Abstract
BackgroundIn most settings, Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease worldwide. Representative data to inform the development of behavioral and biomedical interventions for FSW in Namibia have not been published.ObjectivesOur objectives were to measure HIV prevalence, identify risk factors for infection, and describe uptake of prevention, testing, and treatment among FSW in Namibia.MethodsWe conducted cross-sectional surveys using Respondent-driven Sampling (RDS) in the Namibian cities of Katima Mulilo, Oshikango, Swakopmund/Walvis Bay, and Windhoek. Participating FSW completed behavioral questionnaires and rapid HIV testing.ResultsCity-specific ranges of key indicators were: HIV prevalence (31.0–52.3%), reached by prevention programs in the past 12 months (46.9–73.6%), condom use at last sex with commercial (82.1–91.1%) and non-commercial (87.0–94.2%) partners, and tested for HIV within past 12 months or already aware of HIV-positive serostatus (56.9–82.1%). Factors associated with HIV infection varied by site and included: older age, having multiple commercial or non-commercial sex partners, unemployment, being currently out of school, and lower education level. Among HIV-positive FSW, 57.1% were aware of their HIV-positive serostatus and 33.7% were on antiretroviral treatment.DiscussionOur results indicate extremely high HIV prevalence and low levels of case identification and treatment among FSW in Namibia. Our results, which are the first representative community-based estimates among FSW in Namibia, can inform the scale-up of interventions to reduce the risk for HIV acquisition and onward transmission, including treatment as prevention and pre-exposure prophylaxis.
Highlights
Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease in most settings, directly or indirectly accounting for an estimated 40–50% of all new HIV infections worldwide [1]
The eligibility rate was 72.5%, 77.6%, 77.5%, and 86.3% in the Katima Mulilo, Oshikango, Swakopmund/Walvis Bay, and Windhoek study sites, respectively
Most FSW in our study reported that they used a condom during the most recent time they had sex with a commercial partner or non-commercial partner, estimates that are higher than the percentage of general population who reported condom use with their last partner during the 2013 Namibia Demographic and Health Survey (NDHS) (67.5%) [20] and comparable to the estimated 85% of FSW who reported using a condom during their last sexual intercourse, as reported by a survey of capital cities in 85 countries in 2012 [25]
Summary
Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease in most settings, directly or indirectly accounting for an estimated 40–50% of all new HIV infections worldwide [1]. Stigmatization, marginalization, or criminalization by societies may disempower FSW to modify their risk and access services [12]. Reliable estimates of HIV prevalence, risk factors for infection, and access to services are needed to inform the development of behavioral, biomedical, and structural interventions for this key population. Female Sex Workers (FSW) bear a disproportionate burden of Human Immunodeficiency Virus (HIV) disease worldwide. Representative data to inform the development of behavioral and biomedical interventions for FSW in Namibia have not been published
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