"I expected little, although I learned a lot": perceived benefits of participating in HIV risk reduction sessions among women engaged in sex work in Uganda.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088690 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6874 (Electronic) Linking ISSN: 14726874 NLM ISO Abbreviation: BMC Womens Health Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2001-

HIV Infections*/epidemiology ; HIV Infections*/prevention & control ; Sex Work*; Adult ; Condoms ; Female ; Humans ; Male ; Risk Reduction Behavior ; Sexual Behavior ; Uganda/epidemiology

Background: The global HIV burden remains a public health concern. Women engaged in sex work (WESW) are at higher risk of acquiring HIV compared to the general adult population. Uganda reports high rates of HIV prevalence among WESW. While WESW in Uganda have long been the subject of surveillance studies, they have not been targeted by theory-informed HIV prevention intervention approaches. In this study, we explored the perceived benefits of an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda.
Methods: As part of a larger randomized clinical trial, we conducted semi-structured in-depth interviews with 20 WESW selected using a stratified purposive sampling. All interviews were conducted in Luganda, language spoken in the study area, and audio-recorded. They were transcribed verbatim and translated to English. Thematic analysis was used to analyze the data.
Results: WESW's narratives focused on: (1) condom use; (2) alcohol/drug consumption; (3) PrEP use; (4) "handling" customers; and (5) "massaging" customers. WESW agreed that male condom was one of the important learning points for them and planned to continue using them while female condoms were received with mixed reactions. Many women appreciated receiving information about the risks of consuming alcohol and drugs, and discussed how they reduced/ eliminated their consumption. PrEP information was appreciated though identified by fewer WESW. Handling a client was discussed as a helpful strategy for safer sex through improved ability to convince customers to use condoms or avoiding sex. Massaging was also beneficial to avoid penetrative sex, but similar to female condom, massaging also yielded mixed perceptions.
Conclusion: WESW found the intervention beneficial and described ways in which it improved their ability to engage in safer sex and stay healthy. The fact that WESW identified other strategies beyond condom use as helpful underlines the importance of adopting a comprehensive approach to behavioral interventions targeting HIV prevention even when combined with other interventions. Additionally, WESW's narratives suggest that incorporating the tenets of social cognitive theory and harm reduction approaches in HIV prevention among this population can result in risk behavior change.
(© 2022. The Author(s).)

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R01 MH116768 United States MH NIMH NIH HHS; R25 MH118935 United States MH NIMH NIH HHS

Keywords: Behavioral interventions; Commercial sex work; HIV risk reduction; Qualitative; Sub-Saharan Africa; Women engaged in sex work

Date Created: 20220513 Date Completed: 20220518 Latest Revision: 20231013

20231013

PMC9100307

10.1186/s12905-022-01759-1

35562821