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. 2013 Oct 15;8(10):e77080.
doi: 10.1371/journal.pone.0077080. eCollection 2013.

Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey

Frances M Cowan  1 , Sibongile Mtetwa, Calum Davey, Elizabeth Fearon, Jeffrey Dirawo, Ramona Wong-Gruenwald, Theresa Ndikudze, Samson Chidiya, Clemens Benedikt, Joanna Busza, James R Hargreaves
Affiliations

Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey

Frances M Cowan et al. PLoS One. .

Abstract

Objectives: To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare.

Design: Respondent driven sampling (RDS) surveys conducted at each site.

Methods: Sex workers were recruited using respondent driven sampling with each respondent limited to recruiting 2 peers. Participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Statistical analysis took account of sampling method.

Results: 870 women were recruited from the three sites. HIV prevalence was between 50 and 70%. Around half of those confirmed HIV positive were aware of their HIV status and of those 50-70% reported being enrolled in HIV care programmes. Overall only 25-35% of those with laboratory-confirmed HIV were accessing antiretroviral therapy. Among those reporting they were HIV negative, 21-28% reported having an HIV test in the last 6 months. Of those tested HIV negative, most (65-82%) were unaware of their status. Around two-thirds of sex workers reported consistent condom use with their clients. As in other settings, sex workers reported high rates of gender based violence and police harassment.

Conclusions: This survey suggests that prevalence of HIV is high among sex workers in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal. Intensifying prevention and care interventions for sex workers has the potential to markedly reduce HIV and social risks for sex workers, their clients and the general population in Zimbabwe and elsewhere in the region.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Chains of recruitment in the RDS sites for Hwange (A), Victoria Falls (B) and Mutare (C).
Each circle represents a participant in the survey and the lines represent the passing of recruitment coupons. Orange circles represent women who tested HIV positive and blue circles HIV negative. The green circles in Mutare represent women for whom the HIV status is missing. Finally, the pink circles represent the seeds.
Figure 2
Figure 2. RDS validation: Outcome measure estimates over waves of recruitment.
Figure 3
Figure 3. Previous knowledge of HIV status.
Figure 4
Figure 4. Percentage of HIV positive female sex workers who knew their status and were on ART (a).
Percentage of all HIV+ female sex workers who reported that they were on ART (b).
See this image and copyright information in PMC

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