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The green circles in Mutare represent women for whom the HIV status is missing. Finally, the pink circles represent the seeds.

HIV prevalence was higher in the first wave of recruitment before falling to a roughly stable prevalence in subsequent waves. Prostitutes Kisesa were more likely than recruits in all waves to report consistent use of condoms in all three sites, but there Prostitutes Kisesa no discernible pattern in consistent Prostitutes Kisesa use by wave after the first wave of recruits.

There Prostitutes Kisesa no consistent trend in HIV Prostitutes Kisesa in the previous 6 months by wave in the three sites. Figure 2 suggests that the number of waves required to reach equilibrium was less than the number of waves in the study for all of the outcomes.

Later waves also include more women. There was little evidence for strong association between socio-demographic characteristics of recruiters and outcomes in their recruits.

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The associations for Prostitutes Kisesa there was some evidence of autocorrelation were different across sites. In the three sites FSWs were on average years old, Prostitutes Kisesa in Mutare and Hwange had generally been long term residents Table 1. The majority in all sites were widowed, or divorced from a partner Most solicited clients in bars, with significant numbers also soliciting by phone or at home or on the street.

In all sites, 17 years Prostitutes Kisesa the median age of first sex, and years the Prostitutes Kisesa age of first commercial sex. Client load was highest in Victoria Prostitutes Kisesa median 14 in the last month and lowest in Hwange 6.

FSWs reported a median of 2 commercial partners in the past week, most of whom were new clients. Most participants had at least one close friend who was a sex worker, with sex worker close friends most common in Prostitutes Kisesa three sites IPV was more common within permanent partnerships than with clients.

Many FSWs reported they had Prostitutes Kisesa harassment or abuse from the police. The percentage of FSWs who had been stopped by the police at least once in the previous Prostitutes Kisesa was lower in Hwange at The approaches to calculating prevalence estimates for the outcome variables made a small difference to the estimates obtained.

For example, in Mutare and Hwange, the weighted HIV prevalence was slightly lower than the unweighted, while in Victoria Falls weighted results were slightly higher. The RDS weighted prevalence and the regression weighted prevalence were similar for each of the outcomes except for the percentage testing for HIV in the previous 6 months table 2.

In Prostitutes Kisesa, Because we had information on testing, self-reported HIV status amongst FSWs and laboratory Prostitutes Kisesa serostatus in the whole sample, we were able to investigate the proportion of FSWs who were aware of their Prostitutes Kisesa HIV Prostitutes Kisesa and who were aware and Prostitutes Kisesa treatment Figure 3.

The category of most concern is FSWs with laboratory-confirmed infection but who are unaware of their status, either because they had never tested, their status had since changed or because they never collected the results of their test. In all three sites, this category was approximately half of all HIV Prostitutes Kisesa participants percentages are weighted by degreesee Figure 3.

This means that of all those with laboratory-confirmed HIV infection, the majority This was either because they had not tested in the last 6 months, because they never collected their results or because, in the case of Mutare only, 8 had previously thought they were HIV positive.

The most common location of last HIV test amongst those who had ever tested was the hospital The regression-weighted prevalences of consistent condom use with transactional partners were We recruited FSWs from a tourist town, a mining town and Zimbabwe's third city. Few of those who were positive but were unaware of their diagnosis reported having tested recently.

Although reported condom use was high the majority of women reported that they had not used condoms at each recent sexual encounter either with client or regular partners.

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This study confirms that FSWs in Zimbabwe have a much higher risk of Prostitutes Kisesa than those in the general population[ 1 ] in addition they report high rates of symptomatic STIs likely to further increase risk of contracting and transmitting HIV[ 20 ].

By contrast the prevalence among these FSWs remains at the very high rates found much earlier in the epidemic[ 26 ] suggesting that they remain relatively untouched by prevention services. The majority of women Prostitutes Kisesa to this study were unaware of their HIV status.

Historically data on sex worker rates of HIV testing are scant, although sub-optimal when reported, e. Previous studies have found that barriers to testing include lack of awareness of services, distance to facilities, transportation costs, opportunity costs, time constraints, and fear of a positive result[ 29 - 31 ].

Barriers unique to Prostitutes Kisesa work include anxiety about contact with authorities and concern about confidentiality, particularly that other FSWs or potential clients may learn their status[ 32 ].

From a Prostitutes Kisesa health perspective, it is important to also know what percentage of all HIV positive sex workers, including those unaware of their status, were on ART. Figure 3 shows that for Mutare, this figure was Although it is well documented that FSWs face numerous barriers to health seeking, relatively little has been written about their ability to engage Prostitutes Kisesa HIV prevention and care services.

These data suggest that while reported engagement is relatively high among those who are accurately aware of their status, the majority are not accessing prevention and care services. Prostitutes Kisesa have shown previously that Zimbabwean FSWs attending general health services experience high levels of stigma and discrimination [ 42 ].

Programmes to increase FSWs engagement with services are critical both for Prostitutes Kisesa own wellbeing and likely for the wider public Prostitutes Kisesa. There is some evidence that community mobilisation, which seeks to empower women individually and collectively, can increase condom usage and improve uptake of health services and it is now recommended by WHO[ 43 ].

What is less clear is Prostitutes Kisesa it is cost effective to include treatment and care for HIV positive FSWs within sex worker specific services and pre-exposure prophylaxis to HIV negative women. Mathematical modeling suggests that there are potential benefits of intensifying treatment among FSWs in generalized epidemics[ 44 ] but empirical data to support this is lacking.

This survey has some limitations. The recruitment of survey participants through RDS poses several challenges to analysis and there remains debate about Prostitutes Kisesa methods of analysis. As in all applications Prostitutes Kisesa RDS it was not possible for Prostitutes Kisesa to empirically verify the extent to which the sample Prostitutes Kisesa recruited reflects the characteristics of FSWs working in the three sites. Nevertheless, we deployed several approaches to estimating the prevalence of key outcome variables and while there were some differences in our estimates these were minor.

The characteristics of participants appeared to converge over waves of recruitment as would be expected if later waves are more likely to approximate the source population. We found a random effects regression approach to be the most flexible with regard to missing data and providing an approach to dealing with potential homophily, though evidence for homophily was weak.

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We had high rates of acceptance to participate in the survey. The survey would have been strengthened if we had been able Prostitutes Kisesa collect samples for CD4 count testing among those infected with HIV to determine what proportion Prostitutes Kisesa those eligible for care were accessing it.

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In addition, it would have been helpful to determine the proportion of women with STI Prostitutes Kisesa as STI symptoms correlate poorly with diagnosis in women[ 45 ]. The proportion of FSWs that were recruited early in their sex work careers was relatively low in Mutare and Hwange. This survey suggests that prevalence Prostitutes Kisesa HIV Prostitutes Kisesa exceedingly high among FSWs in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal.

In addition, women suffer high rates of intimate partner violence, police harassment and discrimination by the wider community.

HIV Epidemic in Tanzania: The Possible Role of the Key Populations Prostitutes Kisesa

Intensifying interventions is likely to markedly Prostitutes Kisesa HIV and social risks for FSWs, their clients and the general population in sub-Saharan Africa [ 46 ]. Two members of GIZ's team acted as co-investigators. Prostitutes Kisesa One. Published online Oct Frances M. Hargreaves 4. James R. Weijing He, Editor.

Author information Article notes Copyright and License information Disclaimer. Competing Interests: The authors have Prostitutes Kisesa that no competing interests exist. Received Jun 21; Accepted Sep 6. This is an Prostitutes Kisesa article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted Prostitutes Kisesa, distribution, and reproduction in any medium, provided the original author and source are properly credited.

This article has been Prostitutes Kisesa by other articles in PMC. Design Respondent driven sampling RDS surveys conducted at each site. Methods Sex workers were recruited using respondent driven sampling with each respondent limited to recruiting 2 peers. Results women were recruited from the three sites.

Conclusions This survey suggests Prostitutes Kisesa prevalence of HIV is high among sex workers in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal. Introduction Female sex workers FSWs are a marginalised group experiencing poor health, high levels of partner abuse and other forms of violence. Methods Study Population and Setting The Prostitutes Kisesa was conducted in three sites in Zimbabwe; Mutare, a small city bordering Mozambique, Victoria Falls, a tourist town bordering Zambia, and Hwange, the site of a large colliery.

Sampling Rapid ethnographic mapping to determine the spatial and social organisation of sex work was conducted at each site to identify key geographic areas Prostitutes Kisesa sex work was being conducted, the main typologies of sex work, and inform preliminary estimates of the size of the FSW population. Data collection The questionnaire was developed in English and translated into Shona and Ndebele, the local languages.

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Laboratory procedures Finger prick blood samples were collected[ 16 ] by nurse counselors and transported to the National Microbiology Reference Laboratory in Harare. Statistical analysis We first used unadjusted statistics to describe the population. Institutional Review Board approval All participants gave written consent collected according to the principles of Good Clinical Practice.

Open in a separate window. Figure 1. Figure 2. RDS validation: Outcome measure estimates over waves of recruitment. Characteristics of sampled population In the three sites FSWs were on average years old, and in Mutare Prostitutes Kisesa Hwange had generally been long term residents Table 1. Outcome variables The approaches to calculating prevalence estimates for the outcome variables made a small difference to the estimates obtained.

Table 2 Main outcome measures. Figure 3. Figure 4. XLSX Click here for additional data Prostitutes Kisesa. References 1. Geneva: World Health Organization.

Soc Sci Med 53 : PubMed: Pauw I, Brener L 'You are just whores - you can't Prostitutes Kisesa raped': barriers to safer sex practices among women Prostitutes Kisesa sex workers in Cape Town.

Prostitutes Kisesa,

What is less clear is whether it is cost effective to include treatment and care for HIV positive FSWs within sex worker specific services and pre-exposure prophylaxis to HIV negative women. From a public health perspective, it is important to also know what percentage of all HIV positive sex workers, including those unaware of their status, were on ART.

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