Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: A cross-sectional analysis

OBJECTIVES:

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.

METHODS:

In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.

RESULTS:

FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.

CONCLUSIONS:

Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.

Purchase full article at:  http://goo.gl/Vi0r9e

By:  Parcesepe AM¹, L'Engle KL², Martin SL³, Green S³, Suchindran C⁴, Mwarogo P⁵.

¹Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA.

²FHI 360, Durham, North Carolina, USA Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA.

³Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁴Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁵FHI 360, Nairobi, Kenya.

Sex Transm Infect. 2016 May 23. pii: sextrans-2016-052549. doi: 10.1136/sextrans-2016-052549. [Epub ahead of print]

  

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Gender-based violence against female sex workers in Cameroon: Prevalence and associations with sexual HIV risk and access to health services and justice

Abstract

BACKGROUND/OBJECTIVES:

Female sex workers (FSWs) are at risk for HIV and physical and sexual gender-based violence (GBV). We describe the prevalence of lifetime GBV and its associations with HIV risk behaviour, access to health services and barriers in accessing justice among FSWs in Cameroon.

METHODS:

FSWs (n=1817) were recruited for a cross-sectional study through snowball sampling in seven cities in Cameroon. We examined associations of lifetime GBV with key outcomes via adjusted logistic regression models.

RESULTS:

Overall, 60% (1098/1817) had experienced physical or sexual violence in their lifetime. GBV was associated with inconsistent condom use with clients (adjusted OR (AOR) 1.49, 95% CI 1.18 to 1.87), being offered more money for condomless sex (AOR 2.09, 95% CI 1.56 to 2.79), having had a condom slip or break (AOR 1.53, 95% CI 1.25 to 1.87) and difficulty suggesting condoms with non-paying partners (AOR 1.47, 95% CI 1.16 to 1.87). Violence was also associated with fear of health services (AOR 2.25, 95% CI 1.61 to 3.16) and mistreatment in a health centre (AOR 1.66, 95% CI 1.01 to 2.73). Access to justice was constrained for FSWs with a GBV history, specifically feeling that police did not protect them (AOR 1.41, 95% CI 1.12 to 1.78).

DISCUSSION:

Among FSWs in Cameroon, violence is prevalent and undermines HIV prevention and access to healthcare and justice. Violence is highly relevant to FSWs' ability to successfully negotiate condom use and engage in healthcare. In this setting of criminalised sex work, an integrated, multisectoral GBV-HIV strategy that attends to structural risk is needed to enhance safety, HIV prevention and access to care and justice.

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By:  Decker MR¹, Lyons C², Billong SC³, Njindam IM², Grosso A², Nunez GT², Tumasang F⁴, LeBreton M⁵, Tamoufe U⁶, Baral S².

¹Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

²Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

³Comité national de lutte contre le sida (CNLS), Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.

⁴PEPFAR DSF Ministère de la Sante Publique (MINSANTE), Yaoundé, Cameroon.

⁵Global Viral, Yaoundé, Cameroon Mosaic, Yaoundé, Cameroon.

⁶Global Viral, Yaoundé, Cameroon.

Sex Transm Infect. 2016 Jun 8. pii: sextrans-2015-052463. doi: 10.1136/sextrans-2015-052463. [Epub ahead of print]

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Relationship between Community Collectivization and Financial Vulnerability of Female Sex Workers in Southern India

Introduction

Studies exploring the linkages between financial vulnerabilities and community collectivization of female sex workers (FSWs) are scarce in India despite having potential policy implications. To fill this gap in the literature, this study attempts to understand the financial vulnerabilities among FSWs and assess the relationship between community collectivization and financial vulnerabilities in southern India.

Data and Methods

Data were drawn from a cross-sectional, behavioral tracking survey (BTS)—2014, conducted among FSWs (N = 2400) in Andhra Pradesh, a southern state of India under the Avahan-India AIDS initiative program. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were estimated through multivariate logistic regression, to assess the independent relationships of the degree of community collectivization indicators with financial vulnerability indicators, adjusting for socio-demographic characteristics.

Results

Most FSWs (87%) reported having either one or more financial vulnerability and nearly one-fifth had a high financial vulnerability. The risk of facing financial vulnerability was significantly lower among FSWs with a high degree of perceived collective efficacy (15% vs 31%; AOR: 0.4; 95% CI: 0.3–0.5) and collective agency (4% vs 21%; AOR: 0.2; 95% CI: 0.1–0.3) as compared to their respective counterparts, after controlling for their individual socio-demographic characteristics. FSWs with a high degree of collective efficacy are also less likely to report different components of financial vulnerability (e.g. income, saving, expenditure, and debt).

Conclusion

This study finding suggests that community-led interventions such as improving collectivization are promising strategies to address financial vulnerabilities and a path to a sustainable reduction of HIV risk. This study calls for further evidence-based research and measurement of the effects of community-led approaches in addressing the financial vulnerabilities of the key population at risk for HIV.

Below:  Distribution of levels of community collectivization indicators among female sex workers (N = 2400) in Andhra Pradesh, India, 2014

Full article at:   http://goo.gl/wKNO0F

By: Sangram Kishor Patel,^1,* Parimi Prabhakar,² Anrudh Kumar Jain,³ Niranjan Saggurti,⁴ and Rajatashuvra Adhikary¹

Shira M Goldenberg, Editor

¹HIV and AIDS Program, Population Council, 142, Golf Links, New Delhi, India

²India HIV/AIDS Alliance, Sarovar Center, Secretariat Road, Hyderabad, India

³Population Council, New York, United States of America

⁴Bill and Melinda Gates Foundation, New Delhi, India

Simon Fraser University, Canada

Published online 2016 May 26. doi:  10.1371/journal.pone.0156060

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Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

Men who have sex with men (MSM) who engage in transactional sex are at increased HIV risk, and face complex barriers to care seeking. Among 2,035 men recruited through an MSM social/sexual networking website in Latin America and who reported being HIV-infected, 186 (9.1%) reported being paid for sex with another man in the past year. Engagement in transactional sex was associated with decreased odds of receiving medical care for HIV (AOR=0.57, 95% CI=0.37–0.85). No significant differences were seen in being on antiretroviral therapy (ART) or ART adherence once in care. Interventions in this population should focus on reducing barriers to engagement in care.

...Results of this analysis suggest that there are disparities in receipt of HIV medical care associated with recent engagement in transactional sex among HIV-infected MSM in Latin America. The ability to access HIV-related medical care is related not only to availability of care facilities, but also barriers and facilitators to engagement and retention in care, and these factors may be compounded for MSM who engage in transactional sex. For example, stigma and discrimination may limit care seeking to a greater extent among men who engage in transactional sex, given multiple sources of stigma. Previous research suggests that MSM may face sexual stigma from multiple dimensions. Stigma from healthcare providers may limit disclosure of sexual orientation or sexual behaviors among MSM, if they anticipate discrimination following disclosure.¹⁶Among people living with HIV, HIV and healthcare stigma has been associated with decreased care-seeking behavior.^9,12 MSM who engage in transactional sex may experience additional stigma due to being involved in sex work, which is illegal and/or socially unacceptable across most of Latin America, and which has been described as a barrier to care seeking among female sex workers.^17,18 Although experienced and/or perceived stigma could act as a mechanism through which MSM who engage in transactional sex in Latin America have decreased engagement in HIV care, we were unable to quantify experiences of stigma in this study. Future work should consider the role of experienced and/or perceived stigma specifically as a barrier to engaging in care in this population.

...Interestingly, although participants who engaged in transactional sex were less likely to be engaged in HIV-related medical care, prior research by this team¹⁵ and by others in other regions²¹ indicates that MSM who engage in transactional sex are more likely to have a history of HIV testing and of HIV diagnosis.^22,23 This may indicate that men who engage in transactional sex are aware of their increased risk and thus are more likely to test for HIV, but that there are structural, interpersonal, and individual factors—including differential power dynamics due to social or economic position, physical or sexual violence, substance use, and/or psychological distress⁷—which are major barriers to linkage and continued engagement in care if diagnosed...

  

Full article at:  http://goo.gl/5RWUOC

By: Katie B. Biello, PhD, MPH, ^1,,2 Catherine E. Oldenburg, MPH,¹ Joshua Rosenberger, PhD,³ Kenneth H. Mayer, MD,^2,,4,,5 David Novak, MSW,⁶ and Matthew J. Mimiaga, ScD, MPH^1,,2,,7,,8

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

¹Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.

²The Fenway Institute, Fenway Health, Boston, Massachusetts.

³Department of Global and Community Health, George Mason University, Fairfax, Virginia.

⁴Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

⁵Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.

⁶OLB Research Institute, Online Buddies, Inc., Cambridge, Massachusetts.

⁷Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

⁸Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.

LGBT Health. 2016 Jun 1; 3(3): 233–237. doi:  10.1089/lgbt.2015.0006

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Promoting male partner HIV testing & safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: A cohort study

BACKGROUND:

Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making.

METHODS:

In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing.

FINDINGS:

Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53 tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p<0·0001); condoms were used in all eight intercourse events after positive results compared with 104 (44%) after of negative results (p<0·0018). Four participants reported intimate partner violence as a result of self-test distribution: two in the post-partum care group and two female sex workers. No other adverse events were reported.

INTERPRETATION:

Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programmes.

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By: Thirumurthy H¹, Masters SH², Mavedzenge SN³, Maman S⁴, Omanga E⁵, Agot K⁵.

Author information

¹Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: harsha@unc.edu.

²Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

³RTI International, San Francisco, CA, USA.

⁴Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

⁵Impact Research and Development Organization, Kisumu, Kenya.

Lancet HIV. 2016 Jun;3(6):e266-74. doi: 10.1016/S2352-3018(16)00041-2. Epub 2016 Apr 8.

  

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Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada

Background

Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers’ experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC.

Methods

Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers’ Health Access). Multivariable logistic regression analyses, using generalized estimating equations (GEE), were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013).

Results

In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%). In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10–1.94), workplace- (AOR = 1.31, 95% CI 1.05–1.63), and community-level violence (AOR = 1.41, 95% CI 1.04–1.92), as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03–1.69), a mental illness diagnosis (AOR = 1.66, 95% CI 1.34–2.06), and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59–7.57) emerged as independent correlates of institutional barriers to health services.

Discussion

Despite Canada’s UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex workers’ health and human rights.

Below: Frequency of institutional-level barriers to health care among sex workers in Vancouver, Canada, 2010–2013

Full article at:   http://goo.gl/2p7VoO

By: 

M. Eugenia Socías, Paul Nguyen, Julio Montaner, Kate Shannon 
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada

M. Eugenia Socías, Julio Montaner, Kate Shannon 

Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada

Jean Shoveller 

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

Chili Bean

Sex Workers United Against Violence Society, Vancouver, BC, Canada

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Transgressive women don't deserve protection: Young men's narratives of sexual violence against women in rural Papua New Guinea

Sexual violence against women and girls is commonplace in Papua New Guinea (PNG). While the experiences of women are rightly given central place in institutional responses to sexual violence, the men who perpetrate violence are often overlooked, an oversight that undermines the effectiveness of prevention efforts. 

This paper draws on interviews conducted with young men as part of a qualitative longitudinal study of masculinity and male sexuality in a rural highland area of PNG. It explores one aspect of male sexuality: men's narratives of sexual violence. Most striking from the data is that the collective enactment of sexual violence against women and girls is reported as an everyday and accepted practice amongst young men. However, not all women and girls were described as equally at risk, with those who transgress gender roles and roles inscribed and reinforced by patriarchal structures, at greater risk. 

To address this situation, efforts to reduce sexual violence against women and girls require an increased focus on male-centred intervention to critically engage with the forms of patriarchal authority that give license to sexual violence. Understanding the perceptions and experiences of men as perpetrators of sexual violence is a critical first step in the process of changing normative perceptions of gender, a task crucial to reducing sexual violence in countries such as PNG.

Purchase full article at:  http://goo.gl/nVL2Zu

By:  Kelly-Hanku A1,2, Aeno H1, Wilson L3, Eves R4, Mek A1, Nake Trumb R1, Whittaker M5, Fitzgerald L5, Kaldor JM1, Vallely A2.

• 1 Sexual and Reproductive and Maternal Health Unit , Papua New Guinea Institute of Medical Research , Goroka , Papua New Guinea.
• 2 Kirby Institute, UNSW Australia , Sydney , Australia.
• 3 School of Political Science and International Studies , University of Queensland , St Lucia , Australia.
• 4 State, Society and Governance in Melanesia Program , Australian National University , Canberra , Australia.
• 5 School of Public Health , University of Queensland , Herston , Australia.
• Cult Health Sex. 2016 Jun 2:1-14. 

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Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs – a rapidly increasing, vulnerable population in southwest China. 

The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14–66) recruited over five years (2010–2014) from 35 National Sentinel Surveillance sites in Guangxi. 

Analyses included Fisher’s exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. 

Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. 

Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. 

Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

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By: Yu YJ1, Li X1, Tam CC2, Zhou Y3, Chen Y3, Shen Z3.

• 1a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA.
• 2b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA.
• 3c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China.
• AIDS Care. 2016 May 30:1-6

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Is Bondage and Discipline, Dominance and Submission, and Sadomasochism Recreational Leisure? A Descriptive Exploratory Investigation

INTRODUCTION:

Recent studies have suggested that, in contrast to traditional psychopathologic explanations, bondage and discipline, dominance and submission, and sadomasochism (BDSM) could be understood as recreational leisure. However, the theoretical framing of BDSM as potential leisure has not been empirically explored.

AIM:

To conduct an initial empirical exploration to determine whether BDSM experience fits established characteristics of recreational leisure.

METHODS:

A convenience sample of BDSM participants (N = 935) completed an online survey (9 demographic questions and 17 leisure questions) that assessed BDSM experience according to important attributes of leisure. Responses also were assessed and statistically compared as being primarily casual or serious leisure according to general BDSM identities (ie, dominants vs submissives vs switches).

MAIN OUTCOME MEASURES:

BDSM experiences were assessed as a form of potential leisure.

RESULTS:

Most BDSM experiences met leisure criteria. Participants reported that "most of the time or nearly always" BDSM was associated with a sense of personal freedom (89.7% of participants), pleasure or enjoyment (98.5%), sense of adventure (90.7%), use of personal skills (90.8%), relaxation or decreased stress (91.4%), self-expression or exploration (90.6%), and positive emotions (96.6%). BDSM seemed to function as primarily serious, rather than casual, leisure, but important statistical differences were observed based on specific BDSM identities.

CONCLUSION:

A leisure science perspective could be valuable to researchers and clinicians in reinterpreting the wide range of diverse BDSM motivations and practices.

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By: Dj Williams1, Prior EE2, Alvarado T3, Thomas JN4, Christensen MC5.

• 1Center for Positive Sexuality, Burbank, CA, USA; Idaho State University, Pocatello, ID, USA. Electronic address: willdj@isu.edu.
• 2Center for Positive Sexuality, Burbank, CA, USA; College of the Canyons, Santa Clarita, CA, USA.
• 3College of the Canyons, Santa Clarita, CA, USA.
• 4Center for Positive Sexuality, Burbank, CA, USA; Idaho State University, Pocatello, ID, USA.
• 5Center for Positive Sexuality, Burbank, CA, USA; University of Texas-San Antonio, San Antonio, TX, USA. 
• J Sex Med. 2016 May 24. pii: S1743-6095(16)30191-6. doi: 10.1016/j.jsxm.2016.05.001.

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Blood-borne viral co-infections among HIV+ inmates

Via:  http://goo.gl/mbSFE5

Porn consumption among adolescent girls in Sweden

Via:  http://goo.gl/7jI6BH

Improving Adherence to Post-Cervical Biopsy Sexual Abstinence in Kenyan Female Sex Workers

PROBLEM:

Cervical biopsies offer a unique opportunity for studying local immune response. To investigate hormonally induced immune fluctuations in cervical tissues of Kenyan female sex workers, we improved biopsy sampling protocol safety. Here, we report on steps taken to minimize exposure to HIV following two cervical biopsies.

METHODS OF STUDY:

Women were asked to abstain from vaginal intercourse to limit HIV exposure during wound healing with financial compensation. A comprehension tool for informed consent, on-site detection of prostate-specific antigens indicating unprotected intercourse within 48 hr, and bi-weekly text message reminders were implemented.

RESULTS:

The implemented methods improved compliance with post-procedure abstinence by two times (P = 0.013). Fourteen days following a cervical biopsy, no sign of genital inflammation or change in HIV T-cell target proportion were observed.

CONCLUSIONS:

This study provides new tools for limiting HIV exposure in studies requiring biopsy sampling among women at risk of acquiring HIV.

Below:  Schematic representation of the study visits

Below:  PSA-semiquant cassette test serial dilutions to indicate PSA concentrations

Below:  Proportion of cervical HIV T-cell targets in HIV-uninfected and HIV-infected FSWs before and after biopsy sampling

Full article at:   http://goo.gl/tX6M5j

By: Lajoie J1,2,3, Boily-Larouche G1, Doering K1, Cheruiyot J4, Oyugi J1,3,4, Broliden K5, Kimani J1,3,4, Fowke KR1,2,3.

• 1Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.
• 2Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
• 3Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
• 4Kenya AIDS Control Program, Nairobi, Kenya.
• 5Department of Medicine Solna, Center for Molecular Medicine, Clinic of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
• Am J Reprod Immunol. 2016 May 24. doi: 10.1111/aji.12520. 

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