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Sex services: Disabled Clients, Cunnilingus, Mistress, Role Play & Fantasy, Slave
To date, limited rigorous evaluations of these approaches have been conducted in sub-Saharan Africa. Cohort members were recruited from entertainment venues across 2 communities in the region using time-location sampling.
All study participants gave consent, and were surveyed and screened for HIV at baseline. A cohort of FSWs was established and is currently under follow-up. Baseline HIV prevalence was Factors associated with both HIV infection and viral suppression at baseline included community, age, number of clients, and substance use. Amount of money charged per client and having tested for sexually transmitted infection in the past 6 months were protective for HIV infection.
Social cohesion among FSWs was protective for viral suppression. Community empowerment approaches hold promise given the high HIV prevalence, limited services and stigma, discrimination, and violence. Comprehensive, community empowerment—based approaches that address the sociostructural vulnerabilities of FSWs to HIV infection, and ensure equitable access to prevention interventions, have been shown to be effective in South Asia and Latin America.
Project Shikamana Stick Together includes a package of biomedical, behavioral, and structural intervention elements set within a larger rights-based framework. Elements include 1 community-led peer education, condom distribution, and HIV counseling and testing in entertainment venues; 2 peer navigation to facilitate linkage to and retention in care and ART; 3 sensitivity training for HIV clinical care providers; 4 texts to promote awareness, solidarity, and adherence to care and ART; and 5 a community-led drop-in center for activities to promote social cohesion and community mobilization to address issues such as stigma, discrimination, violence prevention, and financial insecurity.
This study design being used to test the feasibility and initial effectiveness of this model is a community-randomized controlled trial conducted in 2 Iringa communities matched on demographics and HIV risk. The intervention arm is receiving the combination prevention package described above, whereas the control arm is receiving the local standard of care.