Addressing broader reproductive health needs of female sex workers through integrated family planning/ HIV prevention services: A non-randomized trial of a health-services intervention designed to improve uptake of family planning services in Kenya

BackgroundDespite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC.MethodsWe conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use.ResultsThe intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners.ConclusionsSelf-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW.Trial registrationClinicaltrials.gov NCT01957813背景：尽管在预防女性性工作者（female sex workers, FSW）的人类免疫缺陷病毒（HIV）及其他性传播感染（sexually transmitted infections, STI）方面已付出诸多努力，但该群体其他性与生殖健康（sexual and reproductive health, SRH）需求——例如预防意外妊娠——却鲜有得到关注。现有研究亟需针对女性性工作者推出综合可及的服务项目，以满足其更广泛的性与生殖健康需求。本研究针对肯尼亚两座城市自助咨询中心（drop-in centers, DIC）就诊的女性性工作者，评估了一项干预措施的效果，该干预旨在提升双重避孕方式的使用率，以预防性传播感染、HIV及意外妊娠。干预内容包括强化同伴教育、常规筛查计划生育（family planning, FP）需求，以及在自助咨询中心扩充非安全套类避孕方式的供给。 方法：本研究采用两组前后测类实验设计，共纳入719名女性性工作者（干预组360人，对照组359人）。研究人员在基线及6个月后对参与者进行访谈，以评估安全套与非安全套类避孕方式使用率的变化情况。 结果：干预措施对非安全套类避孕方式的使用率具有显著正向影响（比值比OR=1.38，95%置信区间CI=(1.04, 1.83)），但对双重避孕方式的使用率无显著作用。研究报告显示，参与者的持续安全套使用率较高，但许多女性同时表示，与付费及非付费伴侣协商使用安全套均存在困难或极大困难。持续安全套使用的最强预测因子为伴侣类型（付费伴侣 vs 非付费/情感伴侣）；女性性工作者报告称，付费与非付费伴侣均会对非安全套类避孕方式的使用产生影响。此外，大量女性性工作者报告曾遭受付费及非付费伴侣的性暴力。 结论：自我报告的持续安全套使用困难，以及工作中有时存在的危险环境，使得女性性工作者更容易面临意外妊娠、性传播感染/HIV感染风险。在安全套基础上补充非屏障避孕方式，对于遏制意外妊娠及其潜在的不良健康、社会与经济后果至关重要。研究结果同时表明，需在安全套之外开发更多策略，以降低女性性工作者的HIV及性传播感染感染风险。 临床试验注册：Clinicaltrials.gov NCT01957813