Exploring HIV Prevention Utilization among Female Sex Workers and Male-to-Female Transgenders
Female sex worker (FSW) and male-to-female transgender (TGW, transgender women) populations both experience elevated levels of HIV infection and have unique prevention needs because of their stigmatized social status and often-precarious economic circumstances. We analyzed data from 104 FSWs and 128 TGW to assess their level of exposure to active and passive HIV prevention services and identify which subgroups are underserved. Data were collected, in Los Angeles for the cross-sectional 2003-2004 HIV Testing Survey (HITS), through face-to-face interviews with participants recruited primarily from street, club, and social service venues. Both groups reported more passive than active prevention exposure, with overall participation less common for FSWs than for TGW. Although some differences were observed between groups, predictors of lower HIV prevention utilization identified in both study populations included African American (versus Hispanic) race/ethnicity, higher household incomes, cohabitation/marriage, and not seeking recent health care. Prevention efforts should increase outreach to these subgroups, tailor programs for those who are African American or partnered, and increase the proportion of FSWs and TGW who periodically engage in active HIV prevention services such as client-centered counseling and small-group interventions to build skills related to safer sex.
Available from: ncbi.nlm.nih.gov
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ABSTRACT: This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was utilized. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than six years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers.
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ABSTRACT: The present study investigated the prevalence of psychological problems and their relationships with relevant HIV prevention behaviors among female sex workers (FSWs). An anonymous cross-sectional survey was conducted. With a mapping exercise, 293 Chinese FSWs were recruited from a red-light district in Hong Kong. Results showed high prevalence of psychological problems among FSWs: substance use (40.4%), probable depression (53.9%), self-harm tendencies (34-38%), poor self-esteem (48-52%), and pessimistic future outlook (46-47%). Inconsistent condom use was common (51% with clients, 23% with one-night-stand sex partner, and 73% with boyfriends). Over 70% had not used HIV-related prevention services in the last 6 months. Multivariate analyses indicated that psychological problems were significantly associated with inconsistent condom use and non-use of prevention services. The poor psychological well-beings of FSWs have important public health implications. Relevant professional services should be provided and integrated with HIV prevention efforts.
Available from: George William Pariyo
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ABSTRACT: Many newly screened people living with HIV (PLHIV) in Sub-Saharan Africa do not understand the importance of regular pre-antiretroviral (ARV) care because most of them have been counseled by staff who lack basic counseling skills. This results in low uptake of pre-ARV care and late treatment initiation in resource-poor settings. The effect of providing post-test counseling by staff equipped with basic counseling skills, combined with home visits by community support agents on uptake of pre-ARV care for newly diagnosed PLHIV was evaluated through a randomized intervention trial in Uganda.
An intervention trial was performed consisting of post-test counseling by trained counselors, combined with monthly home visits by community support agents for continued counseling to newly screened PLHIV in Iganga district, Uganda between July 2009 and June 2010, Participants (N = 400) from three public recruitment centres were randomized to receive either the intervention, or the standard care (the existing post-test counseling by ARV clinic staff who lack basic training in counseling skills), the control arm. The outcome measure was the proportion of newly screened and counseled PLHIV in either arm who had been to their nearest health center for clinical check-up in the subsequent three months +2 months. Treatment was randomly assigned using computer-generated random numbers. The statistical significance of differences between the two study arms was assessed using chi-square and t-tests for categorical and quantitative data respectively. Risk ratios and 95% confidence intervals were used to assess the effect of the intervention.
Participants in the intervention arm were 80% more likely to accept (take up) pre-ARV care compared to those in the control arm (RR 1.8, 95% CI 1.4-2.1). No adverse events were reported.
Provision of post-test counseling by staff trained in basic counseling skills, combined with home visits by community support agents had a significant effect on uptake of pre-ARV care and appears to be a cost-effective way to increase the prerequisites for timely ARV initiation.
The trial was registered by Current Controlled Trials Ltd C/OBioMed Central Ltd as ISRCTN94133652 and received financial support from Sida and logistical support from the European Commission.
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