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Table 3 Findings on personal-level risk factors, including behavioral, interpersonal, and psychosocial factors

From: Socio-demographic characteristics and risk factors for HIV transmission in female bar workers in sub-Saharan Africa: a systematic literature review

Author Year CountryTime in bar workSex work and type of clientsHIV risk awareness and willingness to testCondom useHIV risk magnifiers
Nagot 2002
Burkina Faso [9]
Median of 6 years, with wide rangeMean of 3.3 clients per weekSelf-assessment of acquiring HIV in the future. Yes: 31%; No: 31%; Don’t know: 37%12% of sex acts condomless
Van Blerk 2007
Ethiopia [24]
Timespan worked in bars often shortSW venue: back rooms of bars; Mean of 1 client per night most nightsHigh HIV risk awarenessHigh condom use with clients almost never with boyfriendsAlcohol consumption among FBWs lowers their control over condom negotiation
Van Blerk 2008
Ethiopia [23]
High risk awareness but feeling powerless to insist on condom use
Many afraid to test for HIV
Forced condomless sex or condom cutting commonSeveral reports of client violence against FBWs
Van Blerk 2011
Ethiopia [25]
SW venue: varies by bar: luxury hotel rooms to backrooms and corridors; Regular clients can become boyfriends Forced condomless sex, sometimes cutting of condomsExpected to drink alcohol; Socially isolated if friends & family know occupation
Sori 2012
Ethiopia [3]
Mean of several years; Frequent bar changesExpectation that low/no wages supplemented by SW; SW venue: back room of bars Condom use occasional with new clients, rare for regulars 
Messersmith 2014 Ghana [6]Few admitted doing transactional sex; widespread agreement that sex work is done by FBWHigh HIV knowledge; 64% FBWs think they are at risk of HIV, most due to partner infidelity
64% had ever tested for HIV
Low levels of alcohol use reported; client alcohol use seen as risky; violence largely IPV, not at bars
Kishindo 1995a
Malawi [26]
Mean 3 yearsExpected to make money from SW not BW; mean of 11 clients per week; SW venue: back rooms of barsLow HIV risk awareness23% lifetime condom useWilling to not use condoms with clients if enough money paid
Stigmatized because they are perceived to spread HIV
Kishindo 1995b
Malawi [8]
All consider BW a temporary occupation;SW venue: in back room, or elsewhere post- shift; 40% report regular clients.High awareness that multiple partners risky; low HIV risk self-perception30% lifetime condom use
Mhalu 1991
Tanzania [27]
Unmarried and longer term FBWs with access to counseling had condom use rates of around 65%
Mnyika 1995
Tanzania [28]
92% of FBWs are aware of the importance of condom use47% lifetime condom use; 44% always have condoms available; 28% regularly insist on condom use with clients
Talle 1995
Tanzania [7]
All FBWs engage in SW; often have clients & boyfriendsHigh awareness, low perceived self-risk for HIVCondom use rareReports of violence if refuse client’s demanded sexual practices
Asking clients to use condoms raises stigma
Talle 1998
Tanzania [10]
All working in Namanga < 1 yearNumber of clients answered imprecisely & perhaps underreported
Mgalla 1997
Tanzania [29]
Almost all have both casual & regular clientsHigh but imperfect HIV awarenessSome condom use with casual clients, none with regulars;Low negotiation power
Riedner 2003
Tanzania [30]
75% of FBWs´ relationships involve moneyCondom use ~ 50% ever with both, regular & casual partners
Akarro 2009
Tanzania [1]
High HIV risk awareness90% report more money for condomless sex96.7% regularly drink alcohol
Beckham 2013
Tanzania [31]
High HIV risk awareness
Reports of FBWs unveiling their occupation in front of doctors to receive appropriate care
Condom decisions often left to client; condomless sex better paidStigmatized if reveal their profession to HCW; often assumed HIV-positive & referred to ART clinic
Ostermannn 2015
Tanzania [32]
FBWs have twice as many lifetime sexual partners as non-FBW peersFBWs willing to test for HIV when tests are required by officialsFBWs less willing than others use home-based HIV testing, more concern re. disclosure
Gysels 2002
Uganda [2]
Women have both casual & regular clients
Some claim to enjoy work: can make money & avoid demands for sex from local men; some do well through SW, others still struggling
High HIV risk awarenessCondom use acceptable with casual, but taboo for regular clientsAlcohol use leads to rape; 82% have been subject to violence, 44% to forced sex. Majority of rape prior to starting bar work
Ntozi 2003
Uganda [33]
Both types of casual & regular clients; prefer casual because they pay higher and mostly cashHigh HIV risk awareness
High stated willingness to test for HIV, but no past testing
Barriers to HIV testing: cost & no facility
Increased condom use in recent yearsAlcohol claimed as reason for multiple partners & low condom use