Abstract
ObjectivesFemale sex workers (FSWs) in sub-Saharan Africa are a key population for HIV prevention and treatment interventions, but less attention is given to their family planning needs. We evaluated the prevalence and predictors of unmet contraceptive need in HIV-positive FSWs.Study designThis cross-sectional analysis used data from an existing longitudinal study of FSWs in Mombasa, Kenya. This analysis included women who were HIV positive, age ≥18 years, pre-menopausal, not currently pregnant or desiring pregnancy, and reported exchanging sex for cash or in-kind payment at the time of enrollment. Unmet contraceptive need was defined as non-use of modern non-barrier contraceptives and not currently trying to become pregnant. Poisson regression was used to identify factors independently associated with unmet contraceptive need.ResultsAmong 346 HIV-positive FSWs, 125 (36.1%) reported modern non-barrier contraceptive use, leaving 221 (63.9%, 95%CI 58.8–68.9%) with unmet contraceptive need. Condom use was the only form of contraception for 129 (37.3%) participants. In unadjusted analyses, unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%CI 1.0–1.5), desire for (more) children (PR 1.3, 95%CI 1.1–1.5), and having 2–3 previous pregnancies compared to 0–1 prior pregnancies (PR 0.8, 95%CI 0.6–0.9). In adjusted analyses, lower number of previous pregnancies and having desire for future children remained significantly associated with a higher prevalence of unmet contraceptive need.ConclusionsUnmet need for modern non-barrier contraception was found in two-thirds of HIV-positive FSWs who reported that they were not currently trying to become pregnant, and was higher in women with the lowest number of prior pregnancies (0–1 prior pregnancies) and in those reporting desire for (more) children in the future. These findings highlight the need for concerted efforts to identify and eliminate barriers to contraceptive use in FSWs living with HIV.
Highlights
In sub-Saharan Africa, 37% of female sex workers (FSWs) are estimated to be living with HIV, making this a key population for prevention and treatment interventions [1,2,3]
Condom use was the only form of contraception for 129 (37.3%) participants
Unmet contraceptive need was associated with physical abuse in the past year by someone other than a regular partner (PR 1.2, 95%confidence intervals (CIs) 1.0–1.5), desire for children (PR 1.3, 95%CI 1.1–1.5), and having 2–3 previous pregnancies compared to 0–1 prior pregnancies (PR 0.8, 95%CI 0.6–0.9)
Summary
In sub-Saharan Africa, 37% of female sex workers (FSWs) are estimated to be living with HIV, making this a key population for prevention and treatment interventions [1,2,3]. Numerous studies in sub-Saharan Africa have reported high rates of unintended pregnancy and induced abortion, often illegal and conducted in unsafe conditions, as well as low levels of reliable contraceptive use in FSWs [6,7,8,9,10,11,12]. A qualitative study in Kenya found that FSWs reported unsupportive operational structure (e.g. long wait times, fees, and inconvenient hours) and discriminatory provider interactions as barriers to receiving reproductive health care [13]. These barriers contribute to unmet contraceptive need, defined as lack of contraceptive use in women of childbearing age who are not trying to become pregnant [16]
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