Mobility and HIV vulnerabilities among female sex workers in Guinea-Bissau: findings from an integrated bio-behavioral survey

Emma M Gorin; Carrie E Lyons; Brooke A Jarrett; Mamadu A Djalo; Kátia Barreto; Fatou M Drame; Stefan Baral

doi:10.1186/s12889-023-16744-y

Mobility and HIV vulnerabilities among female sex workers in Guinea-Bissau: findings from an integrated bio-behavioral survey

BMC Public Health. 2023 Sep 25;23(1):1856. doi: 10.1186/s12889-023-16744-y.

Authors

Emma M Gorin^{1

2}, Carrie E Lyons³, Brooke A Jarrett³, Mamadu A Djalo⁴, Kátia Barreto⁴, Fatou M Drame⁴, Stefan Baral³

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. emg2237@cumc.columbia.edu.
² Present address: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. emg2237@cumc.columbia.edu.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
⁴ ENDA Santé, CP 1041, Bissau, Guinea-Bissau.

Abstract

Background: Mobility is an important risk determinant for HIV given the potential for intermittent access to HIV services. Mobility may be particularly relevant among female sex workers, (FSW) who have been shown to be at high risk for HIV in settings around the world. Data regarding the role mobility plays in exacerbating HIV risks among FSW across Sub-Saharan Africa remains limited, and data on FSW in Guinea-Bissau is sparse.

Methods: FSW in four regions of Guinea-Bissau were recruited with a respondent-driven sampling (RDS) method and participated in an integrated bio-behavioral survey between September 27, 2017 and January 26, 2018. Associations between reported general mobility, mobility to or residence in Bissau, and social and HIV vulnerabilities among FSW in Guinea-Bissau were assessed using multivariable logistic regression models. Population proportions were weighted for RDS sampling, while logistic regression models were not.

Results: Survey respondents included 323 individuals in Bissau, 45 in Bissorã, 140 in Bafatá, and 59 in Gabu. Statistical analyses demonstrated that mobility to more than one destination was significantly associated with recent sex without a condom (ie, sex without a condom within the last three sex acts) with both clients (aOR: 2.47 (95% CI: 1.08, 5.64)) and non-paying partners (aOR: 5.39 (95% CI: 2.61, 11.15)) compared to non-mobility. However, mobility to one or more locations was also associated with higher odds of receiving HIV prevention information, and mobility to more than one location was associated with participating in programming with HIV-related organizations.

Conclusions: These results suggest that while some prevention services including HIV prevention information reach mobile FSW in Guinea-Bissau more than their non-mobile counterparts, the higher rates of condomless sex among mobile FSW suggest that HIV prevention needs may remain unmet for mobile FSW in Guinea-Bissau. Additionally, the results suggest a nuanced relationship between mobility, place of residence, and HIV and social vulnerabilities and prevention indicators.

Keywords: Female Sex Workers (FSW); Guinea-Bissau; HIV; Mobility; Respondent-Driven Sampling (RDS).

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Coitus
Female
Guinea-Bissau / epidemiology
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Logistic Models
Sex Workers*

Abstract

Publication types

MeSH terms

Grants and funding