ART uptake and adherence among female sex workers (FSW) globally: A scoping review

ABSTRACT

We conducted the first scoping literature review on ART uptake and adherence among Female Sex Workers (FSW), following PRISMA-ScR guidelines. Searches were conducted in PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting an ART uptake or adherence result among FSW aged 18 or older; peer-reviewed; published in English between 1996 and 2018. Our search identified 6,735 studies; 30 met eligibility requirements. ART uptake ranges from 0 to 100% and adherence ranges from 50–90%, depending on measurement methods. Uptake and adherence influencing factors are mapped onto a social ecological model (SEM). Knowledge and beliefs, substance use, food insecurity and sex-work engagement were negatively associated, while older age, relationships and social support were positively associated with ART uptake and adherence. Standardised methods to measure uptake and adherence prevalence must be established for data comparison. Evidence regarding ART uptake and adherence barriers and facilitators span multiple SEM levels, although more research is needed regarding structural and occupational level influencers. Results suggest that the multi-level ART uptake and adherence barriers faced by FSW require complex multi-level evidence-based interventions. Study findings can inform ART interventions, future research, and offer guidance to other support services with FSW, such as PrEP interventions.

KEYWORDS:

• Antiretroviral therapy (ART)
• female sex workers (FSW)
• scoping review
• uptake
• adherence

Acknowledgements

We would like to thank all of the researchers who contributed to the studies included in this review.

Conflicts of interest

Susan Sherman is an expert witness in opioid legislation on the plaintiff’s side.

Notes

1 We faced a tension regarding language as we aimed to both use the authors’ language and be consistent when talking about sex and gender. Overwhelmingly, when discussing sex work, authors described participants in sexed language, (e.g. female sex worker). In no instance was the nuance of sex or gender categories discussed. We chose to use the authors’ language when discussing their studies and therefore do switch back and forth between sexed and gendered language.

2 Many articles were excluded for multiple reasons, but were categorized only once, often to ‘wrong population’.

Additional information

Funding

This work was supported by the NIH/NIDA R34DA04561903, the Drug Dependence Epidemiology Training Program NIH/NIDA (T32DA007292), the Johns Hopkins University Hopkins Population Center (R24HD042854), and the Johns Hopkins University Center for AIDS Research (P30AI094189). National Institute on Drug Abuse.