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HIV testing behaviour and HIV prevalence among female sex workers in Ukraine: findings from an Integrated Bio-Behavioural Survey, 2013–2014
  1. Anna Tokar1,
  2. Iana Sazonova2,
  3. Sharmistha Mishra3,4,
  4. Pavlo Smyrnov2,
  5. Tetiana Saliuk2,
  6. Jeffrey V Lazarus1,
  7. Jacqueline E W Broerse5,
  8. Maria Roura1,6,
  9. James Blanchard7,
  10. Marissa L Becker7
  1. 1 Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
  2. 2 International Charitable Foundation 'Alliance for Public Health, Kiev, Ukraine
  3. 3 Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  4. 4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam and Amsterdam Public Health Institute, Amsterdam, The Netherlands
  6. 6 Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  7. 7 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Anna Tokar, Barcelona Institute for Global Health (ISGlobal), University of Barcelona, c.Rosselló, 132, 2nd floor, ES-08036, Barcelona, Spain; annatokar{at}


Objectives Ukraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.

Methods We used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013–2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.

Results Recent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).

Conclusion HIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one’s status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs.

  • female sex workers (FSWs)
  • AIDS
  • HIV testing
  • Ukraine

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  • Handling editor Jane S Hocking

  • Contributors AT conceived the study. AT and IS conducted the data analysis. AT wrote the paper. IS, SM and MLB contributed to writing the paper. JEWB, JB, JVL, IS, MLB, MR, PS, SM and TS provided critical comments on the manuscript. JEWB, JB, JVL, IS, MLB, MR, PS, SM and TS approved the final version of the manuscript.

  • Funding This study was financed by the TransGlobal Health Program as a part of the Erasmus Mundus Joint Doctorate Programme. IBBS was funded by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Research Ethics Boards of the Committee on Medical Ethics of the Gromachevsky Institute of Epidemiology and Infectious Diseases and from the Committee of the Professional Ethics of the Ukrainian Sociological Society (No 468, 04.04.2013).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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