Abstract
BackgroundHIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs’ access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services.MethodsA systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported.Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203.ResultsThis review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work.ConclusionsFSWs’ access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population.
Highlights
HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment
The findings of this review show that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among female sex workers (FSWs) in sub-Saharan Africa
The present review shows that factors related to approachability include, awareness on availability HTC services, and attitudes about testing and HIV risk perception
Summary
HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Female sex workers (FSWs) are at heightened risk of acquiring HIV compared to other females of reproductive age [1,2,3]. According to a systematic review and meta-analysis study, the risk of acquiring HIV across SSA is 13 times higher for FSWs [1]. A modelling study on population attributable fraction (PAF) estimates of HIV infections estimated that, the PAF of HIV infections among women of reproductive age in the general population due to female sex work in SSA was 18% in 2011 [12]. Due to structural barriers in most SSA countries, FSWs are less likely to access HIV prevention and treatment services [13]. To achieve the UNAIDS goal of ending the HIV epidemic as a public health threat by 2030,the emphasis has been to ensure equitable access of FSWs and other key populations (KPs) to HIV prevention services including HTC [14]
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