Engagement in HIV services over time among young women who sell sex in Zimbabwe

• Published in: PloS one Vol. 17; no. 6; p. e0270298
• Main Authors: Napierala, Sue, Chabata, Sungai T, Davey, Calum, Fearon, Elizabeth, Busza, Joanna, Mushati, Phillis, Mugurungi, Owen, Hatzold, Karin, Cambiano, Valentina, Phillips, Andrew, Hargreaves, James R, Cowan, Frances M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.06.2022; Public Library of Science (PLoS)
• Subjects: Adult; Age; Age determination; Age groups; Biology and Life Sciences; Care and treatment; Drug therapy; Female; Health aspects; Health services; HIV; HIV (Viruses); HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Medical tests; Medicine and Health Sciences; People and Places; Prevalence; Prevention; Questionnaires; Research and Analysis Methods; Risk factors; Seeds; Sex oriented businesses; Sex Workers; Sexual health; Sexually transmitted diseases; Social Sciences; STD; Surveys; Viral Load; Working women; Young adults; Zimbabwe - epidemiology; Zimbabwe; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0270298

Young female sex workers (FSW) are disproportionately vulnerable to HIV. Zimbabwe data show higher HIV incidence and lower engagement in services compared to older FSW. Utilizing data from a combination HIV prevention and treatment intervention, we describe engagement in the HIV services over time among FSW 18-24 years, compared to those ≥25 years of age. Data were collected via respondent-driven sampling (RDS) surveys in 14 communities in 2013 and 2016, with >2500 FSW per survey. They included blood samples for HIV and viral load testing. As the intervention had no significant impact on HIV care cascade outcomes, data were aggregated across study arms. Analyses used RDS-II estimation. Mean age in 2013 and 2016 was 31 and 33 years, with 27% and 17% aged 18-24 years. Overall HIV prevalence was 59% at each timepoint, and 35% and 36% among younger FSW. From 2013 to 2016 there was an increase in young HIV-positive FSW knowing their status (38% vs 60%, OR = 2.51, p<0.01). Outcomes for all FSW improved significantly over time at all steps of the cascade, and the relative change over time was similar among older versus younger FSW for most cascade variables. Young FSW had improvements in care cascade outcomes, and proportionate improvements similar to older FSW, yet they remain less engaged in services overall. This implies that the dedicated FSW services in Zimbabwe are having a comparably positive impact across age groups, however more is likely required to address young FSW's unique vulnerabilities and needs.