Abstract
BackgroundLittle is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan.MethodsWe conducted a biobehavioral survey of FSW and sexually exploited female adolescents using respondent-driven sampling (RDS) in Juba (November 2015–March 2016) and in Nimule (January–March 2017) to estimate achievements toward the UNAIDS 90–90-90 targets (90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART]; and of these, 90% are virally suppressed). Eligibility criteria were girls and women who were aged ≥15 years; spoke English, Juba Arabic, or Kiswahili; received money, goods, or services in exchange for sex in the past 6 months; and resided, worked, or socialized in the survey city for ≥1 month. Data were weighted for RDS methods.ResultsWe sampled 838 FSW and sexually exploited female adolescents in Juba (HIV-positive, 333) and 409 in Nimule (HIV-positive, 108). Among HIV-positive FSW and sexually exploited female adolescents living in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on ART; and of these, 62.2% were virally suppressed. In Nimule, 79.5% of FSW and sexually exploited female adolescents living with HIV self-reported being aware of their HIV status; of these, 62.9% self-reported being on ART; and of these, 75.7% were virally suppressed.ConclusionsAlthough awareness of HIV status is the lowest of the 90–90-90 indicators in many countries, treatment uptake and viral suppression were lowest among FSW and sexually exploited female adolescents in South Sudan. Differentiated service delivery facilitate linkage to and retention on treatment in support of attainment of viral suppression.
Highlights
Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW)
Among FSW and sexually exploited female adolescents living with HIV in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on antiretroviral therapy (ART); of these, 62.2% were virally suppressed (Fig. 1a)
When adjusted for viral suppression, 80.5% of FSW and sexually exploited female adolescents were aware of their HIV status; of these, 81.8% were on ART; and of these, 70.1% were virally suppressed
Summary
Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan. Hakim et al BMC Public Health (2022) 22:132 Key populations and their partners account for over half of new HIV infections globally despite accounting for only a fraction of the population [5]. Sex work has further been found to contribute to epidemic dynamics even in high HIV prevalence settings, reinforcing the notion that HIV services need to reach all populations [7]. Little is known about progress toward reaching 90–90-90 targets among key populations, including FSW. Because stigma hinders HIV service utilization and may prompt key population members who access them to conceal their behaviors, program data alone are insufficient to characterize the epidemic among key populations [12]
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