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Effect of interventions to control sexually transmitted disease on the incidence of HIV iinfection in female sex workers. There is a need to gain a better understanding of the latter Prostitutes Elst that sexual networks of men who have sex with men in Kenya also include women from the general population [26].

Table 1 summarises the sociodemographic and sex work characteristics of the interviewed FSWs.

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Sex workers in the African cities were younger, better educated, more mobile, Prostitutes Elst more often a higher number of clients and less often a regular partner.

Particular to Mozambique was that more than half of FSWs was of foreign origin, while in the other cities they were almost all nationals. Prostitutes Elst 2 presents the results of where FSWs usually procure male condoms, seek general health care and where they Prostitutes Elst care for different HIV and SRH services, the last time they used the service, and the results of the pairwise comparison between cities.

Heterosexual behaviours among men who sell sex to men in coastal Kenya - PMC

General health care, such as when ill, at all cities was most commonly sought at public health facilities. FSWs in Durban responded by far most frequently because it was nearby In Mombasa, the most common responses were because it was nearby In Mysore, cost We assessed SRH care seeking practices in four cities with different health service delivery options for sex workers. Such a standardised comparison across cities has to Prostitutes Elst knowledge never been done and it clearly shows that where and why FSWs seek care is highly context-specific.

At the time of the survey, there was Prostitutes Elst broad range of public and private health facilities in Durban, but no facilities that specifically targeted FSWs Prostitutes Elst key populations. The only targeted service was mobile outreach by a non-governmental agency that mostly focused on condom distribution and HIV testing. It is therefore not surprising that only these two commodities were reported by a Prostitutes Elst proportion of Prostitutes Elst to have been received from targeted services.

The same non-governmental agency also had a youth outreach programme, which in South Africa is broadly defined as anyone up to 35 years, and an important number of FSWs, of which most are 35 years Prostitutes Elst less, Prostitutes Elst been reached by this programme. Nevertheless, also for condoms and HTS the public health facilities were a more important source of care.

In the Tete-Moatize area, there is a small stand-alone clinic at the outskirts of Moatize offering condoms, contraceptive services, STI care and HTS during the evening.

The clinic was a prominent source of condoms, contraception and STI care, with about one third of FSWs reporting it, and less for HTS, with about one sixth reporting it. The Prostitutes Elst sector was, however, also here the most important service provider. This is an important fact to take Prostitutes Elst account when implementing interventions to improve access to SRH services.

To allow the detection of substantial changes in the main project indicators namely the percentage of FSWs that uses contraception and the percentage of FSWs that received an HIV test in the previous 6 months between the baseline and the end-of-project assessment, with a significance level of 0.

In particular for services requiring ongoing care and repeated visits, such as HIV care and contraception, it has to be explored whether services are best procured locally or at the place of origin and how linkage between both might be improved. The link between mobility and poor retention Prostitutes Elst HIV care has been well documented but effective strategies to tackle the problem are still lacking [ 5 ].

In addition, FSW-targeted services are offered, in the context of ongoing research, at a clinic in Mombasa [ 15 ] and Prostitutes Elst in neighbouring Kilifi [ Prostitutes Elst ]. Only for cervical cancer screening it was important, with more than one third screened, possibly Prostitutes Elst cervical cancer screening is still not widely available at the general health facilities in Mombasa [ 21 ].

Mombasa was the only site where a relatively large proportion of FSWs received care in the private-for-profit sector. In none of the other sites was this an important source of care.

The probable reason is that the Kenya private sector is one of the most developed and dynamic in sub-Saharan Africa [ 22 ]. In the focus group discussions that were concurrently held with FSWs in Mombasa, those who preferred private clinics mentioned as main reasons that they are treated well and with respect at these clinics, and that stigma and discrimination were minimal [ 21 ].

Mysore is characterised by the large presence of Prostitutes Elst Ashodaya clinic. This clinic was established in and is operated by a sex worker collective. For services not offered at the clinic, such as contraception, the public sector remains the most important provider.

In this context, it might be Prostitutes Elst expanding the set of services Prostitutes Elst the clinic to include contraception.

Also the reasons for seeking care at a specific place differed by city. Cost appears particularly important in Mysore and, to a smaller degree, in Mombasa, but less Prostitutes Elst in Durban and Tete.

Proximity appears to be an important criterion at the African sites and less in Mysore. It also might signal that newly introduced services may initially have low Prostitutes Elst as FSWs may be reluctant to move from existing services. Though FSWs gave mostly practical reasons for choosing services, such Prostitutes Elst habit, proximity or cost, motives related to quality of care were relatively more highlighted by users of targeted Prostitutes Elst, which could indicate that they perceive these specialised services to have a higher quality of care than other providers.

This is consistent with what has been documented elsewhere [ 1211 ]. They are, however, often not endorsed or favoured by governments and most Prostitutes Elst require additional funding, often in the form of project funding, which may not be sustainable [ 23 — 27 ]. A review of facility-based SRH services for female sex workers in Africa concluded that targeted services have limited coverage and a narrow scope of services, mostly focusing on HIV and STI interventions rather than on broader SRH services [ 26 ].

A less expensive and more sustainable alternative may be Prostitutes Elst reduce the barriers in accessing the regular services, such as a negative reception by providers and other users. These barriers are however often difficult to alleviate and lower service coverage is generally achieved than by stand-alone FSW clinics [ 28 ]. Our baseline assessment shows Prostitutes Elst targeted services have the potential to reach a large proportion of FSWs, as is the case for STI care and HTS in Mysore, but that their presence does not guarantee high coverage, as is observed in Mombasa and Tete.

The face-to-face interviews Prostitutes Elst conducted provided valuable quantitative information on where and why FSWs seek care, Prostitutes Elst this Prostitutes Elst faces limitations such as recollection bias, poor understanding of the question or social desirability bias.

In Tete an electronic questionnaire was used, while in the other cities it was paper-based, but we do not believe that this has substantially influenced the comparability of the results.

Reporting bias has never been shown to Prostitutes Elst substantially different between face-to-face electronic and paper-based questionnaires, unlike between face-to-face and self-administered questionnaires [ 2930 ]. In a next phase, the results were triangulated with the Prostitutes Elst of the focus group discussions, key informant interviews and health facility assessments that were conducted concurrently [ 21 ] and a city-specific intervention package was developed.

The baseline assessment shows that this needs to be site-specific, taking into account the current coverage by targeted and regular health services and the reasons why a place is chosen. Reasons for choosing a particular place of care are mostly practical, such as being nearby. Health services specifically targeted at FSWs are relatively more often chosen because of their perceived higher quality of care.

The best model to improve access to care needs to be tailored to the specific context of each city. Prostitutes Elst should combine the strengthening and expanding of targeted services where relevant and sustainable, with improving access to and linkages Prostitutes Elst the general health services. Formal analysis: YL RG. Funding acquisition: YL. Writing - original draft: YL. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Results Socio-demographic characteristics Table 1 summarises the sociodemographic and sex work characteristics of the Prostitutes Elst FSWs. Download: PPT. Table 1. Socio-demographic and sex work characteristics, by Prostitutes Elst.

Place of care Table 2 presents the results of where FSWs usually procure male condoms, seek general health care and where they sought care for different HIV and SRH services, the last time they used the Prostitutes Elst, and the results of the pairwise comparison between cities.

Table 4. Discussion We assessed SRH care seeking practices in four cities with different health service delivery options for sex workers. Supporting Information. S1 Dataset.

Abstract. HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute. prevalence and Trends of HIV Infection among Sex Workers in High Risk Cities in than any other Sub-Saharan country (Geibel, van der Elst et al.

In Mombasa, the most common responses were because it was nearby

Where do sex Prostitutes Elst go for health care? A community based study in Abidjan, Cote d'Ivoire. Sexually Transmitted Infections. Behavioural categorization has the advantage of being objective and unambiguous in directly describing sexual risk, but behaviour may not correspond to personally held notions of sexuality, particularly in the context of sex work [ 40 ]. Ongoing local qualitative work concurs with observations elsewhere that bisexually active and identifying MSM are less likely to disclose Prostitutes Elst sex behaviour or access health services [ 14142 ], highlighting the need to understand the relationship between behavioural risk and sexual identity in aligning sexual health responses to potentially very diverse notions of individual need and accessibility.

Although the accuracy of prospective event-level measurement in assessing HIV acquisition and Prostitutes Elst risk is well established [ 4344 ], the intensity of follow-up and staff time required was considerable, limiting achievable sample size and the duration of follow-up. Further, findings Prostitutes Elst not be generalizable to MSM sex workers in other contexts. The study recruited from a research-engaged population of MSM, aware of their Prostitutes Elst status and with free access to relevant information, counselling and prevention materials.

Entitlement to services that are otherwise expensive to access is likely to have preferentially selected for recruitment of MSM-SW on low incomes through street-based sex Prostitutes Elst, which may be unrepresentative of the full spectrum of MSM-SW working locally.

Lastly, inferences are necessarily limited to men who sell sex to men — in light of findings, male sex workers with exclusively female partners and clients may well exist locally, but were not identified or included in this study.

Bisexually active male sex workers in coastal Kenya create potential transmission pathways for HIV and other sexually transmitted infections to partners and clients in both MSM and heterosexual networks. However, these Prostitutes Elst are not simply MSM sex workers who happen to have female partners; rather, their behaviour differs from that of exclusive MSM sex workers in important ways that result in a lower risk of HIV infection and transmission.

Modelling projections will tend to overestimate the bridging potential of MSM sex workers and other MSM populations unless they account for such risk differences. This article is published with the permission of the Director of the Kenya Medical Research Institute. Prostitutes Elst of authors: A. Author manuscript; available in PMC Jan 8.

Adrian D. Smitha Allan D. Grahamb, Prostitutes Elst Harold W. Jaffea and Eduard J. Sanders b, d, e. Allan D. Susan M. Harold W. Eduard J. Author information Copyright and License information Disclaimer. Correspondence to Adrian D. Copyright notice. This is an open access article distributed under the Creative Commons Attribution License 4. Prostitutes Elst publisher's final edited version of this article is available at AIDS.

Design Descriptive behavioural study. Methods A novel, validated daily event and partner diary self-completed by 82 MSM who sold sex over a follow-up period of 42 days with weekly review. Conclusion Bisexually active male sex workers in coastal Kenya create HIV and other sexually transmitted infection transmission pathways to partners and clients in both MSM and heterosexual networks, but differed from exclusive Prostitutes Elst in Prostitutes Elst lower HIV acquisition and transmission risks.

Keywords: diary study, Kenya, male sex work, men who Prostitutes Elst sex with men, MSM sex workers, sexual behaviour. Methods Study site and population The prospective diary study was nested in two ongoing cohort studies of adults at high risk of HIV Prostitutes Elst, or with known HIV infection, in Prostitutes Elst, Kenya [ 2124 ].

Diary instrument Event diaries were developed in a pilot programme over 6 months with a group of MSM volunteers. Open in a separate window. Data management and analysis Diary entries were error-checked with participants at weekly collection, Prostitutes Elst double-entered using a pictographic abstraction program Microsoft FoxPro. Results Eighty-two diary participants reported at least one male sexual partner who paid cash for sex over an average follow-up of Participant characteristics Table 1 reports selected characteristics of MSM diary study participants who reported selling sex to men during prospective follow-up.

A baseline cross-sectional survey among female sex workers (FSWs) was van der Elst EM, Okuku HS, Nakamya P, Muhaari A, Davies A. Smith A, Muhaari A, Agwanda C, Kowuor D, van der Elst E, et al.. () Female clients and partners of MSM sex workers in Mombasa.

Table 1 Characteristics of study participants who reported selling sex to men during diary follow-up prospective diary Prostitutes Elst, Coastal Kenya, Differences in male—male sexual behaviour between exclusive and bisexual MSW MSW diary participants reported sexual events with men.

Table Prostitutes Elst Adjusted associations with frequency of anal intercourse with male partners all MSM sex workers, prospective diary study, Coastal Kenya, Prostitutes Elst intercourse Condomless penetrative intercourse Condomless sex frequency male vs.

Prostitutes Elst Over a brief duration of detailed Prostitutes Elst observation the majority of MSM who sold sex to men also reported sexual behaviours with women, often including anal intercourse.

Conclusion Prostitutes Elst active male sex workers in coastal Kenya create potential transmission pathways for HIV and other sexually transmitted infections to partners and clients in both MSM and heterosexual networks.

Footnotes Contribution of authors: A. References 1. Global epidemiology of HIV infection in men who have sex with men. PLoS One. HIV and related risk behavior among men who have sex with men in Zanzibar, Tanzania: results of a behavioral surveillance survey. AIDS Behav. Prostitutes Elst infection in high risk men who have sex with men in Mombasa, Kenya. HIV infection and sexually transmitted infections among men who have sex with men in Senegal.

Men who have sex with men in Mozambique: identifying a hidden population at high-risk for HIV. Male sex workers: practices, contexts, and vulnerabilities Prostitutes Elst HIV acquisition and transmission. A comparative analysis of sexual risk characteristics of Black men who have sex with men or with men and women.

Arch Sex Behav. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis.

HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. Sex Transm Infect. J Acquir Immune Defic Syndr. Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. Sex Trans Dis. Evidence for population level declines in adult HIV prevalence in Kenya. Male sex workers who sell sex to men also engage in anal intercourse with women: evidence from Mombasa, Kenya.

Kenya HIV prevention response and mode of transmission analysis. Kenya AIDS indicator Prostitutes Elst final report. Gouws E, Cuchi P. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in Prostitutes Elst Kenya. Smith AD. Visual sexual behavioural and partner diaries applied Prostitutes Elst African MSM.

Statistical methods in medical research. United Kingdom: Blackwell Science Ltd; Long JS. Regression models for categorical and limited dependent variables. London: SAGE; Prostitutes Elst W. Biological and demographic causes of high HIV and sexually transmitted Prostitutes Elst prevalence in men who have sex with men. Cassels S, Katz DA.

Seroadaptation among men who have sex with men: emerging research themes. Evaluation of HIV type 1 strains in men having sex with men and in female sex workers in Mombasa, Prostitutes Elst.

HIV Type 1 transmission Prostitutes Elst among men having sex with men and heterosexuals in Kenya.

Shepperd G. Rank, gender and homosexuality: Mombasa as a key to understanding sexual Prostitutes Elst. In: Caplan P, editor. The Cultural Construction of Sexuality. London: Tavistock; Murray S, Roscoe W. Boy-wives and female husbands. Studies of African homosexualities. New York: St. High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with Prostitutes Elst MSM in Nigeria.

AIDS Care. Alcohol and sexual risk behavior Prostitutes Elst men who have sex with men in South African township communities. Clients of sex workers in different regions of the world: hard to count. Culture Health Sexuality.

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Levels and correlates of internalized homophobia among men who have sex with men in Pretoria, South Africa. Newcomb ME, Mustanski B. Internalized homophobia and internalizing Prostitutes Elst health problems: a meta-analytic review.

Clin Psychol Rev. The accuracy of self-reports of condom use and sexual behavior. J Appl Soc Prostitutes Elst. Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Ann Behav Med.


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Heterosexual behaviours among men who sell sex to men in coastal Kenya - PMC

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