An Urgent Need for Integration of Family Planning Services into HIV Care: The High Burden of Unplanned Pregnancy, Termination of Pregnancy, and Limited Contraception Use among Female Sex Workers in Côte d'Ivoire

HIV infection and unintended pregnancy are occupational risks of commercial female sex work (FSW). The burden of unintended pregnancy among FSW including maternal and infant outcomes in the context of HIV is largely unknown.

From March to July 2014, 466 FSW were enrolled. Unintended pregnancy was common, and 64% of participants had ≥1 TOP. Half of FSW experiencing TOPs did so without a medical professional, resulting in frequent complications. Contraceptive use was lowest among younger FSW, and 37% of 20-24 year olds reported multiple TOPs. FSW with a TOP history reported 19% less consistent condom use with clients than women who never had a TOP (adjusted-prevalence ratio, 0.81; 95% confidence interval: 0.74 to 0.88), whereas use of reliable nonbarrier contraceptive methods was comparable between the groups. Although FSW were engaged in HIV testing and prevention services, only 59% of FSW had received HIV testing before childbirth during their last pregnancy, and 30% of HIV-infected FSW had lost ≥1 children.

Low contraceptive use and high burden of unintended pregnancy result in poor reproductive outcomes for FSW and avoidable mother-to-child HIV transmission risks. Integration of family planning and antenatal services into HIV prevention and care programs accessed by FSW could enhance reproductive outcomes and HIV prevention goals.

Below: The relationship between age, pregnancy history, and contraception use among female sex workers in Abidjan, Cote d’Ivoire, 2014 (n = 466). A, History of pregnancy and termination of pregnancy (TOP) across age categories. B, Use of barrier and nonbarrier contraception across age categories. Reliable nonbarrier contraception included injectable and oral contraceptive methods, implants, intrauterine devices and sterilization. Any reliable contraception included use of reliable nonbarrier methods listed above and/or consistent condom use with clients.

Via (PDF); http://ow.ly/d/3Kge 

By: Schwartz S1, Papworth E, Thiam-Niangoin M, Abo K, Drame F, Diouf D, Bamba A, Ezouatchi R, Tety J, Grover E, Baral S.

• 1*Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD; †Programme National de Lutte Contre le SIDA, Ministere de la Lutte Contre Le SIDA, Abidjan, Côte d'Ivoire; ‡Enda Santé, Dakar, Senegal; §Gaston Berger University, Department of Geography, School of Social Sciences, St. Louis, Senegal; and ‖Blety, Abidjan, Côte d'Ivoire.