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Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania.

Authors
  • Barnhart, Dale A1
  • Harling, Guy1, 2, 3
  • Muya, Aisa4, 5
  • Ortblad, Katrina F6
  • Mashasi, Irene5
  • Dambach, Peter7
  • Ulenga, Nzovu5
  • Mboggo, Eric5
  • Oldenburg, Catherine E8, 9, 10
  • Bärnighausen, Till W3, 7, 11
  • Spiegelman, Donna12, 13
  • 1 a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA.
  • 2 b Institute for Global Health , University College London , London , UK.
  • 3 c Africa Health Research Institute , KwaZulu-Natal , South Africa. , (South Africa)
  • 4 d Amref Health Africa , Dar es Salaam , Tanzania. , (Tanzania)
  • 5 e Management and Development for Health , Dar es Salaam , Tanzania. , (Tanzania)
  • 6 f Department of Global Health , University of Washington , Seattle , USA.
  • 7 g Institute of Public Health , University of Heidelberg , Heidelberg , Germany. , (Germany)
  • 8 h Francis I. Proctor Foundation , University of California , San Francisco , USA.
  • 9 i Department of Ophthalmology , University of California , San Francisco , USA.
  • 10 j Department of Epidemiology and Biostatistics , University of California , San Francisco , USA.
  • 11 k Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA.
  • 12 l Departments of Epidemiology, Biostatistics, Nutrition, and Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA.
  • 13 m Center for Methods in Implementation and Prevention Science , Yale School of Public Health , New Haven , USA.
Type
Published Article
Journal
AIDS care
Publication Date
Sep 01, 2019
Volume
31
Issue
9
Pages
1096–1105
Identifiers
DOI: 10.1080/09540121.2019.1612018
PMID: 31079476
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011-2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs' higher - though sub-optimal - engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.

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