From: A systematic review of the clinical and social epidemiological research among sex workers in Uganda
Source | Setting | Design | Objective | Sample size and characteristics | Results |
---|---|---|---|---|---|
Bukenya et al., 2013 | Kampala | Longitudinal cohort: cross-sectional baseline analysis | To describe the prevalence and determinants of inconsistent condom use | N = 905 sexually active Ugandan female sex workers | 40.2 % inconsistent condom use with paying clients in the last month. Increased risk: sex work not the sole source of income, sexual debut before 14 years, daily consumption of alcohol, fewer paying clients in last month, and currently pregnant. Decreased risk: currently married, higher number of sexual partners. |
Erickson et al., 2015 | Gulu, northern Uganda | Cross-sectional survey | To describe the prevalence and correlates of dual contraceptive use | N = 400 Ugandan female sex workers | 45.0 % had ever used dual contraceptives. |
Increased odds of dual contraceptive use: older age, prior unintended pregnancy, HIV testing. Decreased odds of dual contraceptive use: rushing client negotiations because of police presence. | |||||
Francis et al., 2013 | Multisite – Uganda (Kampala), Tanzania | Longitudinal cohort: cross-sectional analysis | To describe intervaginal cleansing among sex workers | N = 200 female sex workers, n = 100 Ugandan female sex workers | Among Ugandan sex workers: 81.8 % consistent condom use in past 3 months; 52.0 % HIV positive. |
Among Ugandan sex workers 100Â % reported intravaginal cleansing ever; 4.5 cleansing acts per day; 80.3Â % participants reported cleansing after half of their total sex acts. The frequency of cleansing was significant higher following sex, menstruation or vaginal discomfort. | |||||
Guédou et al., 2012 | Multisite: Uganda (Kampala), South Africa, Benin, India | Double blind RCT: cross-sectional secondary analysis | To examine the association between prevalent intermediate vaginal flora (IVF), bacterial vaginosis (BV) and HIV infection among all sex workers screened for the RCT | N = 1367 female sex workers, n = 516 Ugandan female sex workers | Among total sample, 27.0 % HIV prevalence, 47.6 % BV prevalence, and 19.2 % IVF. BV and IVF were significantly associated with HIV. |
Among Ugandan sex workers, HIV prevalence 32.4Â %, additional stratified analyses not available. | |||||
Guédou et al., 2013 | Multisite: Uganda (Kampala), South Africa, Benin, India | Double blind RCT: longitudinal secondary analysis | To examine predictors of recurrent BV | N = 440 female sex workers with >1 episode of BV, n = 167 from Uganda | Among total sample, BV incident rate of 20.8 recurrences/100-person-months; Risk factors: vaginal cleansing increased risk; consistent condom use and vaginal candidiasis decreased risk. |
Among Ugandan sex workers, 7.9 recurrences/100 person-months. No additional stratified analyses available. | |||||
Matovu et al., 2012 | Kampala | Cross-sectional survey | To assess sexual risk behaviours, condom use and STI infection among sex workers | N = 259 Ugandan female sex workers | 55.1 % used condoms inconsistently in past month; 77.2 % self-reported STI in past 12 months; 86 % sought treatment 3 days after recognition of symptoms; consistent condom use was 72.1 % with causal partners, 40.8 % with regular partners, 6.3 % with spouses. |
Morris et al., 2006 | Multisite - Uganda/Kenya on the Mobassa-Kampala highway | Longitudinal study: diaries of sexual activity for 30 days | To exploring the effect of condom use among sex worker on the trans-Africa highway in contributing to HIV epidemic | N = 578 Ugandan/Kenyan female sex workers, n = 175 Ugandan | Total of 14072 sex acts, 77.7 % of sex acts used condoms; Modelling – using HIV prevalence of 30.0–50.0 % it was estimated there are 3200–4148 new HIV infections per year on the Mombasa-Kampala highway. |
Morris et al., 2009 | Multisite - Uganda/Kenya on the Mobassa-Kampala highway | Longitudinal study: diaries of sexual activity for 30 days | To describe sexual behaviour among sex workers on the Mombasa-Kampala highway, compare risk between Ugandan and Kenyan sex workers | N = 578 Ugandan/Kenyan female sex workers, n = 175 Ugandan | Compared to Ugandan sex workers, Kenyan sex workers had higher consistent condom use (79.2 % vs 73.9 %), more likely to use condom during sex act, higher condom use with regular clients. |
Compared to Ugandan bars, bars in Kenya were more likely to: have condom dispensers, (25.0Â % vs 1.0Â %); distribute or sell condoms, (73.9Â % vs 47.6Â %); and have more weekly condom distribution. | |||||
Muldoon et al., 2014 | Gulu, northern Uganda | Cross-sectional survey | To examine the proportion of sex workers with a history of LRA abduction, access to post-abduction reintegration services and relative mental health | N = 400 Ugandan female sex workers, n = 129 with history of abduction | From a sample of 400 sex workers, 32.3 % had been abducted, 43.4 % had accessed a reintegration program. Mental health status was not significantly different between those who did and did not access a reintegration program. HIV prevalence 41.1 %. |
Muldoon et al., 2015 | Gulu, northern Uganda | Cross-sectional survey | To describe the prevalence and correlates of client violence, assess relationship between policing and client violence | N = 400 Uandan female sex workers | Most common forms of client violence: physical assault (58.7 %), rape (38.3 %), gang rape (15.8 %). HIV prevalence was 33.8 %. Inconsistent condom use was 84.0 %. |
Increased odds of client violence: rushing client negotiations because of police presence, servicing clients in a bar, inconsistent condom use with any client, working for a manager/pimp. | |||||
Pickering et al., 1997a | Fishing village in south-western Uganda | Longitudinal study: diaries of sexual activity for 6 months | To describe sexual mixing patterns inside and outside town | N = 26 Ugandan female sex workers | Women contributed 421 women-weeks; 15 were married and 42.0 % of sex partner were with commercial partner; 11 were single and 20.0 % of sex acts were with non-commercial partners; 90.0 % of contacts were from men resident in the village. |
Pickering et al., 1997b | Trading town in south-western Uganda | Longitudinal study: diaries of sexual activity for 6 months | To describe sexual mixing patterns | N = 48 Ugandan female sex workers | Women contributed 789 women-weeks; average 5.8 clients per week; 10.0 % of clients were non-commercial; condom use was 99.0 % with commercial partners. |
Pickering et al., 1997c | Trading town and fishing village in south-western Uganda | Longitudinal study: diaries of sexual activity for 6 months | To describe sexual mixing patterns | N = 81 Ugandan female sex workers | Women contributed 1280 women-weeks; 34 women from fishing villages and rural areas 90.0 % of sex acts with local men; 47 women from town contacts 87.0 % of sex partners were with with truck drivers or outside clients; 52.0 % were HIV positive, no significant difference by location. |
Redd et al., 2014 | Kampala | Longitudinal cohort: longitudinal clinical analysis | To determine the rates of HIV primary and super-infection among sex workers in Kampala | N = 85 HIV positive Ugandan female sex workers | The prevalence of HIV superinfection was 8.2 % (3.4/100 person-years) and was not significantly different from the rate of primary infection in the same population (3.7/100 person-years). |
Schwitters et al., 2015 | Kampala | Cross-sectional survey | To estimate the prevalence of client initiated violence in the previous 6 months among sex workers | N = 1467 Ugandan female sex workers | 81.8 % had experienced at least one form of client-initiated violence in previous 6 months: 39.1 % physical abuse, 44.7 % verbal abuse, 49.1 % forced sex, 54.9 % not paid. |
Increased odds of violence: longer duration in sex work, more frequent client demand for unprotected sex, consumption of 5+ alcoholic drink, soliciting in outdoor spaces (e.g. streets, parks, parking lots etc.). | |||||
Ssemwanga et al., 2012a | Kampala | Longitudinal cohort: longitudinal clinical analysis | To identify prevalence of multiple HIV infections and associated features of partnership histories | N = 324 HIV-positive Ugandan female sex workers | 9.0 % had multiple infections, sex workers working in same localities had phylogenetically similar viruses. |
Ssemwanga et al., 2012b | Kampala | Longitudinal cohort: longitudinal clinical analysis | To classify HIV drug resistance among ART naïve women with new HIV diagnosis | N = 42 ART naïve Ugandan female sex workers with new HIV diagnosis | HIV drug resistance point prevalence estimate of 2.6 % (95 % confidence interval, 0.1 %–13.8 %). |
Van Damme et al., 2008 | Multisite: Uganda (Kampala), South Africa, Benin, India | Double blind RCT: primary analysis | To investigate efficacy of cellulose sulphate microbicide gel to reduce new HIV infection | N = 1398 HIV-negative female sex workers total; N = 303 Ugandan | Cellulose sulphate gel did not prevent HIV infection and may have increased the risk of HIV acquisition, hazard ratio 1.61 (0.9–3.0). Within Ugandan sub-group, sex workers reported 17–19 (med) sex partners, 19–21 (med) sex acts in previous 7 days. 97.5 % condom use per sex act. Additional stratified analyses not available. |
Vandepitte et al., 2011 | Kampala | Longitudinal cohort: cross-sectional baseline analysis | To examine baseline prevalence and risk factors of HIV and STIs | N = 1027 Ugandan female sex workers | HIV prevalence 37.0 %, gonorrhoea 13.0 %, chlamydia 8.9%, T. Vaginalis 17.1 %, BV 55.0 %, candida infection 11 %, HSV-2 antibodies 79.9%, active syphilis 10.0 %. |
Increased HIV risk: older age, widowed, lack of education, sex work as sole income, street-based sex work, not knowing HIV status, using alcohol and intravaginal cleansing with soap. | |||||
Vandepitte et al., 2012a | Kampala | Longitudinal cohort: cross-sectional baseline analysis | To assess the prevalence and determinants of mycoplasma genitalium (MG) among sex workers | N = 1025 endocervical swabs from Ugandan female sex workers | MG prevalence: 14.0 % - more prevalent in HIV+; less prevalent in older women, those who were pregnant but never gave birth. Associated with gonorrhoeae, candida, trichomonas vaginalis. |
Vandepitte et al., 2012b | Kampala | Longitudinal cohort: cross-sectional baseline clinical analysis | To describe the symptoms and signs associated with MG among Ugandan sex workers | N = 1027 Ugandan female sex workers | MG prevalence 14.0 %, increased risk: dysuria and mucopurulent vaginal discharge. |
Vandepitte et al., 2013 | Kampala | Longitudinal cohort: longitudinal clinical analysis | To investigating the patterns of clearance and recurrence of untreated MG | N = 119 Ugandan female sex workers with MG | Overall clearance rate 25.7/100 person years; 55.0 % spontaneously cleared infection within 3 months, 83.0 % within 6 months, 93.0 % within 12 months. Infection recurred in 39.0 % of women. |
Vandepitte et al., 2014a | Kampala | Longitudinal cohort: nested case control | To examining the temporal association between MG status prior to HIV infection | N = 168 Ugandan female sex workers, n = 42 cases, n = 126 controls | 42 sex workers acquired HIV during the study, incident rate of 3.6/100 person years; Non-significant association between MG infection and HIV acquisition. |
Vandepitte et al., 2014b | Kampala | Longitudinal cohort: longitudinal clinical analysis | To assess the prevalence and antimicrobial susceptibility patterns of gonorrhoea among sex workers in Kampala | N = 148 Ugandan female sex workers with diagnosis of gonorrhoea | 83.1 % ciproflaxin resistance, 68.2 % penicillin resistance. 97.3 % tetracycline resistance. |