title: Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Infection and Population Health, University College London, London, United Kingdom ; Zimbabwe AIDS Prevention Project Trust, Harare, Zimbabwe ; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.forename: Sibongile
authors.initials: S
authors.lastname: Mtetwa
authors.forename: Calum
authors.initials: C
authors.lastname: Davey
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fearon
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dirawo
authors.forename: Ramona
authors.initials: R
authors.lastname: Wong-Gruenwald
authors.forename: Theresa
authors.initials: T
authors.lastname: Ndikudze
authors.forename: Samson
authors.initials: S
authors.lastname: Chidiya
authors.forename: Clemens
authors.initials: C
authors.lastname: Benedikt
authors.forename: Joanna
authors.initials: J
authors.lastname: Busza
authors.forename: James R
authors.initials: JR
authors.lastname: Hargreaves
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D060386:Sex Workers / Q000706:statistics & numerical data*; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology