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Evolution of Condom Use Among a 5-Year Cohort of Female Sex Workers in Zambia

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Abstract

Observing sexual behaviour change over time could help develop behavioural HIV prevention interventions for female sex workers in Zambia, where these interventions are lacking. We investigated the evolution of consistent condom use among female sex workers and their clients and steady partners. Participants were recruited into an HIV incidence cohort from 2012 to 2017. At each visit, women received HIV counselling and testing, screening for sexually transmitted infections (STIs) and free condoms. Our outcome was reported consistent (100%) condom use in the previous month with steady partners, repeat clients, and non-repeat clients. Consistent condom use at baseline was highest with non-repeat clients (36%) followed by repeat clients (27%) and steady partners (17%). Consistent condom use between baseline and Month 42 increased by 35% with steady partners, 39% with repeat clients and 41% with non-repeat clients. Access to condoms, HIV/STI counselling and testing promoted positive sexual behaviour change.

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References

  1. UNAIDS. UNAIDS Data 2019 [Internet]. Geneva, Switzerland; 2019. https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf

  2. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.

    Article  Google Scholar 

  3. Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo Y-R. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan africa: a systematic review. AIDS Behav. 2012;16(4):920–33.

    Article  Google Scholar 

  4. Malama K, Sagaon-Teyssier L, Parker R, Tichacek A, Sharkey T, Kilembe W, et al. Client-initiated violence against zambian female sex workers: prevalence and associations with behavior, environment, and sexual history. J Interpers Violence [Internet]. 2019. https://journals.sagepub.com/eprint/JV2HWHPXSKWEGMM5VAJY/full

  5. World Health Organisation. WHO Expands Recommendation on Oral Pre-Exposure Prophylaxis of HIV Infection (PrEP) [Internet]. Geneva, Switzerland: WHO; 2015. https://apps.who.int/iris/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf;jsessionid=0FF1F0C2002F493E392EB772FD8FE6DF?sequence=1

  6. Cairns G. PrEP spreads across Africa – slowly [Internet]. United Kingdom: Aidsmap. 2018. http://www.aidsmap.com/news/aug-2018/prep-spreads-across-africa-slowly

  7. Shea J, Bula A, Dunda W, Hosseinipour MC, Golin CE, Hoffman IF, et al. The drug will help protect my tomorrow: perceptions of integrating prep into hiv prevention behaviors among female sex workers in Lilongwe. MALAWI AIDS Educ Prev. 2019;31(5):421–32.

    Article  Google Scholar 

  8. Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A, et al. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health. 2020;20(1):69.

    Article  CAS  Google Scholar 

  9. Charania MR, Crepaz N, Guenther-Gray C, Henny K, Liau A, Willis LA, et al. Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998–2007. AIDS Behav. 2011;15(7):1283–97.

    Article  Google Scholar 

  10. Van Rossem R, Meekers D, Akinyemi Z. Consistent condom use with different types of partners: evidence from two Nigerian surveys. AIDS Educ Prev. 2001;13(3):252–67.

    Article  Google Scholar 

  11. Adu-Oppong A, Grimes RM, Ross MW, Risser J, Kessie G. Social and behavioral determinants of consistent condom use among female commercial sex workers in Ghana. AIDS Educ Prev. 2007;19(2):160–72.

    Article  Google Scholar 

  12. Ntumbanzondo M, Dubrow R, Niccolai LM, Mwandagalirwa K, Merson MH. Unprotected intercourse for extra money among commercial sex workers in Kinshasa Democratic Republic of Congo. AIDS Care. 2006;18(7):777–85.

    Article  CAS  Google Scholar 

  13. Gallo MF, Warner L, Bell AJ, Bukusi EA, Sharma A, Njoroge B, et al. Determinants of condom use among female sex workers in kenya: a case-crossover analysis. J Women’s Health. 2011;20(5):733–8.

    Article  Google Scholar 

  14. Kayembe PK, Mapatano MA, Busangu AF, Nyandwe JK, Musema GM, Kibungu JP, et al. Determinants of consistent condom use among female commercial sex workers in the Democratic Republic of Congo: implications for interventions. Sex Transm Infect. 2008;84(3):202–6.

    Article  CAS  Google Scholar 

  15. Kinsler JJ, Blas MM, Cabral A, Carcamo C, Halsey N, Brown B. Understanding STI risk and condom use patterns by partner type among female sex workers in Peru. Open AIDS J. 2014;30(8):17–20.

    Article  Google Scholar 

  16. Fehrenbacher AE, Chowdhury D, Jana S, Ray P, Dey B, Ghose T, et al. Consistent condom use by married and cohabiting female sex workers in india: investigating relational norms with commercial versus intimate partners. AIDS Behav. 2018;22(12):4034–47.

    Article  Google Scholar 

  17. Okafor UO, Crutzen R, Aduak Y, Adebajo S, Van den Borne HW. Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review. Afr J AIDS Res. 2017;16(3):257–68.

    Article  Google Scholar 

  18. Gunn JKL, Roth AM, Center KE, Wiehe SE. The Unanticipated benefits of behavioral assessments and interviews on anxiety, self-esteem and depression among women engaging in transactional sex. Community Ment Health J. 2016;52(8):1064–9.

    Article  Google Scholar 

  19. Chudakov B, Ilan K, Belmaker RH, Cwikel J. The motivation and mental health of sex workers. J Sex Marital Ther. 2002;28(4):305–15.

    Article  Google Scholar 

  20. Kilembe W, Inambao M, Sharkey T, Wall KM, Parker R, Himukumbwa C, et al. Single mothers and female sex workers in zambia have similar risk profiles. AIDS Res Hum Retrovir. 2019;35(9):814–25.

    Article  Google Scholar 

  21. de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European study group on heterosexual transmission of HIV. N Engl J Med. 1994;331(6):341–6.

    Article  Google Scholar 

  22. Hubbard AE, Ahern J, Fleischer NL, der Laan MV, Lippman SA, Jewell N, et al. To GEE or Not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21(4):467–74.

    Article  Google Scholar 

  23. Tracas A, Bazzi AR, Artamonova I, Rangel MG, Staines H, Ulibarri MD. Changes in condom use over time among female sex workers and their male noncommerical partners and clients. AIDS Educ Prev. 2016;28(4):312–24.

    Article  Google Scholar 

  24. Li Q, Li X, Stanton B. Alcohol use among female sex workers and male clients: an integrative review of global literature. Alcohol Alcohol. 2010;45(2):188–99.

    Article  Google Scholar 

  25. Fritz KE, Woelk GB, Bassett MT, McFarland WC, Routh JA, Tobaiwa O, et al. The association between alcohol use, sexual risk behavior, and hiv infection among men attending beerhalls in harare, Zimbabwe. AIDS Behav. 2002;8.

  26. Roth EA, Benoit C, Jansson M, Hallsgrimdottir H. Public drinking venues as risk environments: commercial sex, alcohol and violence in a large informal settlement in Nairobi, Kenya. Human Ecol. 2017;45(2):277–83.

    Article  Google Scholar 

  27. Chersich MF, Luchters SMF, Malonza IM, Mwarogo P, King’ola N, Temmerman M. Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections. Int J STD AIDS. 2007;18(11):764–9.

    Article  CAS  Google Scholar 

  28. Chersich MF, Bosire W, King’ola N, Temmerman M, Luchters S. Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers. Global Health. 2014;10:22.

    Article  Google Scholar 

  29. Wang B, Li X, Stanton B, Zhang L, Fang X. Alcohol use, unprotected sex, and sexually transmitted infections among female sex workers in China. Sex Transm Dis. 2010;37(10):629–36.

    Article  Google Scholar 

  30. Feldblum PJ, Nasution MD, Hoke TH, Damme KV, Turner AN, Gmach R, et al. Pregnancy among sex workers participating in a condom intervention trial highlights the need for dual protection. Contraception. 2007;76(2):105–10.

    Article  Google Scholar 

  31. Mbita G, Mwanamsangu A, Plotkin M, Casalini C, Shao A, Lija G, et al. Consistent condom use and dual protection among female sex workers: surveillance findings from a large-scale, community-based combination HIV prevention program in Tanzania. AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02642-1.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Li JL, Kilembe W, Inambao M, Vwalika B, Parker R, Sharkey T, et al. Fertility intentions and long-acting reversible contraceptive use among HIV-negative single mothers in Zambia. Am J Obstet Gynecol. 2020. https://doi.org/10.1016/j.ajog.2019.12.269.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Macaluso M, Demand MJ, Artz LM, Hook EWI. Partner type and condom use. AIDS. 2000;14(5):537.

    Article  CAS  Google Scholar 

  34. Duncan EAW. Influence of partner type on condom use. J Hum Behav Soc Environ. 2011;21(7):784–802.

    Article  Google Scholar 

  35. Malama K, Kilembe W, Inambao M, Hoagland A, Sharkey T, Parker R, et al. A couple-focused, integrated unplanned pregnancy and HIV prevention program in urban and rural Zambia. Am J Obstet Gynecol. 2020. https://doi.org/10.1016/j.ajog.2020.01.007.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F, et al. Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Global Health. 2014;10(10):46.

    Article  Google Scholar 

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Acknowledgements

We wish to acknowledge the support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH123256.

Funding

This study was supported by the International AIDS Vaccine Initiative (IAVI) with the generous support of the American people through the United States Agency for International Development (USAID, https://www.usaid.gov/). A full list of IAVI donors can be found at https://www.iavi.org/; National Institutes of Health (https://www.nih.gov/) grants (R01 MH66767, R01 HD40125, and R01 MH95503; R01 AI051231); the AIDS International Training and Research Program Fogarty International Center (D43 TW001042); and the Emory Center for AIDS Research (P30 AI050409). The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.

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Authors and Affiliations

  1. Aix-Marseille University, INSERM, IRD, SESSTIM, ORS PACA, Institut Hospitalo-Universitaire, 19-21 Boulevard Jean Moulin, 13005, Marseille, France

    Kalonde Malama, Luis Sagaon-Teyssier & Bruno Spire

  2. Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Lusaka, Zambia

    Kalonde Malama, Tyronza Sharkey & William Kilembe

  3. IAVI, New York, NY, USA

    Matt A. Price

  4. University of California At San Francisco, San Francisco, CA, USA

    Matt A. Price

  5. Rwanda Zambia HIV Research Group, Emory University, Atlanta, GA, USA

    Rachel Parker, Kristin M. Wall, Amanda Tichacek & Susan Allen

  6. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Kristin M. Wall

  7. Center for Family Health Research in Zambia, Rwanda Zambia HIV Research Group, Ndola, Zambia

    Mubiana Inambao

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  1. Kalonde Malama
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Contributions

KM analysed the data and wrote the manuscript. SA, WK and MI conceived the original study and reviewed the manuscript. LST, RP and KMW supported the analysis and reviewed the manuscript. AT, MA, TS and BS reviewed the manuscript.

Corresponding author

Correspondence to Kalonde Malama.

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Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

The Emory University Institutional Review Board (IRB00071160) and the University of Zambia Research Ethics Committee (REF. No. 011-01-14) approved this study.

Consent to Participate

All enrolled FSWs provided written informed consent to participate in this study.

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Malama, K., Price, M.A., Sagaon-Teyssier, L. et al. Evolution of Condom Use Among a 5-Year Cohort of Female Sex Workers in Zambia. AIDS Behav 26, 470–477 (2022). https://doi.org/10.1007/s10461-021-03403-9

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