Structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition among female bar workers in Dar es Salaam, Tanzania

ABSTRACT

In sub-Saharan Africa, female bar workers (FBWs) often serve as informal sex workers. Little is known about the prevalence of HIV and HIV-related risk factors among FBWs in Dar es Salaam (DSM), Tanzania. Using an adapted Structural HIV Determinants Framework, we identified structural, interpersonal, psychosocial, and behavioral risk factors for HIV acquisition. We compared the prevalence of HIV and HIV-related risk factors among a random sample of 66 FBWs from DSM to an age-standardized, representative sample of female DSM-residents from the 2016 Demographic and Health and 2011–2012 AIDS Indicator Surveys. Compared to other women in DSM, FBWs had elevated prevalence of all four groups of risk factors. Key risk factors included gender and economic inequalities (structural); sexual violence and challenges negotiating condom use (interpersonal); depression, post-traumatic stress disorder, and low social support (psychosocial); and history of unprotected sex, multiple sex partners, and high alcohol consumption (behavioral). HIV prevalence did not differ between FBWs (7.1%, 95% CI 3.7-13.3%) and survey respondents (7.7%, 95% CI: 5.3-11.1%), perhaps due to FBWs’ higher – though sub-optimal – engagement with HIV prevention strategies. Elevated exposure to HIV-related risk factors but low HIV prevalence suggests economic, psychosocial, and biomedical interventions may prevent HIV among FBWs in DSM.

KEYWORDS:

• Tanzania
• female bar workers
• sex risk behaviors
• HIV prevalence
• HIV prevention

Acknowledgements

We would like to thank the Kinondoni District Medical Officer as well as the bar owners, bar managers and female bar worker participants for their assistance conducting this study.

Disclosure statement

The authors declare that they have no conflict of interest.

ORCID

Dale A. Barnhart http://orcid.org/0000-0003-0129-0313

Additional information

Funding

This study was supported by the National Institutes of Health (R01-AI112339). DAB was supported by the National Institutes of Health (1DP1ES025459). GH is supported by the Wellcome Trust and Royal Society (grant number 210479/Z/18/Z). KFO was supported in part by the National Institute of Allergy and Infectious Disease (T32-AI007535). CEO was supported in part by the National Institute on Drug Abuse (T32-DA013911) and the National Institute of Mental Health (R25-MH083620). TB was supported by the Alexander von Humboldt-Stiftung Humboldt Foundation for the National Institutes of Health through the Alexander von Humboldt Professor award, which is funded by the Federal Ministry of Education and Research; the Wellcome Trust (208766/Z/17/Z); the European Commission (RECODID 825746, WHO-PENatScale 825823); the Clinton Foundation Health Access Initiative (7481731); and the National Institutes of Health through the National Institute of Child Health and Human Development (R01-HD084233), the National Institute on Aging (P01-AG041710), the National Institute of Allergy and Infectious Diseases (R01-AI124389) and the Fogarty International Center (D43-TW009775).