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Characterizing Multi-level Determinants of HIV Prevalence Among Female Sex Workers in Maseru and Maputsoe, Lesotho

Abstract

Lesotho has a broadly generalized HIV epidemic with nearly one in three reproductive-aged women living with HIV. Given this context, there has been limited research on specific HIV risks. In response, this study aimed to characterize the burden of HIV and multi-level correlates of HIV infection amongst female sex workers (FSW) in Lesotho. Respondent driven sampling was used to recruit 744 FSW from February to September 2014 in Maseru and Maputsoe, Lesotho. Robust Poisson regression was used to model weighted prevalence ratios (PR) for HIV, leveraging a modified social ecological model. The HIV prevalence among participants was 71.9% (534/743), with a mean age of 26.8 (SD 7.2). Both individual and structural determinants involving stigma were significantly associated with HIV. Women with the highest enacted stigma score (≥ 5) had a 26% higher prevalence of HIV than individuals that did not experience any stigma (PR 1.26, 95% CI 1.01, 1.57). These data reinforce the extraordinarily high burden of HIV borne by FSW even in the context of the generalized HIV epidemic observed in Lesotho and across southern Africa. Moreover, stigma represents a structural determinant that is fundamental to an effective HIV response for FSW in Lesotho.

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Acknowledgements

We would like to acknowledge and thank the sex work community for their participation and effective mobilization to disseminate messages about this study. We also wish to thank the study staff and interviewers who worked on this project at personal risk, including disclosure of sexual orientation to their families or communities. The Lesotho Ministry of Health was instrumental in the oversight, direction, and supervision of the study, and we are grateful for the considerable government engagement and ownership of this work.

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.

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Correspondence to Mitra Moazzami.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Appendix 1

Appendix 1

See Table 4.

Table 4 Category groupings for stigma characteristics [response options: (Yes/No)]

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Moazzami, M., Ketende, S., Lyons, C. et al. Characterizing Multi-level Determinants of HIV Prevalence Among Female Sex Workers in Maseru and Maputsoe, Lesotho. AIDS Behav 24, 714–723 (2020). https://doi.org/10.1007/s10461-019-02495-8

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Keywords

  • HIV
  • Lesotho
  • Stigma
  • Female sex workers
  • Epidemiology