Engagement in HIV services over time among young women who sell sex in Zimbabwe

Sue Napierala*, Sungai T. Chabata, Calum Davey, Elizabeth Fearon, Joanna Busza, Phillis Mushati, Owen Mugurungi, Karin Hatzold, Valentina Cambiano, Andrew Phillips, James R. Hargreaves, Frances M. Cowan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction Young female sex workers (FSW) are disproportionately vulnerable to HIV. Zimbabwe data show higher HIV incidence and lower engagement in services compared to older FSW. Utilizing data from a combination HIV prevention and treatment intervention, we describe engagement in the HIV services over time among FSW 18-24 years, compared to those ≥25 years of age. Materials and methods Data were collected via respondent-driven sampling (RDS) surveys in 14 communities in 2013 and 2016, with >2500 FSW per survey. They included blood samples for HIV and viral load testing. As the intervention had no significant impact on HIV care cascade outcomes, data were aggregated across study arms. Analyses used RDS-II estimation. Results Mean age in 2013 and 2016 was 31 and 33 years, with 27% and 17% aged 18-24 years. Overall HIV prevalence was 59% at each timepoint, and 35% and 36% among younger FSW. From 2013 to 2016 there was an increase in young HIV-positive FSW knowing their status (38% vs 60%, OR = 2.51, p<0.01). Outcomes for all FSW improved significantly over time at all steps of the cascade, and the relative change over time was similar among older versus younger FSW for most cascade variables. Discussion Young FSW had improvements in care cascade outcomes, and proportionate improvements similar to older FSW, yet they remain less engaged in services overall. This implies that the dedicated FSW services in Zimbabwe are having a comparably positive impact across age groups, however more is likely required to address young FSW's unique vulnerabilities and needs.

Original languageEnglish
Article numbere0270298
JournalPLoS ONE
Issue number6 6
Publication statusPublished - 28 Jun 2022

Bibliographical note

Funding Information:
This research was supported by the UN Population Fund (Cowan - through Zimbabwe's Integrated Support Fund funded by UK Department for International Development, Irish Aid, and Swedish International Development Cooperation Agency), and the National Institute of Mental Health (Napierala - 1K01MH110316). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
Copyright: © 2022 Napierala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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