Journal Article

At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda

Doshi, Reena H., Hladik, Wolfgang, Hakim, Avi J., Musinguzi, Geofrey, Ogwal, Moses, Serwadda, David, Sande, Enos, Standish, Jonathan, Kiyingi, Herbert

2022

Overview

Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues. Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / AIDS / Birth control / Chlamydia / Condoms / Confidence intervals / Family planning / Female sex workers / Gonorrhea / Gynecology / Health services / HIV / Human immunodeficiency virus / Informed consent / Intrauterine devices / IUD / Lubricants & lubrication / Maternal and Child Health / Medicine / Medicine & Public Health / Pregnancy / Reproductive Health / Reproductive Medicine / Sex industry / Sexually transmitted diseases / STD / Syphilis / Transplants & implants / Uganda / Vagina / Womens health