Engagement in Antiretroviral Treatment and Modern Contraceptive Methods Among Female Sex Workers Living With HIV in Lesotho

Abstract

Female sex workers (FSW) are disproportionately affected by HIV in Lesotho, which highlights the importance of contraception and antiretroviral therapy (ART) given occupational risks of unwanted pregnancies. Seven hundred and forty-four FSW recruited through respondent-driven sampling in Maputsoe and Maseru in Lesotho completed a questionnaire and HIV testing in 2014. RDS-adjusted HIV prevalence was high (66.1; 95% CI: 58.7–72.8); 56% of HIV + participants were not using non-barrier contraception, and 32% were on ART. Among HIV-positive FSW not using non-barrier contraception, negative correlates of ART engagement were older age, lower HIV education, and consuming 5+ alcoholic drinks/day. Tailored HIV information delivery efforts for FSW in Lesotho’s high HIV burden environment may reduce horizontal and vertical transmission risks.

Keywords:

• Contraception
• epidemiology
• HIV
• Sub-Saharan Africa
• vertical transmission

Acknowledgements

The authors thank the research and outreach team at Population Services International, Lesotho, for connecting us with this community of women through recruitment and other community engagement strategies. We are grateful to a number people from the collaborating institutions, including Sosthenes Ketende and Ashley Grosso from JHU; Dr. Limpho Maile, Dr. Mosilinyane Letsie, Tsietso Mot’soane, David Mothabeng, Puleng Ramphalla-Phatela, and Dr. Kyaw Thin from the Lesotho Ministry of Health; and Dwan Dixon, Pierre Loup-Lesage, and Brian Pedersen from PSI. We are grateful to Lesotho Planned Parenthood for their support of the study and referral services for study participants. This study would not have been possible without the leadership of this community of women and the efforts of the community advisory boards who ensured successful completion of all research activities.

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This study was funded by the U.S. Agency for International Development (USAID, AID-674-A-00-00001), and implemented by Population Services International/Lesotho (PSI). Stefan Baral's efforts were supported in part by the Johns Hopkins University Center for AIDS Research, an NIH funded program (1P30AI094189), which is supported by the following NIH Co- Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH,NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.