Mothers who sell sex: a potential paradigm for integrated HIV, sexual, and reproductive health interventions among women at high risk of HIV in Burkina Faso.
BACKGROUND
Antenatal care is a point of entry into the health system for women across Africa and may facilitate the uptake of HIV services among female sex workers (FSWs). This study aimed to evaluate the determinants of motherhood among FSWs, their sexual risks, and their engagement in health care.


METHODS
A cross-sectional study was conducted from January to July 2013 among FSWs in Ouagadougou and Bobo-Dioulasso, Burkina Faso. The study used respondent-driven sampling for HIV testing and behavioral data collection. Predictors of motherhood and the association of motherhood and sex work dynamics were assessed separately using logistic regression.


RESULTS
Of the 696 women enrolled, the majority of participants (76.6%, n = 533) had at least 1 biological child. Mothers were more likely to have a nonpaying partner [adjusted odds ratio (aOR), 1.73; 95% confidence interval (CI): 1.20 to 2.49], and significantly less likely to currently desire to conceive (aOR, 0.21; 95% CI: 0.13 to 0.33). Motherhood was predictive of having reduced condomless vaginal or anal sex with a new client [age-adjusted odds ratio (aaOR), 0.80; 95% CI: 0.65 to 0.97] in the past 30 days, and increased condomless vaginal or anal sex with a nonpaying partner (aaOR, 1.49; 95% CI: 1.13 to 1.96). Motherhood was prognostic of a higher likelihood of ever being tested for HIV (aaOR, 1.89; 95% CI: 1.55 to 2.31). Motherhood was predictive of reporting limited difficulty when accessing health services (aaOR, 0.15; 95% CI: 0.67 to 0.34).


CONCLUSIONS
Motherhood is common among FSWs. The results indicate that FSWs who are mothers may have more exposure to health care because of seeking antenatal/perinatal services, presenting important opportunities for inclusion in the HIV continuum of care and to prevent vertical transmission.
*Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD; †Programme d'Appui au Monde Associatif Communautaire de Lutte Contre le VIH/SIDA (PAMAC), Ouagadougou, Burkina Faso; ‡Institut de Recherche en Sciences de la Santé (IRSS), Bobo Dioulasso, Burkina Faso; §Enda Santé, Dakar, Senegal; and ‖Section de Géographie dans l'Unité de Formation et de Recherche (UFR) Lettres et Sciences Humaines, Université Gaston Berger, Saint-Louis, Senegal.
Erin
E
Papworth
Sheree
S
Schwartz
Odette
O
Ky-Zerbo
Benjamin
B
Leistman
Gautier
G
Ouedraogo
Cesaire
C
Samadoulougou
Ashley
A
Grosso
Fatou
F
Drame
Daouda
D
Diouf
Sosthenes C
SC
Ketende
Stefan
S
Baral
D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D017280:Condoms; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D009035:Mothers; D016017:Odds Ratio; D012307:Risk Factors; D060386:Sex Workers; D047568:Unsafe Sex; D055815:Young Adult