Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal

Jean Olivier Twahirwa Rwema, Carrie E. Lyons, Sosthenes Ketende, Anna L. Bowring, Amrita Rao, Carly Comins, Daouda Diouf, Fatou M. Drame, Benjamin Liestman, Karleen Coly, Cheikh Ndour, Gnilane Turpin, Souleymane Mboup, Coumba Toure-Kane, Delivette Castor, Nafissatou Leye-Diouf, Halimatou Diop-Ndiaye, Stefan Baral

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS: In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS: The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS: Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.

Original languageEnglish (US)
Pages (from-to)63-71
Number of pages9
JournalJournal of acquired immune deficiency syndromes (1999)
Volume81
Issue number1
DOIs
StatePublished - May 1 2019

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Senegal
Sex Workers
Condoms
HIV
Confidence Intervals
Negotiating
Violence
Community Networks
Sex Work
Africa South of the Sahara
Social Class

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal. / Twahirwa Rwema, Jean Olivier; Lyons, Carrie E.; Ketende, Sosthenes; Bowring, Anna L.; Rao, Amrita; Comins, Carly; Diouf, Daouda; Drame, Fatou M.; Liestman, Benjamin; Coly, Karleen; Ndour, Cheikh; Turpin, Gnilane; Mboup, Souleymane; Toure-Kane, Coumba; Castor, Delivette; Leye-Diouf, Nafissatou; Diop-Ndiaye, Halimatou; Baral, Stefan.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 81, No. 1, 01.05.2019, p. 63-71.

Research output: Contribution to journalArticle

Twahirwa Rwema, JO, Lyons, CE, Ketende, S, Bowring, AL, Rao, A, Comins, C, Diouf, D, Drame, FM, Liestman, B, Coly, K, Ndour, C, Turpin, G, Mboup, S, Toure-Kane, C, Castor, D, Leye-Diouf, N, Diop-Ndiaye, H & Baral, S 2019, 'Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal', Journal of acquired immune deficiency syndromes (1999), vol. 81, no. 1, pp. 63-71. https://doi.org/10.1097/QAI.0000000000001991
Twahirwa Rwema, Jean Olivier ; Lyons, Carrie E. ; Ketende, Sosthenes ; Bowring, Anna L. ; Rao, Amrita ; Comins, Carly ; Diouf, Daouda ; Drame, Fatou M. ; Liestman, Benjamin ; Coly, Karleen ; Ndour, Cheikh ; Turpin, Gnilane ; Mboup, Souleymane ; Toure-Kane, Coumba ; Castor, Delivette ; Leye-Diouf, Nafissatou ; Diop-Ndiaye, Halimatou ; Baral, Stefan. / Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 81, No. 1. pp. 63-71.
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abstract = "BACKGROUND: Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS: In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS: The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8{\%} [95{\%} confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95{\%} CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95{\%} CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95{\%} CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95{\%} CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS: Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.",
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AU - Twahirwa Rwema, Jean Olivier

AU - Lyons, Carrie E.

AU - Ketende, Sosthenes

AU - Bowring, Anna L.

AU - Rao, Amrita

AU - Comins, Carly

AU - Diouf, Daouda

AU - Drame, Fatou M.

AU - Liestman, Benjamin

AU - Coly, Karleen

AU - Ndour, Cheikh

AU - Turpin, Gnilane

AU - Mboup, Souleymane

AU - Toure-Kane, Coumba

AU - Castor, Delivette

AU - Leye-Diouf, Nafissatou

AU - Diop-Ndiaye, Halimatou

AU - Baral, Stefan

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N2 - BACKGROUND: Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS: In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS: The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS: Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.

AB - BACKGROUND: Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal. METHODS: In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants. RESULTS: The respondent driven sampling-adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU. CONCLUSIONS: Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.

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