and development issues, particularly in the context of HIV. In this paper, we conceptualise social capital as an umbrella concept capturing processes including networks, norms, trust and relationships that open up opportunities for participation and collective action that allow communities to address issues of common concern. We specifically outline social capital as comprising three distinct forms: bonding, bridging and linking social capital. Rather than presenting original data, we draw on three well-documented and previously published case studies of health volunteers in South Africa. We explore how social contexts shape the possibility for the emergence and sustainability of social capital. We identify three cross-cutting contextual factors that are critical barriers to the emergence of social capital: poverty, stigma and the weakness of external organisations' abilities to support small groups. Our three case studies suggest that the assumption that social capital can be generated from the ground upwards is not reasonable. Rather, there needs to be a greater focus on how those charged with supporting small groups—non-governmental organisations, bureaucracies and development agencies—can work to enable social capital to emerge. Copyright © 2014 John Wiley & Sons, Ltd.
    Journal of Community & Applied Social Psychology 05/2014; 25(2). DOI:10.1002/casp.2199 · 1.19 Impact Factor
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    ABSTRACT: Background For effective implementation of HIV-related behavioral interventions, better understanding the demographic characteristics of infected patients in relation with high-risk behavior profiles, physical and mental health are essential. Methods In a cross-sectional descriptive study, 400 HIV infected patients from December 2011 through January 2013 were evaluated regarding their demographic features, and four selected subscales (high-risk behaviors, self-efficacy, well-being, and social participation). A validated questionnaire of 62 items was used for assessment. Results Almost 33% of all participants were women, 28% were younger than 30 years old, and 43% were never married; 50% had no permanent jobs. Women, widowed participants, patients <30 years, and those with higher educational levels had higher mean HIV risk behavior scores. In simple and multiple linear regression models, women >50 years and <30 years had the highest scores (β = 2.714, p < 0.0001; β = 2.00, p < 0.001). Furthermore, male and illiterate patients had higher social participation scores while female and divorced participants had higher well-being and self-efficacy scores. Conclusion We propose that demographic features play a critical role in increasing engagement in HIV-related high-risk behaviors; these characteristics also affect patients’ social participation, well-being and self-efficacy. High-risk behaviors and social participation scores among women of different age groups and the youth highlight the need for future age and gender-specific educational and behavioral interventions among them.
    Journal of Infection and Public Health 08/2014; 7(6). DOI:10.1016/j.jiph.2014.07.014
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