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Exploring the Association Between Mobility and Access to HIV Services Among Female Sex Workers in Zimbabwe

Abstract

Female sex workers (FSW) face structural barriers to HIV-service access, however the effect of their mobility is uncertain. Using cross-sectional data from 2839 FSW in 14 sites in Zimbabwe, we explored the association between mobility (number of trips, distance, duration) in the past 12 months and five HIV-service-access outcomes: exposure to community mobilisation, clinic attendance, HIV testing, antiretroviral treatment initiation, and viral suppression (< 1000 copies per mL). We used modified-Poisson regression, and natural-effects models to estimate how the effect of trip frequency was mediated by distance and duration away. Each additional trip in 12 months was associated with increased community-mobilisation-event attendance (adjusted RR 1.08, 95% CI 1.04–1.12) and attending clinic two-or-more times (adjusted RR 1.02, 95% CI 1.00–1.05). There was little evidence of any other associations, or of mediation. Our findings are consistent with literature that found the effects of mobility to vary by context and outcome. This is the first study to consider many FSW-mobility and HIV-service-access measures together. Future research on mobility and health-related behaviour should use a spectrum of measures.

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Correspondence to Calum Davey.

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Calum Davey was funded by a Strategic Skills pre-doctoral Fellowship from the Medical Research Council, UK. Jeffrey Dirawo, James R. Hargreaves, and Frances M. Cowan received no funding for this work. None of the authors have conflicts of interest to declare. We are very grateful to all of the women who gave their time to be interviewed and for their assistance in recruiting their peers.

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Davey, C., Dirawo, J., Hargreaves, J.R. et al. Exploring the Association Between Mobility and Access to HIV Services Among Female Sex Workers in Zimbabwe. AIDS Behav 24, 746–761 (2020). https://doi.org/10.1007/s10461-019-02559-9

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Keywords

  • Sex work
  • Migration
  • Mobility
  • Healthcare
  • HIV