HIV prevalence and characteristics of sex work among female sex workers in Hargeisa, Somaliland, Somalia.

OBJECTIVE: To measure prevalence of HIV and syphilis and describe characteristics of sex work among female sex workers (FSWs) in Hargeisa, Somaliland, Somalia. METHODS: A cross-sectional survey recruited 237 FSWs using respondent-driven sampling (RDS). A face-to-face, structured interview using handheld-assisted personal interviewing (HAPI) on personal digital assistants (PDAs) was completed and blood collected for serological testing. RESULTS: FSWs 15-19 years old accounted for 6.9% of the population; 20-24 year-old constituted an additional 18.0%. The majority (86.6%) never attended school. International (59.0%) and interzonal (10.7%) migration was common. Most (95.7%) reported no other source of income; 13.8% had five or more clients in the last 7 days. A minority (38.4%) had heard of STIs, even fewer (6.9%) held no misconceptions about HIV. Only 24% of FSW reported using a condom at last transactional sex, and 4% reported ever been tested for HIV. HIV prevalence was 5.2% and syphilis prevalence was 3.1%. CONCLUSION: Sex work in Hargeisa, Somaliland, Somalia, is characterized by high numbers of sexual acts and extremely low knowledge of HIV. This study illustrates the need for targeted HIV prevention interventions focusing on HIV testing, risk-reduction awareness raising, and review of condom availability and distribution mechanisms among FSWs and males engaging with FSWs

Engagement with HIV Prevention Treatment and Care among Female Sex Workers in Zimbabwe: a Respondent Driven Sampling Survey.

To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare

Migration, Sex Work and Risk Environments: Experiences of Somali Migrant Female Sex Workers in Nairobi, Kenya and Implications for Service Access and Use

The aim of this qualitative PhD research was to fill identified gaps in knowledge, specifically, why do Somali female sex workers (FSW) in Nairobi, Kenya remain at high risk of HIV despite availability of targeted HIV prevention services. Globally, the evidence shows that sex workers are at higher risk than the general population, they have a disproportionate burden of HIV, and as a migrant group they may not have access to services. However, even with targeted services for sex workers, this group of migrant FSW was not accessing services. The research aimed to understand identity construction of Somali migrant FSWs, and how do risk environments and resilience amongst female sex workers who migrate affect health and health seeking behaviour. Throughout 2012-2013, the research team sought to interview migrant FSWs, through contacts with a Community Based Organization. The study was beset with challenges due to the changing security situation in Eastleigh. In total, 15 Somali FSWs were interviewed two to four times each, for a total of 50 interviews. Results are presented in three chapters, the first focuses on social networks and support; the second chapter on practices of routine discrimination and violence; and the third chapter looks at experiences of health services and health seeking behaviour. Somali FSWs in Nairobi are vulnerable and basic human rights not being met including the right to health, stemming from a lack of documented migration status, amongst other factors. FSWs experience systematic targeting by law enforcement, high levels of violence and harassment and lack of economic opportunities. Cultural factors, such as a religious context resulting in an external sense of control, assuming ‘Allah will fix it’, is compounded by exceptionally low self-esteem and a belief they are ‘bad Muslims’. Finally, their health seeking behaviour is poor, and oftentimes they simply cannot afford and do not prioritize their health over feeding and providing accommodation for their children. The primary implication for the research is that interventions need to go beyond biomedical sexual health and behaviour change campaigns to take into consideration the dynamics of intersectionality in the design and implementation of interventions

Estimating the population size of female sex workers and transgender women in Sri Lanka.

We implemented population size estimation of female sex workers (FSW) and transgender women (TGW) in Sri Lanka in 2018 using several approaches (geographical mapping, service and unique object multiplier and a modified Delphi method during the stakeholder consensus meeting). Mapping was done in 49 randomly selected Divisional Secretariats, which provided a basis for extrapolation of size estimates to the national level. Two types of adjustments were applied on the mean (minimum-maximum) population estimate obtained during mapping: (1) an adjustment for mobility to reduce double counting of FSW and TGW frequenting multiple spots, obtained during mapping; (2) an adjustment for "a hidden population", obtained from surveys among FSW and TGW. For the multiplier method, we used data from services of non-governmental organisations that FSW and TGW were in contact with, and surveys based on respondent-driven sampling. Surveys were carried out in the cities of Colombo (FSW, TGW), Kandy (FSW), Galle (FSW) and Jaffna (TGW). We estimated that there are 30,000 FSWs in Sri Lanka, with a plausible range of 20,000-35,000, which implies a prevalence of FSW of 0.56% (0.37-0.65%) among adult females. This study provided baseline estimates of 2,200 TGW in the country, with a plausible range of 2,000-3,500, which is 0.04% (0.04-0.07%) of adult male population. Our estimates of the proportional contribution of the FSW and TGW populations among the adult population in Sri Lanka are consistent with the The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended estimates for Asia and the Pacific. The results provide an important point for macro- and micro-level planning of HIV services, allocating programme resources and assessing programme coverage and quality

HIV case reporting in the countries of North Africa and the Middle East.

The aim of the paper is to provide an overview of HIV case reporting data for the year 2011 from the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR). Fourteen countries provided data for the year 2011 and reported a total of 4263 HIV cases of which 66.8% were men. The highest number of reported HIV cases in men per 100,000 population was in Oman (5.8), Somalia (5.5) and Iran (3.3), while in women in Somalia (7.6), Oman (3.9) and Morocco (2.4). In the majority of the countries, the most common reported mode of transmission was heterosexual. This could be due to under-reporting of male-to-male transmission and more frequent testing of men than women

Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use

OBJECTIVE: To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam. METHODS: We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression. FINDINGS: Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20-34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19-3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12-3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05-10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44-7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care. CONCLUSION: Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential antenatal preventive care appears to be compromised

HSV-2 serology can be predictive of HIV epidemic potential and hidden sexual risk behavior in the Middle East and North Africa.

BACKGROUND: HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral surveys are limited in this region and when available have serious limitations in assessing the risk of HIV acquisition. We demonstrate the potential use of herpes simplex virus-2 (HSV-2) seroprevalence as a marker for HIV risk within MENA. METHODS: We designed a mathematical model to assess whether HSV-2 prevalence can be predictive of future HIV spread. We also conducted a systematic literature review of HSV-2 seroprevalence studies within MENA. RESULTS: We found that HSV-2 prevalence data are rather limited in this region. Prevalence is typically low among the general population but high in established core groups prone to sexually transmitted infections such as men who have sex with men and female sex workers. Our model predicts that if HSV-2 prevalence is low and stable, then the risk of future HIV epidemics is low. However, expanding or high HSV-2 prevalence (greater than about 20%), implies a risk for a considerable HIV epidemic. Based on available HSV-2 prevalence data, it is not likely that the general population in MENA is experiencing or will experience such a considerable HIV epidemic. Nevertheless, the risk for concentrated HIV epidemics among several high-risk core groups is present. CONCLUSIONS: HSV-2 prevalence surveys provide a useful mechanism for identifying and corroborating populations at risk for HIV within MENA. HSV-2 serology offers an effective tool for probing hidden sexual risk behaviors in a region where quality behavioral data are limited