Abstract
BackgroundFemale sex workers in sub-Saharan Africa face high unmet need for family planning and higher risk for unintended pregnancy. Community empowerment HIV prevention approaches have the potential to increase family planning uptake and present an opportunity to integrate HIV, reproductive health, and contraception. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use.MethodsThis study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.)ResultsAmong the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02–1.56]) and 36% (aRR 1.36 [95%CI: 1.13–1.64) higher than among those who had not attended.ConclusionThere is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.
Highlights
Female sex workers (FSW) in sub-Saharan Africa (SSA) are at heightened risk for unintended pregnancy as well as for Human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), demonstrating a high unmet need for family planning (FP) [1, 2]
This study provides an overview of the reproductive health profile of this population of FSW
The working environments of FSW in sub-Saharan Africa can place them at higher risk of unintended pregnancy, as well as STI including HIV
Summary
Female sex workers (FSW) in sub-Saharan Africa (SSA) are at heightened risk for unintended pregnancy as well as for HIV and other sexually transmitted infections (STI), demonstrating a high unmet need for family planning (FP) [1, 2]. Program surveillance data in Tanzania found 5.7% dual protection use and 16% consistent condom use among FSW attending services [9] Once pregnant, these same challenges may constitute barriers to accessing antenatal care (ANC) or prevention of mother-to-child transmission (PMTCT) services [10, 11]. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use
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