Abstract
Introduction‘Sisters with a Voice’, Zimbabwe's nationally scaled comprehensive programme for female sex workers (FSWs), intensified community mobilization activities in three sites to increase protective behaviours and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation.MethodsWe used mixed methods to collect data at three sites: in‐depth interviews (n = 22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer‐administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS‐1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education.Results870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio‐demographic differences, we found higher estimates of the proportion of HIV‐positive FSWs and HIV‐positive FSWs who knew their status and reported being on ART in Mutare and Victoria Falls in 2015 compared to 2011. Reported condom use with clients did not differ by year; however, condom use with regular partners was higher in 2015 in Mutare and Hwange. Reported HIV testing in the last six months among HIV‐negative FSWs was higher in 2015 across sites: for instance, in Victoria Falls it was 13.4% (95% CI 8.7% to 19.9%) in 2011 and 80.8% (95% CI 74.0 to 87.7) in 2015. FSWs described positive perceptions of the Sisters programme, ease of engaging with health services, and improved solidarity among peers. Programme data showed increases in service use by 2015 across all sites.ConclusionsImprovements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilization intervention. Engagement with services for FSWs is critical for countries to reach 90‐90‐90 targets.
Highlights
The World Health Organization and UNAIDS recommend that sex workers access comprehensive HIV prevention, testing, and treatment [1,2,3]
Female sex workers (FSWs) have a high burden of HIV [4], and 15% of HIV infections in the general adult population globally are considered attributable to unsafe commercial sex [5]
We describe the prevalence of programme engagement and key HIV status, prevention and care indicators in 2011 and 2015, accounting for the Respondent Driven Sampling (RDS) design using RDS-I weighting [39] to be consistent across years, as previously reported for the 2011 survey [33]
Summary
The World Health Organization and UNAIDS recommend that sex workers access comprehensive HIV prevention, testing, and treatment [1,2,3]. Female sex workers (FSWs) have a high burden of HIV [4], and 15% of HIV infections in the general adult population globally are considered attributable to unsafe commercial sex [5]. This proportion is likely to increase over time [6]. Sex workers suffer criminalization [7], stigma, discrimination and violence in a number of settings, heightening their vulnerability to HIV [8,9] Due to their social marginalization, sex workers often choose to access targeted, non-judgmental, and tailored services to meet their needs [10,11]. Despite evidence of their effectiveness [12,13,14], targeted programmes for FSWs in most countries consist of small scattered projects, with limited scope and coverage [15,16,17,18]
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