Sexually transmitted infections · 2026
Prevalence and factors associated with sexually transmitted infections and engagement in HIV care among female sex workers in two large cities of Zimbabwe: Analysis of respondent-driven sampling surveys in 2023.
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Hove Tsitsi, Chabata Sungai T, Makamba Memory, Fearon Elizabeth, Jones Harriet S, Matambanadzo Primrose, Chinozvina Tariro, Maguma Jaspar, Takaruza Albert, Dirawo Jeffrey, Mugurungi Owen, Yekeye Raymond, Hargreaves James R, Steen Richard, Cowan Frances M
Аннотация
BACKGROUND: Female sex workers (FSWs) in Zimbabwe, where sexually transmitted infections (STIs) are managed syndromically, are at high risk of STIs and HIV.
METHODS: We conducted a respondent-driven sampling (RDS) survey to assess the prevalence, engagement in HIV care and factors associated with STIs among FSWs in two cities of Zimbabwe. Participants self-completed an audio computer-assisted self-interview. Participants were offered HIV testing, and if positive, were tested for HIV viral load. Additionally, 45% were randomly selected and screened for syphilis, gonorrhoea (GC), chlamydia (CT) and trichomonas (TV). RDS-II weighted HIV and STI prevalence and 95% CIs were calculated. The HIV treatment cascade was determined for FSWs living with HIV. Factors associated with having at least one STI (GC/CT/TV) were determined using modified Poisson regression.
RESULTS: We recruited 3006 FSWs from Harare and Bulawayo. HIV prevalence was 41.3% (95% CI 38.1% to 44.6%). Among FSWs living with HIV, 83.4% (95% CI 79.0% to 87.0%) reported being aware of their status. Of those aware, 97.3% (95% CI 94.4% to 98.8%) reported being on antiretroviral therapy (ART), and of those on ART, 93.1% (95% CI 89.3% to 95.7%) were virally suppressed. Overall, 90.1% (95% CI 86.6% to 92.7%) of FSWs living with HIV were virally suppressed. The prevalence of active syphilis was 4.4% (95% CI 3.2% to 6.0%), gonorrhoea was 13.4% (95% CI 11.3% to 15.9%), CT was 20.7% (95% CI 18.2% to 23.5%) and TV was 23.7% (95% CI 21.0% to 26.6%). Of the 598 FSWs with a current STI, 52.4% (95% CI 47.4% to 57.3%) did not have HIV infection. Factors associated with increased relative risk of having at least one STI, after adjusting for age and city, included being divorced/separated, living with HIV and reporting STI symptoms in the past year.
CONCLUSION: While there have been huge gains in identifying and treating FSWs living with HIV, many STIs remain undetected, and a significant proportion of HIV-negative FSWs are affected by these infections, suggesting an urgent need for improved STI management including access to cheap point of care diagnostics.
METHODS: We conducted a respondent-driven sampling (RDS) survey to assess the prevalence, engagement in HIV care and factors associated with STIs among FSWs in two cities of Zimbabwe. Participants self-completed an audio computer-assisted self-interview. Participants were offered HIV testing, and if positive, were tested for HIV viral load. Additionally, 45% were randomly selected and screened for syphilis, gonorrhoea (GC), chlamydia (CT) and trichomonas (TV). RDS-II weighted HIV and STI prevalence and 95% CIs were calculated. The HIV treatment cascade was determined for FSWs living with HIV. Factors associated with having at least one STI (GC/CT/TV) were determined using modified Poisson regression.
RESULTS: We recruited 3006 FSWs from Harare and Bulawayo. HIV prevalence was 41.3% (95% CI 38.1% to 44.6%). Among FSWs living with HIV, 83.4% (95% CI 79.0% to 87.0%) reported being aware of their status. Of those aware, 97.3% (95% CI 94.4% to 98.8%) reported being on antiretroviral therapy (ART), and of those on ART, 93.1% (95% CI 89.3% to 95.7%) were virally suppressed. Overall, 90.1% (95% CI 86.6% to 92.7%) of FSWs living with HIV were virally suppressed. The prevalence of active syphilis was 4.4% (95% CI 3.2% to 6.0%), gonorrhoea was 13.4% (95% CI 11.3% to 15.9%), CT was 20.7% (95% CI 18.2% to 23.5%) and TV was 23.7% (95% CI 21.0% to 26.6%). Of the 598 FSWs with a current STI, 52.4% (95% CI 47.4% to 57.3%) did not have HIV infection. Factors associated with increased relative risk of having at least one STI, after adjusting for age and city, included being divorced/separated, living with HIV and reporting STI symptoms in the past year.
CONCLUSION: While there have been huge gains in identifying and treating FSWs living with HIV, many STIs remain undetected, and a significant proportion of HIV-negative FSWs are affected by these infections, suggesting an urgent need for improved STI management including access to cheap point of care diagnostics.