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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/23804

Title: Sexual and reproductive health services utilization by female sex workers is context-specific: results from a cross-sectional survey in India, Kenya, Mozambique and South Africa
Authors: Lafort, Yves
Greener, Ross
Roy, Anuradha
Greener, Letitia
Ombidi, Wilkister
Lessitala, Faustino
Skordis-Worrall, Jolene
Beksinska, Mags
Gichangi, Peter
Reza-Paul, Sushena
Smit, Jenni A.
Chersich, Matthew
Delva, Wim
Issue Date: 2017
Citation: Reproductive Health, 14, p. 1-10 (Art N° 13)
Abstract: Background: Female sex workers (FSWs) are extremely vulnerable to adverse sexual and reproductive health (SRH) outcomes. To mitigate these risks, they require access to services covering not only HIV prevention but also contraception, cervical cancer screening and sexual violence. To develop context-specific intervention packages to improve uptake, we identified gaps in service utilization in four different cities. Methods: A cross-sectional survey was conducted, as part of the baseline assessment of an implementation research project. FWSs were recruited in Durban, South Africa (n = 400), Mombasa, Kenya (n = 400), Mysore, India (n = 458) and Tete, Mozambique (n = 308), using respondent-driven sampling (RDS) and starting with 8-16 'seeds' identified by the peer educators. FSWs responded to a standardised interviewer-administered questionnaire about the use of contraceptive methods and services for cervical cancer screening, sexual violence and unwanted pregnancies. RDS-adjusted proportions and surrounding 95% confidence intervals were estimated by non-parametric bootstrapping, and compared across cities using post-hoc pairwise comparison tests with Dunn-Sidak correction. Results: Current use of any modern contraception ranged from 86.2% in Tete to 98.4% in Mombasa (p = 0.001), while non-barrier contraception (hormonal, IUD or sterilisation) varied from 33.4% in Durban to 85.1% in Mysore (p < 0.001). Ever having used emergency contraception ranged from 2.4% in Mysore to 38.1% in Mombasa (p < 0.001), ever having been screened for cervical cancer from 0.0% in Tete to 29.0% in Durban (p < 0.001), and having gone to a health facility for a termination of an unwanted pregnancy from 15.0% in Durban to 93.7% in Mysore (p < 0.001). Having sought medical care after forced sex varied from 34.4% in Mombasa to 51.9% in Mysore (p = 0.860). Many of the differences between cities remained statistically significant after adjusting for variations in FSWs' sociodemographic characteristics. Conclusion: The use of SRH commodities and services by FSWs is often low and is highly context-specific. Reasons for variation across cities need to be further explored. The differences are unlikely caused by differences in socio-demographic characteristics and more probably stem from differences in the availability and accessibility of SRH services. Intervention packages to improve use of contraceptives and SRH services should be tailored to the particular gaps in each city.
Notes: [Lafort, Yves; Gichangi, Peter; Chersich, Matthew; Delva, Wim] Univ Ghent, Int Ctr Reprod Hlth, Ghent, Belgium. [Greener, Ross; Greener, Letitia; Beksinska, Mags; Smit, Jenni A.] Univ Witwatersrand, Fac Hlth Sci, MatCH Res Unit, Durban, South Africa. [Roy, Anuradha] Ashodaya Samithi, Mysore, Karnataka, India. [Ombidi, Wilkister; Gichangi, Peter] Int Ctr Reprod Hlth Kenya, Mombasa, Kenya. [Lessitala, Faustino] Int Ctr Reprod Hlth Mozamb, Maputo, Mozambique. [Skordis-Worrall, Jolene] Univ Coll London, Inst Global Hlth, London, ON, Canada. [Gichangi, Peter] Univ Nairobi, Nairobi, Kenya. [Reza-Paul, Sushena] Univ Manitoba, Winnipeg, MB, Canada. [Chersich, Matthew] Univ Witwatersrand, Fac Hlth Sci, Wits Reprod Hlth & HIV Inst, Johannesburg, South Africa. [Delva, Wim] Univ Stellenbosch, South African DST NRF Ctr Excellence Epidemiol Mo, Stellenbosch, South Africa. [Delva, Wim] Hasselt Univ, Ctr Stat, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/23804
DOI: 10.1186/s12978-017-0277-6
ISI #: 000392890600002
ISSN: 1742-4755
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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