title: HIV prevention and care-seeking behaviour among female sex workers in four cities in India, Kenya, Mozambique and South Africa.
abstract: OBJECTIVE
  To identify gaps in the use of HIV prevention and care services and commodities for female sex workers, we conducted a baseline cross-sectional survey in four cities, in the context of an implementation research project aiming to improve use of sexual and reproductive health services.
  
  
  METHODS
  Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison.
  
  
  RESULTS
  Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P < 0.05) after adjusting for differences in FSWs' socio-demographic characteristics.
  
  
  CONCLUSIONS
  The use of HIV prevention and care by FSWs is often insufficient and differed greatly between cities. Differences could not be explained by variations in socio-demographic sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium. yves.lafort@ugent.be.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lafort
authors.affiliation: MatCH Research Unit, University of the Witwatersrand, Durban, South Africa.
authors.forename: Ross
authors.initials: R
authors.lastname: Greener
authors.affiliation: Ashodaya Samithi, Mysore, India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Roy
authors.affiliation: MatCH Research Unit, University of the Witwatersrand, Durban, South Africa.
authors.forename: Letitia
authors.initials: L
authors.lastname: Greener
authors.affiliation: International Centre for Reproductive Health-Kenya, Mombasa, Kenya.
authors.forename: Wilkister
authors.initials: W
authors.lastname: Ombidi
authors.affiliation: International Centre for Reproductive Health-Mozambique, Maputo, Mozambique.
authors.forename: Faustino
authors.initials: F
authors.lastname: Lessitala
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Haghparast-Bidgoli
authors.affiliation: MatCH Research Unit, University of the Witwatersrand, Durban, South Africa.
authors.forename: Mags
authors.initials: M
authors.lastname: Beksinska
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|International Centre for Reproductive Health-Kenya, Mombasa, Kenya.|University of Nairobi, Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Gichangi
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Sushena
authors.initials: S
authors.lastname: Reza-Paul
authors.affiliation: MatCH Research Unit, University of the Witwatersrand, Durban, South Africa.|Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Smit
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chersich
authors.affiliation: International Centre for Reproductive Health, Ghent University, Gent, Belgium.|The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa.|Center for Statistics, Hasselt University, Diepenbeek, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Delva
mesh_terms: D000293:Adolescent; D000328:Adult; D002947:Cities; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans; D007194:India / Q000453:epidemiology; D007630:Kenya / Q000453:epidemiology; D009073:Mozambique / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D060386:Sex Workers / Q000523:psychology*; D013019:South Africa / Q000453:epidemiology
keywords: Afrique subsaharienne; HIV prevention and care; Inde; India; Sub-Saharan Africa; care-seeking behaviour; comportamiento de búsqueda de cuidados; comportement de recherche de soins; condom use; educación por pares; female sex workers; peer education; prevención y cuidados del VIH; professionnelles du sexe; prévention et traitement du VIH; trabajadoras sexuales; uso de preservativos; utilisation du préservatif; África Subsahariana; éducation par les pairs