HIV AMONG FEMALE SEX WORKERS IN ETHIOPIA: PREVALENCE, ACCESS TO INTERVENTIONS AND EFFECT OF DROP-IN CENTERS

Abstract

Background: Even though attempts have been made to contain and reduce HIV infection among female sex workers (FSWs), it continues to be one of the major health challenges in low and middle-income countries (LMICs). However, HIV burden in FSWs and their access to prevention interventions have not been fully understood in Ethiopia. Therefore, this study generates evidence to fill the existing knowledge gap in this regard. Objectives: The objective of this study was to assess the HIV prevalence, access to prevention interventions, their associated factors to HIV positivity, and the effect of Drop-in centers (DICs) among FSWs in Ethiopia. Methods: A cross sectional study was employed in sixteen cities in Ethiopia from January to June 2020. Demographic, behavioral and HIV related data were collected from 6,085 FSW using a respondent-driven sampling technique (RDS). Data were analyzed using STATA 14.1 statistical software. Descriptive results were presented in proportion with 95% confidence interval (CI). A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. ATT (Average Treatment Effect on the Treated) was used to assess the effect of access to DICs on each outcome variable. Results: HIV prevalence among FSWs was 18.73% (95% CI: 17.77, 19.74). Being older than 35 years (AOR= 8.11; 95% CI: 6.08, 10.32), having syphilis (AOR= 2.61; 95% CI: 1.04, 3.42), being widowed (AOR=2.19; 95% CI: 1.61, 2.91), and not being able to read and write (AOR=1.98·0; 95% CI: 1.54, 2.44) were independently associated with HIV infection. Half, 50.38%, of HIV-positive FSWs knew that they were HIV positive; 92.88% of them were on ART, and 91.68% of those on ART had achieved viral suppression of less than 1000 copies per milliliter. Access to DICs increase the probability of HIV testing among all FSWs (ATT = 7.58%; P<0.001), capturing HIV-positive FSWs (ATT = 7.02%; P = 0.003), helps HIV positive FSWs to know their HIV status (ATT = 6.93%; P=0.001), and enhance consistent condom use (ATT = 4.39%; P = 0.01). Conclusions: HIV prevalence among FSWs is considerably high. Although a great majority of FSWs who knew their HIV status were on ART and had achieved viral suppression, only about xvi half of HIV-positive FSWs were aware of their HIV status. Access to DICs has increased HIV test uptake and consistent condom use. The findings indicates the importance of expanding DICs, and strengthening targeted HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030.