Abstract
BackgroundSex workers in Uganda are at significant risk for HIV infection. We characterized the HIV epidemic among Kampala female sex workers (FSW).MethodsWe used respondent-driven sampling to sample FSW aged 15+ years who reported having sold sex to men in the preceding 30 days; collected data through audio-computer assisted self-interviews, and tested blood, vaginal and rectal swabs for HIV, syphilis, neisseria gonorrhea, chlamydia trachomatis, and trichomonas vaginalis.ResultsA total of 942 FSW were enrolled from June 2008 through April 2009. The overall estimated HIV prevalence was 33% (95% confidence intervals [CI] 30%-37%) and among FSW 25 years or older was 44%. HIV infection is associated with low levels of schooling, having no other work, never having tested for HIV, self-reported genital ulcers or sores, and testing positive for neisseria gonorrhea or any sexually transmitted infections (STI). Two thirds (65%) of commercial sex acts reportedly were protected by condoms; one in five (19%) FSW reported having had anal sex. Gender-based violence was frequent; 34% reported having been raped and 24% reported having been beaten by clients in the preceding 30 days.ConclusionsOne in three FSW in Kampala is HIV-infected, suggesting a severe HIV epidemic in this population. Intensified interventions are warranted to increase condom use, HIV testing, STI screening, as well as antiretroviral treatment and pre-exposure prophylaxis along with measures to overcome gender-based violence.
Highlights
Sex workers in Uganda are at significant risk for Human immunodeficiency virus (HIV) infection
Joint United Nations Programme on AIDS (UNAIDS) has put forward a bold vision to end the global HIV epidemic by 2030, [2] beginning by first meeting the 90-90-90 “fast-track” targets by 2020.1 These achievements are only possible by implementing comprehensive packages of prevention and HIV care services for all populations, especially those with highest HIV burden, incidence, and transmission rates
Most (83%) female sex workers (FSW) have ever been to school, and 51% had completed at least 7 years of schooling, equivalent to primary school education
Summary
Sex workers in Uganda are at significant risk for HIV infection. We characterized the HIV epidemic among Kampala female sex workers (FSW). UNAIDS has put forward a bold vision to end the global HIV epidemic by 2030, [2] beginning by first meeting the 90-90-90 “fast-track” targets by 2020.1 These achievements are only possible by implementing comprehensive packages of prevention and HIV care services for all populations, especially those with highest HIV burden, incidence, and transmission rates. Key populations, including sex workers, are critical to controlling the HIV pandemic. A recent review estimated that female sex workers (FSW) are 13.5 times more likely to be HIV infected than other women [3]. Sex workers require tailored public health interventions that address critical gaps in HIV prevention, HIV testing, case-finding, linkage, retention, and adherence to antiretroviral therapy. FSW are at increased risk for HIV due to frequent sex with numerous clients, inconsistent
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