Prevalence of HIV and Associated Risks of Kampala among Youth in the Slums of Kampala

Purpose. 

The purpose of this study is to examine the prevalence of and risk factors for engaging in sex work among youth living in Kampala, Uganda. 

Methods. 

Analyses are based on a cross-sectional study (N = 1,134) of youth aged 12-18 years, living in the slums of Kampala, conducted in Spring of 2014. The analytic sample consisted of only sexually active youth (n = 590). Youth who reported engaging in sex work were compared to youth who did not report sex work. Multivariable analyses were conducted to examine factors associated with sex work. 

Results. 

Among the youth who had ever had sexual intercourse (n = 590), 13.7% (n = 81) reported engaging in sex work. Self-reported HIV prevalence was 13.9% among the total sample (n = 81) and 22.5% (n = 18) among youth engaged in sex work. Engaging in sex work was associated with being female (AOR 10.4; 95% CI: 3.9, 27.4), being an orphan (AOR 3.8; 95% CI: 1.7, 8.4), ever drinking alcohol (AOR 8.3; 95% CI 3.7, 19.0), and experiencing any rape (AOR 5.3; 95% CI: 2.9, 9.5). 

Discussion. 

The reported prevalence of sex work is high among youth in the slums of Kampala and is associated with high HIV prevalence, ever drinking alcohol, previously being raped, and being an orphan.

Table 2

Bivariate and multivariable associations between sex work and covariates among youth living in the slums of Kampala (n = 590).

Variable	Sex workers Yes n (%)	Sex workers No n (%)	Total sample n (%)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P
	81 (13.7)	509 (68.3)	590 (100)
Age
12–14 years	4 (4.9)	27 (5.3)	31 (5.3)	Ref	—	0.67
15-16 years	15 (18.5)	116 (22.8)	131 (22.2)	0.9 (0.3–2.8)
17-18 years	62 (76.5)	366 (71.9)	428 (72.5)	1.1 (0.4–3.4)
Sex, n (%)
Females	76 (93.8)	271 (53.2)	347 (58.8)	Ref	Ref	∗∗
Males	5 (6.2)	238 (46.8)	243 (41.2)	13.4 (5.3–33.5)	10.4 (3.9–27.4)
School attendance
Yes	67 (83.7)	480 (94.3)	547 (93.8)	Ref	Ref	∗∗
No	13 (16.3)	23 (5.7)	36 (6.2)	4.1 (2.0–8.4)	2.2 (0.8–5.7)
Religion
Christian Catholic	28 (34.6)	196 (38.5)	224 (38.0)	Ref	—	0.09
Christian (other)	37 (45.7)	169 (33.2)	206 (34.9)	1.5 (0.9–2.6)
Muslim	11 (13.6)	118 (23.2)	129 (21.9)	0.7 (0.3–1.4)
Other	5 (6.2)	26 (5.1)	31 (5.3)	1.3 (0.5–3.8)
Parental drunkenness
Yes	51 (63.0)	259 (51.0)	310 (52.6)	1.6 (1.0–2.7)	—	0.05
No	30 (37.0)	249 (49.0)	279 (47.4)	Ref
No parents alive	36 (44.4)	108 (21.2)	144 (24.4)	5.4 (2.7–10.9)	3.8 (1.7–8.5)	∗∗
1 parent alive	33 (40.7)	205 (40.3)	238 (40.3)	2.6 (1.3–5.2)	1.7 (0.8–3.6)
2 parents alive	12 (14.8)	196 (38.5)	208 (35.3)	Ref	Ref
Ever alcohol use
Yes	72 (90.0)	271 (53.5)	343 (58.4)	7.8 (3.7–16.6)	8.3 (3.7–19.0)	∗∗
No	8 (10.0)	236 (46.5)	244 (41.6)	Ref	Ref
Any rape
Yes	55 (67.9)	98 (19.2)	153 (25.9)	8.9 (5.3–14.9)	5.3 (2.9–9.5)	∗∗
No	26 (32.1)	411 (80.8)	437 (74.0)	Ref	Ref
Parental abuse of youth
Yes	35 (43.2)	197 (38.8)	232 (39.4)	1.8 (1.1–2.9)	0.8 (0.4–1.4)	0.45
No	46 (56.8)	311 (61.2)	357 (60.6)	Ref	Ref
HIVa
Yes	18 (22.5)	63 (12.5)	81 (13.9)	—	—	∗
No	62 (77.5)	440 (87.5)	502 (86.1)
Other STIa
Yes	63 (77.8)	248 (48.7)	311 (52.7)	—	—	∗∗
No	18 (22.2)	261 (51.3)	279 (47.3)

Note: P value is obtained from chi-square analyses.

aHIV and other STIs not included in the logistic regression analyses due to HIV/STI being hypothesized outcomes of commercial sex work instead of risk factors.

Full article at: http://goo.gl/vtZVwm

By:   Swahn MH¹, Culbreth R¹, Salazar LF¹, Kasirye R², Seeley J³.

¹School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995, USA.

²Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda.

³London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

AIDS Res Treat. 2016;2016:5360180. doi: 10.1155/2016/5360180. Epub 2016 Apr 28. 

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Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda

Background

The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance.

Methods

We enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed.

Results

Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education.

Conclusion

Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.

Below:  Screening profile of women attending month 24 clinic visit in the Good health for Women project cohort

Full article at:  http://goo.gl/RWiFHR

By: Yunia Mayanja,1,* Aggrey David Mukose,2,‡ Susan Nakubulwa,1,‡ Gloria Omosa-Manyonyi,3,‡ Anatoli Kamali,#1 andDavid Guwatudde#2

¹MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

²Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

³College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

Simon Fraser University, Canada

Published online 2016 May 12. doi:  10.1371/journal.pone.0155383

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

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A Systematic Review of the Clinical and Social Epidemiological Research among Sex Workers in Uganda

Background

In response to the high burden of disease among sex workers and their position as a population heavily affected by the HIV epidemic, there has been a growing body of literature investigating the prevalence and risk factors associated with HIV risk among sex workers. To contextualize and summarize the existing research evidence base, a systematic review was conducted to synthesize the epidemiological literature on sex workers in Uganda.

Methods

Database selection and search strategy development followed the Cochrane Collaboration’s standards for conducting systematic review searches. All studies that included sex workers as the primary research participants were included in the review. The search was then geographically restricted to the country of Uganda. Items were identified from 18 databases (grey and peer-review) on March 10–11, 2015.

Results

A total of 484 articles were retrieved from the database search. After removal of duplicates, a total of 353 articles were screened for eligibility and 64 full-text articles were assessed. The final review included 24 studies with quantitative methodology conducted among sex workers in Uganda. 

• The HIV prevalence among female sex workers ranged from 32.4 – 52.0% 
• and between 8.2 – 9.0% had multiple HIV infections. 
• Both multi-drug resistance to antiretroviral therapy (2.6 %) and antibiotics (83.1 %) were observed. 
• Between 33.3 – 55.1 % reported inconsistent condom use in the past month. 
• In the previous 6 months, over 80% of sex workers experienced client-perpetrated violence 
• and 18% experienced intimate partner violence. 
• Over 30% had a history of extreme war-related trauma.

Conclusions

There was limited information on socio-structural factors that affect sex workers’ commercial working environments in Uganda, including the role of policing and criminalization, as well as the prevalence and factors associated with violence. The majority of the existing evidence is based in Kampala, highlighting a need for information on sex work in other regions of Uganda. Additionally, there is limited information on features of the non-commercial components of sex workers’ lives as well as the services needed to reduce risks outside of the sex industry.

Full article at:  http://goo.gl/ucfpAv

By:  Katherine A. Muldoon

School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver V6T 1Z9, BC, Canada

Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, ON, Canada

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Structural Determinants of Dual Contraceptive Use among Female Sex Workers in Gulu, Northern Uganda

To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda.

The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use.

Among the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age, prior unintended pregnancy, and HIV testing. Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use.

Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.

Purchase full article at: http://goo.gl/RQmYsB

By: Erickson M1, Goldenberg SM1, Ajok M2, Muldoon KA1, Muzaaya G2, Shannon K3.

• 1Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
• 2The AIDS Support Organization, Gulu, Uganda.
• 3Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Electronic address: gshi@cfenet.ubc.ca.  

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Policing the Epidemic: High Burden of Workplace Violence among Female Sex Workers in Conflict-Affected Northern Uganda

Sex workers in sub-Saharan Africa experience a high burden of HIV with a paucity of data on violence and links to HIV risk among sex workers, and even less within conflict-affected environments. Data are from a cross-sectional survey of female sex workers in Gulu, northern Uganda (n = 400). Logistic regression was used to determine the specific association between policing and recent physical/sexual violence from clients. 

A total of 196 (49.0%) sex workers experienced physical/sexual violence by a client. From those who experienced client violence the most common forms included physical assault (58.7%), rape (38.3%), and gang rape (15.8%) Police harassment was very common, a total of 149 (37.3%) reported rushing negotiations with clients because of police presence, a practice that was significantly associated with increased odds of client violence (adjusted odds ratio: 1.61, 95% confidence intervals: 1.03-2.52). Inconsistent condom use with clients, servicing clients in a bar, and working for a manager/pimp were also independently associated with recent client violence. 

Structural and community-led responses, including decriminalisation, and engagement with police and policy stakeholders, remain critical to addressing violence, both a human rights and public health imperative.

Purchase full article at: http://goo.gl/bjT0dc

By: Muldoon KA1,2, Akello M3, Muzaaya G3, Simo A2, Shoveller J1, Shannon K1,2,4.

• 1 School of Population and Public Health , University of British Columbia , Vancouver , Canada.
• 2 British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
• 3 The AIDS Support Organization , Gulu , Uganda.
• 4 Department of Medicine , University of British Columbia, St. Paul's Hospital , Vancouver , Canada.  

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Understanding the Socio-Structural Context of High HIV Transmission in Kasensero Fishing Community, South Western Uganda

In Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission remains high with an incidence of 4.3 and 3.1 per 100 person-years in women and men, respectively, and an HIV prevalence of 44 %, reaching up to 74 % among female sex workers. We explored the social contextual factors for the high HIV transmission at Kasensero to inform future policy and preventive interventions.

We conducted 20 in-depth interviews, including both HIV positive and HIV negative respondents, and 12 focus-group discussions involving a total of 92 respondents from the Kasensero fishing community from April-September 2014. Content analysis was performed to identify recurrent themes.

Our findings suggest that the high HIV transmission in Kasensero is a complex function of eight themes including; positive/negative attitudes about HIV and combination HIV prevention such as the demand for services versus ART/circumcision disinhibition; HIV depository; Multiple partners; Frequent unprotected sex; Clothing; Parental behaviors; Pressure within the sex industry; and Cross generational sex.

The current combination HIV prevention services by the RHSP need to be enhanced with more government involvement including ensuring sustainable supply of ART and circumcision services since they are reportedly highly demanded. Community involvement through the engagement of popular peers could also help in the campaign to change the HIV predisposing culture, misconceptions and risky social norms of the population.

Full article at: http://goo.gl/ZX7xNS

By: 

Muhamadi Lubega^1234*, Neema Nakyaanjo¹, Sumaya Nansubuga³, Edgar Hiire¹, Godfrey Kigozi¹, Gertrude Nakigozi¹, Tom Lutalo¹, Fred Nalugoda¹, David Serwadda¹, Ronald Gray¹⁵, Maria Wawer¹⁵, Caitlin Kennedy⁵ and Steven James Reynolds¹⁴⁵

¹Rakai Health Sciences Program, Old Bukoba road, Kalisizo, Uganda

²Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinsika Institutet, Stockholm, Sweden

³School of Graduate Studies and Research Busoga University, Iganga, Uganda

⁴Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

⁵Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA

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