Abstract
Using respondent driven sampling, female sex workers were recruited to assess the HIV cascade of care in a rural area in Malawi.
BACKGROUND
Globally, female sex workers (FSW) are 14 times more likely to be infected with HIV than adult women of the general population. In Nsanje, a large number of women engage in sex work near the mostly male work sites and transport routes. The MSF FSW project in Nsanje is a community-based SW peer-led intervention aiming to provide the continuum of care for this group.
METHOD
Between February and April 2019, a cross-sectional study was implemented in 3 sites in Nsanje district using respondent driven sampling (RDS). Eligible participants were women and girls aged 13 years or older who had lived and worked in the district in the last six months and had sexual intercourse with someone in exchange for money or goods in the last 30 days (excluding intercourse with their main partner). Consenting participants were interviewed and tested for HIV as well as for syphilis, gonorrhoea and chlamydia. Viral load (VL) and CD4 count were measured for all HIV-positive participants and RDS-adjusted proportions were calculated.
RESULTS
In total, 363 participants were included, of whom 64.7% [95%CI: 59.6-
69.5] were already receiving care from MSF. The median age was 26 [IQR: 20-33] years and the median duration of sex work was 4 years [3-7]. HIV prevalence was 52.4% [47.3-57.6], HIV status awareness was 95.2% [91.3-97.4], ART coverage (self-reported) was 95.2% [91.2-97.4] and VL suppression was 80.8% [74.7-85.8]. The prevalence of syphilis was 29.7% [25.3-34.5], gonorrhoea 9.5% [6.9-12.9] and chlamydia 12.5% [9.3-16.6]. Among HIV-positive participants, the median CD4 was 552 cells/µL [394-781]. Half of the participants reported having ever experienced sexual violence (47.6% [42.4-52.7]).
CONCLUSIONS
Our findings suggest a population with high exposure to sexual violence, and a relatively high prevalence of HIV and STIs. Participants demonstrated a high awareness of HIV-positive status and a high linkage to care.
