Abstract
Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts (Mombasa, Kenya, and Dnipro, Ukraine); (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events (first sex, first exchange of sex for money or other resources, self-identification as sex workers, entry into formal sex work, access to prevention program services); sexual behaviors (condom use, anal sex, sex under the influence of drugs or alcohol); partnerships (regular and first-time clients, regular and first-time transactional sex partners, and husbands and boyfriends); alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health (pregnancies, abortions, contraceptives). HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts.
Highlights
Across epidemic contexts, female sex workers (FSWs) and adolescent girls and young women (AGYW) experience a disproportionate burden of human immunodeficiency virus (HIV) [1]1
Adjusted regression models will include age and account for a priori potential confounders identified in prior literature to be associated with prevalent HIV infection among AGYW and among FSWs in Kenya
This study will deepen our understanding about the HIV risks, vulnerabilities, and prevalence among AGYW during the transition period and how these risks vary across the two study contexts
Summary
Female sex workers (FSWs) and adolescent girls and young women (AGYW) experience a disproportionate burden of human immunodeficiency virus (HIV) [1]1. FSWs are 13 times more likely to be infected with HIV compared to females of reproductive age [1]. In 2017, of the estimated 760,000 new HIV infections in adult women worldwide, 44.7% were among AGYW (aged 15–24 years). AGYW accounted for 61.5 and 58.6% of persons aged 15 to 24 years who were living, and newly infected, with HIV in 2017, respectively. HIV prevention interventions tailored for FSWs only reach women after they self-identify as sex workers. HIV prevalence data by age and duration in SW from Kenya suggest that women may be at increased risk for HIV prior to, and within, very early stages of SW [4, 5]
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