High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda. (March 2019)

• Record Type: Journal Article
• Authors: Goldenberg, Shira M; Muzaaya, Godfrey; Akello, Monica; Braschel, Melissa; Birungi, Josephine; Shannon, Kate
• Is Part Of: International journal of STD & AIDS. Volume 30:Number 3(2019)
• Page Start: 275
• Page End: 283
• Publication Date: 2019-03
• Subjects: Sex workers -- antiretroviral therapy -- HIV diagnosis -- women living with HIV -- key populations; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/0956462418804658
• Languages: English
• ISSNs: 0956-4624

Abstract

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.