What are the consequences when international actors step in to protect LGBT people from discrimin... more What are the consequences when international actors step in to protect LGBT people from discrimination with programs that treat their sexualities in isolation from the “facts on the ground”? Robert Lorway tells the story of the unexpected effects of The Rainbow Project (TRP), a LGBT rights program for young Namibians begun in response to President Nujoma's notorious hate speeches against homosexuals. Lorway highlights the unintended consequences of this program, many of which ran counter to the goals of local and international policy makers and organizers. He shows how TRP inadvertently diminished civil opportunities at the same time as it sought to empower youth to claim their place in Namibian culture and society. Tracking the fortunes of TRP over several years, Namibia’s Rainbow Project poses questions about its effectiveness in the faces of class distinction and growing inequality. It also speaks to ongoing problems for Western sexual minority rights programs in Africa in the midst of political violence, heated debates over anti-discrimination laws, and government-sanctioned anti-homosexual rhetoric.
The authors describe the plight of sex workers, a particularly disadvantaged community that is hi... more The authors describe the plight of sex workers, a particularly disadvantaged community that is highly marginalized and vulnerable. Sex workers were hard hit by the pandemic. The authors examine the impact of COVID-19 on sex workers’ lives and livelihoods, their response to the crisis, and the strategies that they employed to battle the pandemic.During the lockdown, female sex workers lost their livelihoods which plunged them and their families into extreme poverty. Even when unlock measures were announced, the business of sex work did not return to normal. Sex work, by its very nature, demands physical proximity—not physical distancing. Consequently, sex workers had to innovate to find work to survive. Loss of livelihoods also brought forth hidden mental health problems. Gripped by anxiety and depression due to the uncertainty about when the pandemic would end, sex workers went into despair. Some even attempted suicide. Violence in the family increased significantly. For sex workers...
The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value o... more The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby "freed," through technology, from the social conditions that might inhibit health services utilization. Following a community-centered collaborative approach, community researchers interviewed their peers who examined and reacted to the technology. Participants reframed the technosubject as intertwined with the social world and the testing kit itself as an object that exerts agency and possesses affective potential. Attending to these socio-material relationalities offers insights into program planning.
ObjectiveLittle is known about barriers to healthcare access for two-spirit, gay, bisexual and qu... more ObjectiveLittle is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba.DesignData were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men.SettingCommunity-based cross-sectional study in Manitoba, Canada.ParticipantsCommunity-based sample of 368 2SGBQ+ men.OutcomesLogistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers’ 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months.ResultsIn multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare...
Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on... more Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. Summary COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.
Global health policy-makers have called for demonstration projects to better understand pre-expos... more Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis' (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the project. Although the project proved immensely successful in terms of retention and adherence, to explain these findings we point towards Ashodaya's history of collectivisation around sexual health-a history of community action that has given rise to new spaces of belonging and accumulated knowledges that became instrumental in the formulation of strategies to confront anticipated challenges during the project. These strategies included: (1) the participation of community leaders as the first participants to take PrEP, followed by the sharing of their experiences through testimonials to their peers; (2) the endorsement of PrEP among community leaders living with HIV, to avoid social divisions around HIV status; and (3) ongoing community-level support from outreach workers that went beyond administering PrEP to address the various needs of the community. These community-led approaches demonstrate that communities hold key insights into the delivery of clinicallyoriented interventions, suggesting the vital role they continue to play in planning and implementing new prevention technologies.
In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pa... more In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and strict policing, especially of the urban poor, which has culminated in violence. This open letter highlights the effects of these measures on how three community-based organizations (CBOs) deliver HIV programs and services to highly stigmatized communities of men who have sex with men living in the counties of Kisumu, Kiambu and Mombasa. In particular, emphasis is placed on how HIV testing programs, which are supported by systematic peer outreach, are being disrupted at a time when global policymakers call for expanded HIV testing and treatment targets among key populations. While government measures have greatly undermined local efforts t...
Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmissio... more Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmission. This study explored the multiple sexual partnering and its predictors among people who visited public social venues (bars, restaurants, hotels, lodges, cafes, karaokes and discos) in Bhutan’s two largest townships of Thimphu and Phuntsholing. Methods: We interviewed 755 sexually active venue patrons from 102 randomly selected venues (56 in Thimphu, 46 in Phuntsholing) from a list of all venues identified as having sex workers or patrons seeking sexual partners. Both bivariate and multivariate analyses were carried out to characterize the predictors of multiple sexual partnering among 755 respondents who had previously had sex. Results: Of the 755 patrons, 46.09% had one sexual partner while the remaining 54.91% had multiple sex partners (greater than or equal to 2 sexual partners) in the 12 months preceding the study. Overall, 6.23% of respondents had received payment from someone at ...
Objective: This report identifies the profound effects that the COVID-19 pandemic and the resulta... more Objective: This report identifies the profound effects that the COVID-19 pandemic and the resultant government lockdown have had on sexual health services delivery to a community of marginalised male sex workers in Nairobi, Kenya. Methods: Based on the experiences shared during ongoing virtual conversations with peer health workers, a case study was developed to identify the challenges encountered by peer health workers. Findings: Peer health workers confronted the new health crisis surrounding COVID-19 while also persisting in their efforts to deliver HIV services to male sex workers. Unable to receive status as ‘essential workers’, their actions often fell short in efforts to maintain male sex workers’ access to vital HIV prevention, treatment and care resources. Conclusion: The struggles encountered, amid dwindling resources, underscore the vital work needed to meet the health needs of a marginalised group that remains largely excluded from the government health system.
0.05. Results The magnitude of unintended pregnancy among female sex workers was 28.6%. During th... more 0.05. Results The magnitude of unintended pregnancy among female sex workers was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%) of those with unintended pregnancy. Female sex workers who had history of abortion formerly had 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had longer duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). Conclusion High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers. Disclosure No significant relationships.
Background: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-u... more Background: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in what contexts the delivery of HIVST to MSM could increase awareness of HIV status and lead to early linkage to HIV treatment and prevention. Methods: The study will be embedded within existing MSM-focused community-based HIV prevention and treatment programmes in 3 counties in Kenya (Kisumu, Mombasa, Kiambu). The study is designed to assess three HIV testing outcomes among MSM, namely a) coverage b) frequency of testing and c) early uptake of testing. The study will adopt a mixed methods programme science approach to the implementation and evaluation of HIVST strategies via: (i) a baseline and endline bio-behavioural survey with 1400 MSM; (ii) a socio-sexual network study with 351 MSM; (iii) a longitudinal qualitative cohort study with 72 MSM; (iv) routine programme monitoring in three sites; (v) a programme-specific costing exercise; and (vi) mathematical modelling. This protocol evaluates the impact of community-based implementation of HIV self-testing delivery strategies among MSM in Kenya on reducing the undiagnosed MSM population, and time for linkage to prevention, treatment and care following HIV self-testing. Baseline data collection started in April 2019 and the endline data collection will start in July 2020.
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonst... more Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We briefly describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects and the lessons these projects offer for community engagement in PrEP implementation.
By 2016, Ukraine had the second largest HIV epidemic in Eastern Europe and Central Asia with 280,... more By 2016, Ukraine had the second largest HIV epidemic in Eastern Europe and Central Asia with 280,358 people living with HIV. Interventions targeted for FSWs are a key component of HIV prevention programs as heterosexual contacts continue to gain higher epidemic significance-the proportion of the sexual way of HIV transmission has steadily increased and reached the value of 73,3% in 2016. However, HIV prevention programs for female sex workers generally provide services to women who self-identify as sex workers. Thus, programs aimed at female sex workers may not reach women who exchange sex for money or other resources, but who do not identify as sex workers.
What are the consequences when international actors step in to protect LGBT people from discrimin... more What are the consequences when international actors step in to protect LGBT people from discrimination with programs that treat their sexualities in isolation from the “facts on the ground”? Robert Lorway tells the story of the unexpected effects of The Rainbow Project (TRP), a LGBT rights program for young Namibians begun in response to President Nujoma's notorious hate speeches against homosexuals. Lorway highlights the unintended consequences of this program, many of which ran counter to the goals of local and international policy makers and organizers. He shows how TRP inadvertently diminished civil opportunities at the same time as it sought to empower youth to claim their place in Namibian culture and society. Tracking the fortunes of TRP over several years, Namibia’s Rainbow Project poses questions about its effectiveness in the faces of class distinction and growing inequality. It also speaks to ongoing problems for Western sexual minority rights programs in Africa in the midst of political violence, heated debates over anti-discrimination laws, and government-sanctioned anti-homosexual rhetoric.
The authors describe the plight of sex workers, a particularly disadvantaged community that is hi... more The authors describe the plight of sex workers, a particularly disadvantaged community that is highly marginalized and vulnerable. Sex workers were hard hit by the pandemic. The authors examine the impact of COVID-19 on sex workers’ lives and livelihoods, their response to the crisis, and the strategies that they employed to battle the pandemic.During the lockdown, female sex workers lost their livelihoods which plunged them and their families into extreme poverty. Even when unlock measures were announced, the business of sex work did not return to normal. Sex work, by its very nature, demands physical proximity—not physical distancing. Consequently, sex workers had to innovate to find work to survive. Loss of livelihoods also brought forth hidden mental health problems. Gripped by anxiety and depression due to the uncertainty about when the pandemic would end, sex workers went into despair. Some even attempted suicide. Violence in the family increased significantly. For sex workers...
The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value o... more The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby "freed," through technology, from the social conditions that might inhibit health services utilization. Following a community-centered collaborative approach, community researchers interviewed their peers who examined and reacted to the technology. Participants reframed the technosubject as intertwined with the social world and the testing kit itself as an object that exerts agency and possesses affective potential. Attending to these socio-material relationalities offers insights into program planning.
ObjectiveLittle is known about barriers to healthcare access for two-spirit, gay, bisexual and qu... more ObjectiveLittle is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba.DesignData were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men.SettingCommunity-based cross-sectional study in Manitoba, Canada.ParticipantsCommunity-based sample of 368 2SGBQ+ men.OutcomesLogistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers’ 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months.ResultsIn multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare...
Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on... more Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya, Ukraine, and India and place these in the broader global context of sex worker communities, drawing on common themes that span geographies. Summary COVID-19-associated lockdowns have significantly disrupted sex work, leading to economic and health challenges for sex workers, ranging from HIV-related services to mental health and exposure to violence. Several adaptations have been undertaken by sex workers and frontline workers, including migration, a move to mobile services, and struggling to find economic supports. Strengthening community-based responses for future pandemics and other shocks is critical to safeguard the health of marginalized populations.
Global health policy-makers have called for demonstration projects to better understand pre-expos... more Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis' (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the project. Although the project proved immensely successful in terms of retention and adherence, to explain these findings we point towards Ashodaya's history of collectivisation around sexual health-a history of community action that has given rise to new spaces of belonging and accumulated knowledges that became instrumental in the formulation of strategies to confront anticipated challenges during the project. These strategies included: (1) the participation of community leaders as the first participants to take PrEP, followed by the sharing of their experiences through testimonials to their peers; (2) the endorsement of PrEP among community leaders living with HIV, to avoid social divisions around HIV status; and (3) ongoing community-level support from outreach workers that went beyond administering PrEP to address the various needs of the community. These community-led approaches demonstrate that communities hold key insights into the delivery of clinicallyoriented interventions, suggesting the vital role they continue to play in planning and implementing new prevention technologies.
In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pa... more In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and strict policing, especially of the urban poor, which has culminated in violence. This open letter highlights the effects of these measures on how three community-based organizations (CBOs) deliver HIV programs and services to highly stigmatized communities of men who have sex with men living in the counties of Kisumu, Kiambu and Mombasa. In particular, emphasis is placed on how HIV testing programs, which are supported by systematic peer outreach, are being disrupted at a time when global policymakers call for expanded HIV testing and treatment targets among key populations. While government measures have greatly undermined local efforts t...
Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmissio... more Introduction: Multiple sexual partnering is a known predictor for risk of STI and HIV transmission. This study explored the multiple sexual partnering and its predictors among people who visited public social venues (bars, restaurants, hotels, lodges, cafes, karaokes and discos) in Bhutan’s two largest townships of Thimphu and Phuntsholing. Methods: We interviewed 755 sexually active venue patrons from 102 randomly selected venues (56 in Thimphu, 46 in Phuntsholing) from a list of all venues identified as having sex workers or patrons seeking sexual partners. Both bivariate and multivariate analyses were carried out to characterize the predictors of multiple sexual partnering among 755 respondents who had previously had sex. Results: Of the 755 patrons, 46.09% had one sexual partner while the remaining 54.91% had multiple sex partners (greater than or equal to 2 sexual partners) in the 12 months preceding the study. Overall, 6.23% of respondents had received payment from someone at ...
Objective: This report identifies the profound effects that the COVID-19 pandemic and the resulta... more Objective: This report identifies the profound effects that the COVID-19 pandemic and the resultant government lockdown have had on sexual health services delivery to a community of marginalised male sex workers in Nairobi, Kenya. Methods: Based on the experiences shared during ongoing virtual conversations with peer health workers, a case study was developed to identify the challenges encountered by peer health workers. Findings: Peer health workers confronted the new health crisis surrounding COVID-19 while also persisting in their efforts to deliver HIV services to male sex workers. Unable to receive status as ‘essential workers’, their actions often fell short in efforts to maintain male sex workers’ access to vital HIV prevention, treatment and care resources. Conclusion: The struggles encountered, amid dwindling resources, underscore the vital work needed to meet the health needs of a marginalised group that remains largely excluded from the government health system.
0.05. Results The magnitude of unintended pregnancy among female sex workers was 28.6%. During th... more 0.05. Results The magnitude of unintended pregnancy among female sex workers was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%) of those with unintended pregnancy. Female sex workers who had history of abortion formerly had 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had longer duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). Conclusion High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers. Disclosure No significant relationships.
Background: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-u... more Background: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in what contexts the delivery of HIVST to MSM could increase awareness of HIV status and lead to early linkage to HIV treatment and prevention. Methods: The study will be embedded within existing MSM-focused community-based HIV prevention and treatment programmes in 3 counties in Kenya (Kisumu, Mombasa, Kiambu). The study is designed to assess three HIV testing outcomes among MSM, namely a) coverage b) frequency of testing and c) early uptake of testing. The study will adopt a mixed methods programme science approach to the implementation and evaluation of HIVST strategies via: (i) a baseline and endline bio-behavioural survey with 1400 MSM; (ii) a socio-sexual network study with 351 MSM; (iii) a longitudinal qualitative cohort study with 72 MSM; (iv) routine programme monitoring in three sites; (v) a programme-specific costing exercise; and (vi) mathematical modelling. This protocol evaluates the impact of community-based implementation of HIV self-testing delivery strategies among MSM in Kenya on reducing the undiagnosed MSM population, and time for linkage to prevention, treatment and care following HIV self-testing. Baseline data collection started in April 2019 and the endline data collection will start in July 2020.
Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonst... more Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities and create spaces for community involvement in the planning and roll out of these projects. We briefly describe the community engagement strategies employed by seven Bill & Melinda Gates Foundation-funded PrEP demonstration projects and the lessons these projects offer for community engagement in PrEP implementation.
By 2016, Ukraine had the second largest HIV epidemic in Eastern Europe and Central Asia with 280,... more By 2016, Ukraine had the second largest HIV epidemic in Eastern Europe and Central Asia with 280,358 people living with HIV. Interventions targeted for FSWs are a key component of HIV prevention programs as heterosexual contacts continue to gain higher epidemic significance-the proportion of the sexual way of HIV transmission has steadily increased and reached the value of 73,3% in 2016. However, HIV prevention programs for female sex workers generally provide services to women who self-identify as sex workers. Thus, programs aimed at female sex workers may not reach women who exchange sex for money or other resources, but who do not identify as sex workers.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infect... more Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach-2nd ed. 1.HIV Infections-drug therapy. 2.HIV Infections-prevention and control. 3.Anti-Retroviral Agents-therapeutic use. 4.Guideline. I.World Health Organization.
This study aimed to: (1) examine the relationship between interpersonal as well as social-demogra... more This study aimed to: (1) examine the relationship between interpersonal as well as social-demographic, cultural and structural factors, and condom non-use by sex workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; main intimate or other non-paying male sex partners (NPPs), as reported by a sample of sex workers (SWs); and (2) understand HIV/sexually transmitted infections (STIs) risk (e.g., numbers of sexual partners; condom use with different partners) among couples comprised of a sub-set of SWs and their NPPs. Bivariate and multivariable logistic regression was used to identify factors associated with condom non-use at last sex by the main NPP, as reported by SWs. Adjusted odds ratios and 95% confidence intervals are reported (AOR[95%CIs]). Data were drawn from cross-sectional surveys in Bagalkot District, Karnataka State, South India. Responses by SWs whose main NPPs agreed to enrol in the study and the main NPP enroled were linked; these responses by couples (pairs of SWs and NPPs) were examined to assess sexual risk for HIV/STIs. Overall, this study included 257 SWs and 76 NPPs. The data from 67 couples (88.2%) could be linked. In over a quarter of partnerships, at least one (SW or NPP) partner reported having another type of partner besides each other (and clients of SWs). In multivariable analysis, significantly increased odds of condom non-use at last sex with the main NPP were found for the following key factors: planning to have a child with their main NPP (AOR = 3.71[1.44-9.58]); and having decisions about condom use made by their main NPP (AOR = 9.87[4.03-24.16]) or both equally (AOR = 3.18[1.39-7.80]) (versus by the SWs herself). Our study highlights the potential risk for HIV/STI acquisition and transmission between NPPs and SWs, and between NPPs and their non-SWs wives and other sex partners. Study results underscore the need for HIV/STI prevention approaches that incorporate informed decision-making about childbearing and parenting, and empowerment strategies for SWs in the context of their relationships with NPPs.
Culture, Health & Sexuality An International Journal for Research, Intervention and Care, 2018
Despite decreased rates of HIV infection in Winnipeg, syphilis incidence continues to rise. Commu... more Despite decreased rates of HIV infection in Winnipeg, syphilis incidence continues to rise. Communities of men who have sex with men shoulder much of this burden of illness. This qualitative study aimed to better understand the co-evolution of HIV and syphilis in Winnipeg through a series of interviews with gay men. Eighteen individuals were recruited through advertising in sexual health centres and through subsequent snowball sampling. Thematic interpretive analysis and inductive reasoning were used to find individual and shared group meanings. We found that HIV formed the contextual ground on which sexual decision-making was made, with three main themes emerging during interviews: 1) bacterial STI transience being contrasted against HIV permanence; 2) syphilis being‘dirty’versus HIV carrying significant stigma, though being spared the label of uncleanliness; and 3) the role of pleasure and intimacy in sexual health decision-making. Based on these findings, we recommend further exploration to develop more effective strategies around syphilis prevention, in particular with regards to the longer-term illness ramifications and its relationship to HIV transmission.
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