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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

A systematic review of the clinical and social epidemiological research among sex workers in Uganda

Author: Katherine A. Muldoon

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

In response to the high burden of disease among sex workers and their position as a population heavily affected by the HIV epidemic, there has been a growing body of literature investigating the prevalence and risk factors associated with HIV risk among sex workers. To contextualize and summarize the existing research evidence base, a systematic review was conducted to synthesize the epidemiological literature on sex workers in Uganda.

Methods

Database selection and search strategy development followed the Cochrane Collaboration’s standards for conducting systematic review searches. All studies that included sex workers as the primary research participants were included in the review. The search was then geographically restricted to the country of Uganda. Items were identified from 18 databases (grey and peer-review) on March 10–11, 2015.

Results

A total of 484 articles were retrieved from the database search. After removal of duplicates, a total of 353 articles were screened for eligibility and 64 full-text articles were assessed. The final review included 24 studies with quantitative methodology conducted among sex workers in Uganda. The HIV prevalence among female sex workers ranged from 32.4–52.0 % and between 8.2–9.0 % had multiple HIV infections. Both multi-drug resistance to antiretroviral therapy (2.6 %) and antibiotics (83.1 %) were observed. Between 33.3–55.1 % reported inconsistent condom use in the past month. In the previous 6 months, over 80 % of sex workers experienced client-perpetrated violence and 18 % experienced intimate partner violence. Over 30 % had a history of extreme war-related trauma.

Conclusions

There was limited information on socio-structural factors that affect sex workers’ commercial working environments in Uganda, including the role of policing and criminalization, as well as the prevalence and factors associated with violence. The majority of the existing evidence is based in Kampala, highlighting a need for information on sex work in other regions of Uganda. Additionally, there is limited information on features of the non-commercial components of sex workers’ lives as well as the services needed to reduce risks outside of the sex industry.
Appendix
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Footnotes
1
CONRAD Sulfate randomized control trial http://​www.​isrctn.​com/​ISRCTN95638385
 
Literature
1.
Baral SD, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:538–49.CrossRefPubMed
2.
Berkley SF, Widy-Wirski R, Okware SI, Downing R, Linnan MJ, White KE, et al. Risk factors associated with HIV infection in Uganda. J Infect Dis. 1989;160:22–30.CrossRefPubMed
3.
Hennis AJ, Kataaha P, Lloyd G, Moore AT, Sutehall GM, Whetstone R, et al. Risk factors for the spread of AIDS in rural Africa: evidence from a comparative seroepidemiological survey of AIDS, hepatitis B and syphilis in southwestern Uganda. AIDS. 1988;2:255–60.CrossRefPubMed
4.
Fleming AF. Seroepidemiology of human immunodeficiency viruses in Africa. Biomed Pharmacother. 1988;42:309–20.PubMed
5.
Marcus R: Gender and HIV/AIDS in Subsaharan Africa: the Cases of Uganda and Malawi. Brighton: BRIDGE, Institute of Develment Studies. 1993
6.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399–410.CrossRefPubMedPubMedCentral
7.
Siegfried N, Van Der Merwe L, Brocklehurst P, Sint TT: Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection (Review). Cochrane Collab 2011;7:1–12
8.
Van Damme L, Govinden R, Mirembe FM, Guédou F, Solomon S, Becker ML, et al. Lack of effectiveness of cellulose sulfate gel for the prevention of vaginal HIV transmission. N Engl J Med. 2008;359:463–72.CrossRefPubMed
9.
Kerrigan D, Wirtz A, Semini I, N’Jie N, Stanciole A, Butler J, Oelrichs R, Beyrer C. The global HIV epidemics among sex workers. The World Bank; 2013
10.
Beyrer C, Crago AL, Bekker LG, Butler J, Shannon K, Kerrigan D, et al. An action agenda for HIV and sex workers. Lancet. 2014;6736:1–14.
11.
Ngugi E, Roth E, Mastin T, Nderitu MG, Yasmin S. Female sex workers in Africa: epidemiology overview, data gaps, ways forward. J Soc Asp HIV/AIDS Res Alliance. 2012;9:148–53.CrossRef
12.
13.
Papworth E, Ceesay N, An L, Thiam-Niangoin M, Ky-Zerbo O, Holland C, et al. Epidemiology of HIV among female sex workers, their clients, men who have sex with men and people who inject drugs in west and central africa. J Int AIDS Soc. 2013;16 Suppl 3:1–11.
14.
Shannon K, Strathdee SA, Goldenberg SM, Duff PK, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2014;6736:1–17.
15.
Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo Y-R. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-saharan Africa: a systematic review. AIDS Behav. 2011;16:920–33.CrossRef
16.
Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014;104:e42–54.CrossRefPubMedPubMedCentral
17.
Ngugi E, Benoit C, Hallgrimsdottir H, Jansson M, Roth EA. Family kinship patterns and female sex work in the informal urban settlement of Kibera, Nairobi, Kenya. Hum Ecol. 2012;40:397–403.CrossRef
18.
19.
20.
21.
Government of Uganda: HIV and AIDS Uganda country progress report. 2013.
22.
Mbonye M, Nalukenge W, Nakamanya S, Nalusiba B, King R, Vandepitte J, et al. Gender inequity in the lives of women involved in sex work in Kampala, Uganda. J Int AIDS Soc. 2012;15 Suppl 1:1–9.PubMed
23.
Mbonye M, Nakamanya S, Nalukenge W, King R, Vandepitte J, Seeley J. “It is like a tomato stall where someone can pick what he likes”: structure and practices of female sex work in Kampala, Uganda. BMC Public Health. 2013;13:741–50.CrossRefPubMedPubMedCentral
24.
Scorgie F, Nakato D, Harper E, Richter M, Maseko S, Nare P, et al. “We are despised in the hospitals”: sex workers’ experiences of accessing health care in four African countries. Cult Health Sex. 2013;15:450–65.CrossRefPubMed
25.
Mbonye M, Rutakumwa R, Weiss H, Seeley J. Alcohol consumption and high risk sexual behaviour among female sex workers in Uganda. Afr J AIDS Res. 2014;13:145–51.CrossRefPubMed
26.
Decker MR, Crago AL, Chu SK, Sherman SG, Seshu MS, Buthelezi K, et al. Human rights violations against sex workers: burden and effect on HIV. Lancet. 2014;6736:1–14.
27.
Chersich MF, Luchters S, Ntaganira I, Gerbase A, Lo Y-RR, Scorgie F, et al. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. J Int AIDS Soc. 2013;16:1–8.CrossRef
28.
Ntozi JPM, Mulindwa IN, Ahimbisibwe F, Ayiga N, Odwee J, Najjumba IM, et al. Has the HIV/AIDS epidemic changed sexual behaviour of high risk groups in Uganda? Afr Health Sci. 2003;3:107–16.PubMedPubMedCentral
29.
Schoemaker J, Twikirize J. A life of fear: sex workers and the threat of HIV in Uganda. Int J Soc Welf. 2012;21:186–93.CrossRef
30.
Scorgie F, Vasey K, Harper E, Richter M, Nare P, Maseko S, et al. Human rights abuses and collective resilience among sex workers in four African countries: a qualitative study. Global Health. 2013;9:33–46.CrossRefPubMedPubMedCentral
31.
Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, et al. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Global Health. 2014;10:47–64.CrossRefPubMedPubMedCentral
32.
Scheibe A, Drame FM, Shannon K. HIV prevention among female sex workers in Africa. J Soc Asp HIV/AIDS Res Alliance. 2012;9:167–72.CrossRef
33.
Baleta A. Lives on the line: sex work in sub-Saharan Africa. Lancet. 2014;6736.
34.
World Health Organization: Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization. 2014(July).
35.
World Health Organization, UNFPA, UNAIDS, Global Network of Sex Work Projects: Prevention and treatment of HIV and other sexually transmitted infections for sex workers in Low- and Middle-Income Countries: Recommendations for a public health approach. 2012(December).
36.
UNAIDS: UNAIDS guidance note on HIV and sex work. Geneva: UNAIDS. 2012.
37.
Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F, et al. Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Global Health. 2014;10:46–75.CrossRefPubMedPubMedCentral
38.
Chersich MF, Luchters S, Ntaganira I, Gerbase A, Lo Y-R, Scorgie F, et al. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. J Int AIDS Soc. 2013;16:17980.CrossRefPubMedPubMedCentral
39.
Shahmanesh M, Patel V, Mabey DC, Cowan FM. Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review. Trop Med Int Heal. 2008;13:659–79.CrossRef
40.
41.
Higgins J, Churchill R, Lasserson T, Chandler J, Tovey D: Methodological Standards for the Conduct of New Cochrane Intervention Reviews (MERCIR). 2013(December).
42.
Moher D, Liberati A, Tetzlaff J, Altman DG. Academia and clinic annals of internal medicine preferred reporting items for systematic reviews and meta-analyses. Annu Intern Med. 2009;151:264–9.CrossRef
43.
Guédou FA, Van Damme L, Deese J, Crucitti T, Becker M, Mirembe F, et al. Behavioural and medical predictors of bacterial vaginosis recurrence among female sex workers: longitudinal analysis from a randomized controlled trial. BMC Infect Dis. 2013;13:208–19.CrossRefPubMedPubMedCentral
44.
Guédou FA, Van Damme L, Mirembe F, Solomon S, Becker M, Deese J, et al. Intermediate vaginal flora is associated with HIV prevalence as strongly as bacterial vaginosis in a cross-sectional study of participants screened for a randomised controlled trial. Sex Transm Infect. 2012;88:545–51.CrossRefPubMed
45.
Morris CN, Ferguson AG. Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: The continuing role for prevention in high risk groups. Sex Transm Infect. 2006;82:368–71.CrossRefPubMedPubMedCentral
46.
Morris CN, Morris SR, Ferguson AG. Sexual behavior of female sex workers and access to condoms in Kenya and Uganda on the Trans-Africa highway. AIDS Behav. 2009;13:860–5.CrossRefPubMed
47.
Redd AD, Ssemwanga D, Vandepitte J, Wendel SK, Ndembi N, Bukenya J, et al. Rates of HIV-1 superinfection and primary HIV-1 infection are similar in female sex workers in Uganda. AIDS. 2014;28:2147–52.CrossRefPubMedPubMedCentral
48.
Ssemwanga D, Ndembi N, Lyagoba F, Bukenya J, Seeley J, Vandepitte J, et al. HIV Type 1 subtype distribution, multiple infections, sexual networks, and partnership histories in female sex workers in Kampala, Uganda. AIDS Res Hum Retroviruses. 2012;28:357–65.CrossRefPubMed
49.
Ssemwanga D, Ndembi N, Lyagoba F, Magambo B, Kapaata A, Bukenya J, et al. Transmitted antiretroviral drug resistance among drug-naive female sex workers with recent infection in Kampala, Uganda. Clin Infect Dis. 2012;54:S339–42.CrossRefPubMed
50.
Vandepitte JM, Bukenya J, Hughes P, Muller E, Buvé A, Hayes R, et al. Clinical characteristics associated with Mycoplasma genitalium infection among women at high risk of HIV and other STI in Uganda. Sex Transm Dis. 2012;39:487–91.CrossRefPubMed
51.
Vandepitte JM, Bukenya J, Weiss HA, Nakubulwa S, Francis SC, Hughes P, et al. HIV and other sexually transmitted infections in a cohort of women involved in high risk sexual behaviour in Kampala, Uganda. Sex Transm Dis. 2011;38:316–23.PubMedPubMedCentral
52.
Vandepitte JM, Hughes P, Matovu G, Bukenya J, Grosskurth H, Lewis DA. High prevalence of ciprofloxacin-resistant gonorrhea among female sex workers in Kampala, Uganda (2008–2009). Sex Transm Dis. 2014;41:233–7.CrossRefPubMed
53.
Vandepitte JM, Muller E, Bukenya J, Nakubulwa S, Kyakuwa N, Buve A, et al. Prevalence and correlates of Mycoplasma genitalium infection among female sex workers in Kampala, Uganda. J Infect Dis. 2012;205:289–96.CrossRefPubMed
54.
Vandepitte JM, Weiss HA, Bukenya J, Kyakuwa N, Muller E, Buve A, et al. Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case–control study. Sex Transm Infect. 2014;90:545–9.CrossRefPubMedPubMedCentral
55.
Vandepitte JM, Weiss HA, Kyakuwa N, Nakubulwa S, Muller E, Buve A, et al. Natural history of Mycoplasma genitalium infection in a cohort of female sex workers in Kampala, Uganda. Sex Transm Dis. 2013;40:422–7.CrossRefPubMedPubMedCentral
56.
Matovu J, Ssebadduka B. Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda. Int J STD AIDS. 2012;23:267–73.CrossRefPubMed
57.
Schwitters A, Swaminathan M, Serwadda D, Muyonga M, Shiraishi RW, Benech I, et al. Prevalence of rape and client-initiated gender-based violence among female sex workers: Kampala, Uganda, 2012. AIDS Behav. 2015;19:68–76.CrossRef
58.
Pickering H, Okongo M, Nnalusiba B, Bwanika K, Whitworth J. Sexual networks in Uganda: casual and commercial sex in a trading town. AIDS Care. 1997;9:199–207.CrossRefPubMed
59.
Pickering H, Okongo M, Ojwiya A, Yirrell D, Whitworth J. Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village. Int J STD AIDS. 1997;8:495–500.CrossRefPubMed
60.
Pickering H, Okongo M, Bwanika K, Nnalusiba B, Whitworth J. Sexual behaviour in a fishing community on Lake Victoria, Uganda. Health Transit Rev. 1997;7:13–20.PubMed
61.
Muldoon KA, Muzaaya G, Betancourt TS, Ajok M, Akello M, Petruf Z, et al. After abduction: exploring access to reintegration programs and mental health status among young female abductees in northern Uganda. Confl Health. 2014;8:1–9.CrossRef
62.
Muldoon KA, Akello M, Muzaaya G, Simo A, Shoveller J, Shannon K: Policing the epidemic: high burden of workplace violence among female sex workers in conflict-affected northern Uganda. Glob Public Health 2015, in press.
63.
Erickson M, Goldenberg SM, Ajok M, Muldoon K a., Muzaaya G, Shannon K: Structural determinants of dual contraceptive use among female sex workers in Gulu, northern Uganda. Int J Gynecol Obstet. 2015;131:91-5.
64.
Gysels M, Pool R, Bwanika K. Truck drivers, middlemen and commercial sex workers: AIDS and the mediation of sex in south west Uganda. AIDS Care. 2001;13:373–85.CrossRefPubMed
65.
Gysels M, Pool R, Nnalusiba B. Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk. Soc Sci Med. 2002;54:179–92.CrossRefPubMed
66.
Lees S, Zalwango F, Andrew B, Vandepitte J, Seeley J, Hayes RJ, et al. Understanding motives for intravaginal practices amongst Tanzanian and Ugandan women at high risk of HIV infection: the embodiment of social and cultural norms and well-being. Soc Sci Med. 2014;102:165–73.CrossRefPubMedPubMedCentral
67.
Marlow HM, Shellenberg K, Yegon E. Abortion services for sex workers in Uganda: successful strategies in an urban clinic. Cult Health Sex. 2014;16:931–43.CrossRefPubMed
68.
Mbonye M, Rutakumwa R, Weiss H, Seeley JLB-W. Alcohol consumption and high risk sexual behaviour among female sex workers in Uganda. Ajar-African J Aids Res. 2014;13:145–51.CrossRef
69.
Nyanzi S. Homosexuality, Sex work, and HIV/AIDS in displacement and post-conflict settings: the case of refugees in Uganda. Int Peacekeeping. 2013;20:450–68.CrossRef
70.
Zalwango F, Eriksson L, Seeley J, Vandepitte J, Grosskurth H: Parenting and money making: sex work and women’s choices in urban Uganda. Wagadu 2010, 8:71–92.
71.
Francis SC, Baisley K, Lees SS, Andrew B, Zalwango F, Seeley J, et al. Vaginal practices among women at high risk of HIV infection in Uganda and Tanzania: recorded behaviour from a daily pictorial diary. PLoS One. 2013;8:e59085.CrossRefPubMedPubMedCentral
72.
Bukenya J, Vandepitte J, Kwikiriza M, Weiss HA, Hayes R, Grosskurth H. Condom use among female sex workers in Uganda. AIDS Care. 2013;25:767–74.CrossRefPubMed
73.
Government of Uganda: UNGASS Country Progress Report: Uganda. Kampala: Government of Uganda. 2010.
74.
Smolak A. A meta-analysis and systematic review of HIV risk behavior among fishermen. AIDS Care. 2013;00:1–10.
75.
Delany-Moretlwe S, Bello B, Kinross P, Oliff M, Chersich M, Kleinschmidt I, et al. HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey. Int J STD AIDS. 2014;25:428–38.CrossRefPubMed
76.
Beyrer C, Baral SD, Kerrigan D, El-Bassel N, Bekker L, Celentano DD. Expanding the space: inclusion of Most-at-Risk Populations in HIV prevention, treatment, and care services. J Acquir Immune Defic Syndr. 2011;57 Suppl 2:1–7.
77.
Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19:67–72.CrossRef
78.
79.
Richter M, Scorgie F, Chersich MF, Luchters S. 'There are a lot of new people in town: but they are here for soccer, not for business' a qualitative inquiry into the impact of the 2010 soccer world cup on sex work in South Africa. Global Health. 2014;10:45–56.CrossRefPubMedPubMedCentral
80.
Rujumba J, Kwiringira J. Interface of culture, insecurity and HIV and AIDS: lessons from displaced communities in Pader District, northern Uganda. Confl Health. 2010;4:18–28.CrossRefPubMedPubMedCentral
81.
Patel S, Schechter MT, Sewankambo NK, Atim S, Lakor S, Kiwanuka N, et al. War and HIV: sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District, northern Uganda. Glob Public Health. 2014;9:325–41.CrossRefPubMed
82.
Mckay S. Reconstructing fragile lives: girls’ social reintegration in northern Uganda and Sierra Leone. Gend Dev. 2004;12:19–30.CrossRef
83.
Westerhaus MJ. Linking anthropological analysis and epidemiological evidence: formulating a narrative of HIV transmission in Acholiland of northern Uganda. J Soc Asp HIV/AIDS. 2007;4:590–605.CrossRef
84.
Oosterhoff P, Mills E, Oosterom M: Addressing sexual violence in and beyond the 'warzone.' Rapid Response 2014;471–4
85.
Decker MR, Pearson E, Illangasekare SL, Clark E, Sherman SG. Violence against women in sex work and HIV risk implications differ qualitatively by perpetrator. BMC Public Health. 2013;13:876.CrossRefPubMedPubMedCentral
86.
Okal J, Chersich MF, Tsui S, Sutherland E, Temmerman M, Luchters S. Sexual and physical violence against female sex workers in Kenya: a qualitative enquiry. AIDS Care. 2011;23(March 2015):612–8.CrossRefPubMed
87.
World AIDS Campaign: Sex work and the law: the case for decriminalization. 2010.
88.
Kerrigan D, Kennedy CE, Morgan-Thomas R, Reza-Paul S, Mwangi P, Win KT, et al. A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up. Lancet. 2014;6736:1–14.
Metadata
Title
A systematic review of the clinical and social epidemiological research among sex workers in Uganda
Author
Katherine A. Muldoon
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2553-0

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