O1-S08.01 High HIV prevalence within a generalised epidemic; condom use, violence, and sexually transmitted infections among female sex workers in Dar es Salaam, Tanzania
- 1National AIDS Control Programme Dar es Salaam, Tanzania, United Rep. of Tanzania
- 2Centers for Disease Control and Prevention, Tanzania, United Rep. of Tanzania
- 3Muhimbili University of Health and Allied Sciences MUHAS, Tanzania, United Rep. of Tanzania
- 4Centres for Disease Control and Prevention, Atlanta, USA
- 5Centres for Disease Control and Prevention, Tanzania, United Rep. of Tanzania
Background In Tanzania, adult HIV prevalence is estimated at 5.8% and 9.3% in Dar es Salaam, well above the level of a generalised epidemic. Nonetheless, HIV infection and a constellation of associated factors are disproportionately borne by marginalised groups within the country. Female sex workers (FSW) are one such group; however, little is known about them in Tanzania.
Method Respondent-driven sampling was used to recruit self-identified FSWs aged 15+ years, living in Dar es Salaam, who reported exchanging sexual intercourse for money in the past month. FSWs were interviewed about their social circumstances, STI risk behaviours and tested for HIV, Hepatitis B, C and other STIs. Point estimates and 95% CI were adjusted for social network size and recruitment patterns using RDSAT.
Results From April to August 2010, 537 FSWs were recruited. Their median age was 29 years (range 15–63). Two FSWs (0.6% 95% CI: 0% to 1.7%) were <10 years when first selling sex (median age 17 years). Condom use at last sex was 82.1% (95% CI: 77.0% to 87.0%), but consistent use varied by type of partner; always condoms use with steady partner was 29.9% (95% CI: 22.8% to 37.6%) and 65.1% (95% CI: 58.4% to 71.4%) with one time client. The major reason for FSWs not using condoms was partner objection (44.1%; 95% CI: 32.6% to 56.2%). The prevalence of STIs and viral hepatitis varied: HIV 30.2% (95% CI: 24.7% to 36.4%); Hepatitis B 5.6 % (95% CI: 3.7% to 8.3%); Hepatitis C 1.4% (95% CI: 0.3% to 3.1%), syphilis 2.1% (95% CI: 0.8% to 3.4%); Gonorrhoea 10% (95% CI: 6.9% to 14.4%), and Chlamydia 6.9% (95% CI: 3.2% to 11.9%). Many (292; 51.7%, 95% CI: 46% to 58%) FSWs had experienced physical violence in the past 12 months and 34.7% (95% CI: 28.7% to 40.6%) had been forced to have sex. Few FSWs were IDU themselves (1.4%; 95% CI: 0.3% to 2.9%), but 5.1% (95% CI: 2.3% to 7.7%) suspected regular clients, and 8.9% (95% CI: 7% to 12%) suspected one-time clients were IDU. These women had significantly higher prevalence of HIV (46.8%; 95% CI: 31.5% to 63.9% compared to 23.1% (95% CI: 16.4% to 29.3%) for FSWs who did not suspect any partner.
Conclusion FSWs of Dar es Salaam have many-fold higher prevalence of HIV than the general population, with variable levels of other STIs. Their health situation calls for multifaceted services and structural interventions beyond HIV education and condom promotion. Preventive, care and treatment and personal level empowerment strategies are desperately needed among FSWs in Dar es Salaam, Tanzania.