TY - JOUR
T1 - Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa
AU - Dhana, Ashar
AU - Luchters, Stanley
AU - Moore, Lizzie
AU - Lafort, Yves
AU - Roy, Anuradha
AU - Scorgie, Fiona
AU - Chersich, Matthew
N1 - Funding Information:
Funding for this study was provided by the European Union Seventh Framework Programme, through the DIFFER project (Diagonal Interventions to Fast Forward Enhanced Reproductive Health) grant agreement number Health-F3-2011-282542. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute.
Funding Information:
Of 49 projects that documented either a funder or an organization responsible for the project, 31 (63%) had reported funding from at least one North American organization – Canada and/or United States of America (USA) - and 20 (41%) had at least one European donor. The President’s Emergency Plan for AIDS Relief (PEPFAR) or the United States Agency for International Development (13/49), as well as Family Health International (12/49), predominated among the USA funders, and many projects centred on research received funding from the USA Centre for Disease Control and Prevention (4/49) and the National Institutes of Health (4/49). European funders included the European Commission as well as individual European countries. Few private funding sources (commercial or donors) were acknowledged. We did, however, locate two instances of mining companies involved in sex work projects, both in Southern Africa [13,65].
Funding Information:
We did, however, find some initiatives to provide regional coordination of projects. The West African Project to Combat AIDS and STIs provided preventive and curative care to FSWs and their clients in nine West African countries, with funding from the Canadian International Development Agency [24]. Coordination of services along several major transport routes was also noted [25-29]. In the West Africa Highways Project, over 36 public, private and community health facilities were upgraded, equipped, and provided with an adequate supply of drugs in five countries. One national level project was also attempted in Malawi, but appears to have reached low coverage over-all [19].
PY - 2014/6/10
Y1 - 2014/6/10
N2 - Background: Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.Methods: On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools.Results: We located 149 articles, which described 54 projects. Most were localised and small-sca≤ focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.Conclusions: Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs' health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
AB - Background: Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.Methods: On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools.Results: We located 149 articles, which described 54 projects. Most were localised and small-sca≤ focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.Conclusions: Sex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs' health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.
KW - Female sex workers
KW - HIV prevention
KW - Health services
KW - Sexual and reproductive health
KW - Sub-saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=84903201609&partnerID=8YFLogxK
U2 - 10.1186/1744-8603-10-46
DO - 10.1186/1744-8603-10-46
M3 - Article
C2 - 24916010
AN - SCOPUS:84903201609
SN - 1744-8603
VL - 10
JO - Globalization and Health
JF - Globalization and Health
IS - 1
M1 - 46
ER -
