Better understanding the timeline of female sex workers’ HIV risk

Sex work is a major driver of heterosexual HIV epidemics worldwide, therefore interventions targeted at female sex workers are important for HIV prevention programs. However, current prevention interventions only reach those who have self-identified as sex workers. Given that women may have acquired HIV before or during the early stages of sex work prior to self-identification, program contact to this group may be delayed. In other words, HIV prevention programs targeted at female sex workers may be intervening too late.

This project includes five studies using hotspot-based (recruiting participants at areas where most female sex workers congregate or meet clients) survey of adolescent girls and young women in Mombasa, Kenya and Dnipro, Ukraine. We will use a novel method of transforming cross-sectional data (information collected at one time point) into longitudinal data (information of the same participants collected over a period of time).

By defining women’s HIV risk in the transition period (from a woman’s first sexual experience until self-declared entry into sex work), as well as the access gap (the time after entry into sex work but prior to engagement with HIV prevention programs), our results could be used to inform the implementation and evaluation of effective HIV prevention programs in Kenya and Ukraine.

Study 1: Cascades of HIV care and determinants of HIV testing among adolescent girls and young women by engagement in sex work in Kenya

The goal of this study is to examine and compare differences between adolescent girls/young women who were engaged in sex work vs. those who were not engaged in sex work. We’ll compare the early elements of their HIV cascade of care (diagnosis and treatment engagement), patterns of HIV testing, and determinants of HIV testing.

Study 2: Vulnerabilities at first sex and their association with lifetime gender-based violence and HIV prevalence among adolescent girls and young women engaged in sex work, transactional sex, and casual sex in Kenya

We will analyze the survey to better understand the links between gender-based violence and HIV among young women engaged in sex work.

Study 3: Quantifying delay in HIV program access among young, female sex workers in Kenya

We will estimate the time from first experience of HIV-associated vulnerabilities to initial program contact among young women engaged in sex work.

Study 4: Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among adolescent and young women engaged in sex work in Kenya

We will:

1. Estimate the prevalence of sexual, structural, and reproductive health vulnerabilities experienced by young women engaged in sex work
2. Assess their level of engagement with programs designed for female sex workers
3. Determine if vulnerabilities vary by age and by contact with programs designed for female sex workers

Study 5: Characterizing the profile of female sex workers in Ukraine by their engagement with HIV/HCV/STI services

We will:

1. Estimate the prevalence of behavioural, structural, and reproductive vulnerabilities experienced by young, female sex workers in Dnipro, Ukraine
2. Estimate the prevalence of program contact and engagement among young, female sex workers across different services
3. Characterize the profile of young, female sex workers who are more likely to engage with programs and use program services