Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study
Abstract Background In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribu...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-09178-3 |
| _version_ | 1797259535103033344 |
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| author | Paul Mee Melissa Neuman Moses Kumwenda Wezzie S. Lora Simon Sikwese Mwiza Sambo Katherine Fielding Pitchaya P. Indravudh Karin Hatzold Cheryl Johnson Elizabeth. L. Corbett Nicola Desmond |
| author_facet | Paul Mee Melissa Neuman Moses Kumwenda Wezzie S. Lora Simon Sikwese Mwiza Sambo Katherine Fielding Pitchaya P. Indravudh Karin Hatzold Cheryl Johnson Elizabeth. L. Corbett Nicola Desmond |
| author_sort | Paul Mee |
| collection | DOAJ |
| description | Abstract Background In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribution to FSW by peer distributors than after facility-based HIV testing and whether FSW regretted HIVST use or experienced associated relationship problems. Methods Peer HIVST distributors, who were FSW, were recruited in Blantyre district, Malawi between February and July 2017. Among HIVST recipients a prospective cohort was recruited. Interviews were conducted at baseline and at end-line, 3 months later. Participants completed daily sexual activity diaries. End-line data were analysed using logistic regression to assess whether regret or relationship problems were associated with HIVST use. Sexual activity data were analysed using Generalised Estimating Equations to assess whether HIVST use was temporally associated with an increase in social harms. Results Of 265 FSW recruited and offered HIVST, 131 completed both interviews. Of these, 31/131(23.7%) reported initial regret after HIVST use, this reduced to 23/131(17.6%) at the 3-month follow-up. Relationship problems were reported by 12/131(9.2%). Regret about HIVST use was less commonly reported in those aged 26–35 years compared to those aged 16–25 years (OR immediate regret—0.40 95% CI 0.16–1.01) (OR current regret—0.22 95% CI 0.07 – 0.71) and was not associated with the HIVST result. There was limited evidence that reports of verbal abuse perpetrated by clients in the week following HIVST use were greater than when there was no testing in the preceding week. There was no evidence for increases in any other social harms. There was some evidence of coercion to test, most commonly initiated by the peer distributor. Conclusions Little evidence was found that the peer distribution model was associated with increased levels of social harms, however programmes aimed at reaching FSW need to carefully consider possible unintended consequences of their service delivery approaches, including the potential for peer distributors to coerce individuals to test or disclose their test results and alternative distribution models may need to be considered. |
| first_indexed | 2024-04-24T23:10:58Z |
| format | Article |
| id | doaj.art-e3472fe973e7469489a2ae133772df5e |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-24T23:10:58Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-e3472fe973e7469489a2ae133772df5e2024-03-17T12:16:40ZengBMCBMC Infectious Diseases1471-23342024-03-0122S111310.1186/s12879-024-09178-3Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort studyPaul Mee0Melissa Neuman1Moses Kumwenda2Wezzie S. Lora3Simon Sikwese4Mwiza Sambo5Katherine Fielding6Pitchaya P. Indravudh7Karin Hatzold8Cheryl Johnson9Elizabeth. L. Corbett10Nicola Desmond11Lincoln International Institute for Rural Health, College of Health and Science, University of LincolnFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineMalawi-Liverpool Wellcome Trust Clinical Research ProgrammeMalawi-Liverpool Wellcome Trust Clinical Research ProgrammePakachere Institute of Health and Development CommunicationMalawi-Liverpool Wellcome Trust Clinical Research ProgrammeFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineMalawi-Liverpool Wellcome Trust Clinical Research ProgrammePopulation Services InternationalGlobal HIV, Hepatitis, STI Programmes, World Health OrganizationFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineMalawi-Liverpool Wellcome Trust Clinical Research ProgrammeAbstract Background In Malawi, female sex workers (FSW) have high HIV incidence and regular testing is suggested. HIV self-testing (HIVST) is a safe and acceptable alternative to standard testing services. This study assessed; whether social harms were more likely to be reported after HIVST distribution to FSW by peer distributors than after facility-based HIV testing and whether FSW regretted HIVST use or experienced associated relationship problems. Methods Peer HIVST distributors, who were FSW, were recruited in Blantyre district, Malawi between February and July 2017. Among HIVST recipients a prospective cohort was recruited. Interviews were conducted at baseline and at end-line, 3 months later. Participants completed daily sexual activity diaries. End-line data were analysed using logistic regression to assess whether regret or relationship problems were associated with HIVST use. Sexual activity data were analysed using Generalised Estimating Equations to assess whether HIVST use was temporally associated with an increase in social harms. Results Of 265 FSW recruited and offered HIVST, 131 completed both interviews. Of these, 31/131(23.7%) reported initial regret after HIVST use, this reduced to 23/131(17.6%) at the 3-month follow-up. Relationship problems were reported by 12/131(9.2%). Regret about HIVST use was less commonly reported in those aged 26–35 years compared to those aged 16–25 years (OR immediate regret—0.40 95% CI 0.16–1.01) (OR current regret—0.22 95% CI 0.07 – 0.71) and was not associated with the HIVST result. There was limited evidence that reports of verbal abuse perpetrated by clients in the week following HIVST use were greater than when there was no testing in the preceding week. There was no evidence for increases in any other social harms. There was some evidence of coercion to test, most commonly initiated by the peer distributor. Conclusions Little evidence was found that the peer distribution model was associated with increased levels of social harms, however programmes aimed at reaching FSW need to carefully consider possible unintended consequences of their service delivery approaches, including the potential for peer distributors to coerce individuals to test or disclose their test results and alternative distribution models may need to be considered.https://doi.org/10.1186/s12879-024-09178-3HIV self-testFemale Sex WorkerSocial harmMalawiSub-Saharan AfricaCoercion |
| spellingShingle | Paul Mee Melissa Neuman Moses Kumwenda Wezzie S. Lora Simon Sikwese Mwiza Sambo Katherine Fielding Pitchaya P. Indravudh Karin Hatzold Cheryl Johnson Elizabeth. L. Corbett Nicola Desmond Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study BMC Infectious Diseases HIV self-test Female Sex Worker Social harm Malawi Sub-Saharan Africa Coercion |
| title | Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study |
| title_full | Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study |
| title_fullStr | Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study |
| title_full_unstemmed | Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study |
| title_short | Experience of social harms among female sex workers following HIV self-test distribution in Malawi: results of a cohort study |
| title_sort | experience of social harms among female sex workers following hiv self test distribution in malawi results of a cohort study |
| topic | HIV self-test Female Sex Worker Social harm Malawi Sub-Saharan Africa Coercion |
| url | https://doi.org/10.1186/s12879-024-09178-3 |
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