Abstract
BackgroundIn Sub-Saharan Africa where HIV disproportionately affects women, heterosexual male sex workers (HMSW) and their female clients are at risk of acquiring or transmitting HIV and other STIs. However, few studies have described HIV and STI risk among HMSW. We aimed to assess and compare recent HIV and syphilis screening practices among HMSW and female sex workers (FSW) in Uganda.MethodsBetween August and December 2019, we conducted a cross-sectional study among 100 HMSW and 240 female sex workers (FSW). Participants were enrolled through snowball sampling, and an interviewer-administered questionnaire used to collect data on HIV and syphilis testing in the prior 12 and 6 months respectively. Integrated change model constructs were used to assess intentions, attitudes, social influences, norms and self-efficacy of 3-monthly Syphilis and 6-monthly HIV testing. Predictors of HIV and syphilis recent testing behaviors were estimated using negative binomial regression.ResultsWe enrolled 340 sex workers of whom 100 (29%) were HMSW. The median age was 27 years [interquartile range (IQR) 25–30] for HMSW and 26 years [IQR], (23–29) for FSW. The median duration of sex work was 36 and 30 months for HMSW and FSW, respectively. HMSW were significantly less likely than FSW to have tested for HIV in the prior 12 months (50% vs. 86%; p = 0.001). For MSW, non-testing for HIV was associated with higher education [adjusted prevalence ratio (aPR) 1.66; 95% confidence interval (CI) 1.09–2.50], poor intention to seek HIV testing (aPR 1.64; 95% CI 1.35–2.04), perception that 6-monthly HIV testing was not normative (aPR 1.33; 95% CI 1.09–1.67) and low self-efficacy (aPR 1.41; 95% CI 1.12–1.79). Not testing for syphilis was associated with low intention to seek testing (aPR 3.13; 95% CI 2.13–4.55), low self-efficacy (aPR 2.56; 95% CI 1.35–4.76), negative testing attitudes (aPR 2.33; 95% CI 1.64–3.33), and perception that regular testing was not normative (aPR 1.59; 95% CI 1.14–2.22).ConclusionsNon-testing for HIV and syphilis was common among HMSW relative to FSW. Future studies should evaluate strategies to increase testing uptake for this neglected sub-population of sex workers.
Highlights
In Sub-Saharan Africa where Human immunodeficiency virus (HIV) disproportionately affects women, heterosexual male sex workers (HMSW) and their female clients are at risk of acquiring or transmitting HIV and other sexually transmitted infections (STI)
A higher proportion of female sex workers (FSW) (82%) reported having children compared to 64% of HMSW
Psychosocial influences of regular syphilis and HIV testing We found that compared to FSW, HMSW had low intentions or attitudes towards 3-monthly Syphilis or 6-montthly HIV testing (Table 3)
Summary
In Sub-Saharan Africa where HIV disproportionately affects women, heterosexual male sex workers (HMSW) and their female clients are at risk of acquiring or transmitting HIV and other STIs. There is global recognition that sex work is a key driver of HIV and other sexually transmitted infections (STI) in the general population [1,2,3,4]. Muhindo et al AIDS Res Ther (2020) 17:48 sex workers (FSW) [3, 4], male sex workers (MSW) are increasingly being recognized as a key population contributing to the global burden of HIV and STI [5,6,7]. The HIV burden among MSW is high in subSaharan Africa (SSA), with an HIV prevalence of 26.3% and 50% in Kenya and Cote d’Ivoire, respectively [15, 16] This is comparable to HIV prevalence observed among FSW (36.9%) in this setting [3], and globally (11.8–30.7%) [3]. Sex workers are a bridge population; up to 15% of HIV infections in the general population are attributed to sex work [4]
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