Structural Barriers to Receiving Health Care Services for Female Sex Workers in Russia

Female sex workers in Russia have been particularly vulnerable to recent social, political, and economic changes. In this article, we describe the facilitators and barriers for sex workers receiving health care services in St. Petersburg, Russia. We conducted observations at medical institutions and nongovernmental organizations and in-depth interviews with 29 female sex workers. We identified the following barriers: poverty, not having documents, lack of anonymity in testing, and the official registration system. We identified the following facilitators: intervention by family members, social connections within the health care system, and referral services from a nongovernmental organization. Our findings indicate a need for reassessing policies and designing programs that better facilitate the use of health care services for the most vulnerable populations. This should include the expansion of support systems and outreach services designed to help female sex workers navigate the health care system

HIV and Partner Violence: Implications for HIV Voluntary\ud Counseling and Testing Programs in Dar es Salaam, Tanzania

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their partners. Findings from this study led to a number of recommendations that could reduce the barriers women face in getting tested for HIV and in disclosing their serostatus to their partners, as well as reduce levels of partner violence. These recommendations pertain to VCT services as well as to the wider community and policy environment

Addressing Intimate Partner Violence Among Female Clients Accessing HIV Testing and Counseling Services: Pilot Testing Tools in Rakai, Uganda.

The World Health Organization recommends that HIV counseling and testing (HCT) programs implement strategies to address how intimate partner violence (IPV) influences women's ability to protect themselves from and seek care and treatment for HIV infection. We discuss the process used to adapt a screening and brief intervention (SBI) for female clients of HCT services in Rakai, Uganda-a setting with high prevalence of both HIV and IPV. By outlining our collaborative process for adapting and implementing the SBI in Rakai and training counselors for its use, we hope other HCT programs will consider replicating the approach in their settings

Diagnosis and disclosure of HIV status: Implications for women’s risk of physical partner violence in the postpartum period

This study prospectively examined whether HIV leads to elevated risk for intimate partner violence (IPV) for women, and how this risk varies depending on HIV status disclosure to a partner

Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention

Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analyzed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomized trial of the microfinance and peer health leadership intervention

Defining Male Support During and After Pregnancy From the Perspective of HIV-Positive and HIV-Negative Women in Durban, South Africa

Greater male support during pregnancy and in the postpartum period may improve health outcomes for mothers and children. To develop effective strategies to engage men we need to first understand the ways that men are currently engaged and the barriers to their greater involvement. We conducted in-depth interviews in isiZulu with 30 HIV-positive women and 16 HIV-negative women who received prenatal care from a public clinic in Durban, South Africa. Interviews were audiotaped, transcribed, translated, and coded for analysis. While less than a quarter of women reported that their partners accompanied them to the clinic, they described receiving other material and psychosocial support from partners. More HIV-positive women reported that their partners were not involved or not supportive, and in some cases direct threats and experiences with violence caused them to fear partner involvement. We need to broaden the lens through which we consider male support during pregnancy and in the postpartum period, and acknowledge that male involvement may not always be in the best interest of women. Engaging supportive partners outside of the clinic setting and incorporating other important social network members are important next steps in the effort to increase support for women

Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations

This systematic narrative review examined the empirical evidence on the effectiveness of mobile health (mHealth) behavioral interventions designed to increase uptake of HIV testing among vulnerable and key populations

Looking to the future: South African men and women negotiating HIV risk and relationship intimacy

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programs can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception

HIV+ women's narratives of non-disclosure: Resisting the label of immorality

Increasing partner disclosure rates among HIV positive individuals is widely seen as an important public health strategy to reduce HIV transmission. One approach for encouraging disclosure is to emphasize individuals’ moral responsibility to disclose their status to their partners. We use South Africa as a case study to draw attention to two problems with labeling non-disclosure as immoral. First, we argue that because women are tested for HIV at much higher rates than men, any approach that involves blaming HIV positive individuals for not disclosing their status will disproportionately burden women. Second, through the narratives of six HIV positive women, we highlight how a focus on morality undervalues the complexity of sexual partnerships. Specifically, women describe how their perceived obligation to disclose is directly influenced by communication with their sexual partners. Women also discuss how the onset of different life events might alter the meaning of HIV and change obligations regarding disclosure within the partnership. The differences in testing rates across gender combined with the complexity of sexual partnerships leads us to suggest that labeling non-disclosure as immoral does little to advance HIV prevention. There is an urgent need to identify alternative interventions that support women through the disclosure process

Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study

Identifying interventions to increase men’s uptake of HIV testing in sub-Saharan Africa is essential for the success of combination HIV prevention. HIV self-testing is an emerging approach with high acceptability, but limited evidence exists on optimal strategies for distributing self-tests. We explored a novel approach of providing multiple self-tests to women at high risk of HIV acquisition in order to promote partner HIV testing and facilitate safer sexual decision-making