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While male participation in ANC care is valuable, the lack of male accompaniment should not constitute an additional barrier to receiving services. Summary scores were dichotomized into hazardous drinking scores of three or more and not hazardous drinking scores of less than three. Mobile FSWs are therefore an important population to study, since mobile populations Prostitutes Iringa be more vulnerable Prostitutes Iringa to unique exposures to HIV and other risks during mobility.

Peer Review reports. A recent global literature review indicated that FSW experience high rates of unmet need for family planning and safe conception services, unintended pregnancies, and abortion, and that they Prostitutes Iringa inconsistent condom use due to restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization [ 3 ].

Qualitative research Prostitutes Iringa Ethiopia found that missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy among FSW [ 7 ]. Program surveillance Prostitutes Iringa in Tanzania found 5. Once pregnant, these same challenges may constitute barriers to accessing antenatal care ANC or prevention of mother-to-child transmission PMTCT services [ 1011 ].

More evidence on the Prostitutes Iringa and correlates of family planning use or nonuse of reproductive health Prostitutes Iringa and FP services is needed to ensure the provision of appropriate services that address the burden of unplanned pregnancy among this vulnerable group.

As sexual and RH knowledge and access to care and contraception all influence FP uptake, community empowerment approaches could theoretically improve FP use.

In Tanzania, a two-community randomized control trial RCT was conducted to evaluate a community empowerment HIV prevention program [ 2324 ]. Using data from this trial, this article seeks to describe family planning use and pregnancy among a population of FSW in Iringa, Tanzania, investigate any differences by HIV status, and evaluate whether engagement in the Shikamana intervention Prostitutes Iringa associated with modern contraceptive Prostitutes Iringa.

This manuscript describes secondary analysis of data from the month follow-up of the Project Shikamana cohort of FSW in Iringa, Tanzania. The project involved a community-randomized trial of a community empowerment-based HIV prevention intervention in two communities in the Iringa region of Tanzania NCT, Nov 2, Randomization occurred at the community level, with one community randomized to receive the intervention. The intervention components included 1 a community-led drop-in center DIC creating a safe space that facilitated social cohesion and mobilization activities; 2 venue-based peer education, condom distribution, and HIV testing; 3 peer service navigation and social support Prostitutes Iringa HIV-infected participants; 4 sensitivity trainings for Prostitutes Iringa providers and police; and 5 text messages to promote engagement in the intervention, and adherence to clinic appointments and antiretroviral therapy ART adherence for FSW living with HIV Prostitutes Iringa 24 ].

The baseline bio-behavioral survey was Prostitutes Iringa from October to April The intervention was then implemented in one community for months, at which point the post-intervention survey was conducted.

Both surveys gathered information on demographics, reproductive histories and family planning Prostitutes Iringa, sexual risk Prostitutes Iringa e. The follow-up survey captured program exposure and engagement in both communities, not limited Prostitutes Iringa the intervention community. At the DIC, monthly seminars were held, with topics chosen by members of the intervention community. The FP session was run by an outreach nurse, who was also available to provide FP methods at the session e.

Following some seminars, participants decided to organize regular weekly meetings at the DIC Prostitutes Iringa specific topics, including family planning, to continue to learn from each other, discuss problems, and identify solutions as a sex worker community.

The DIC was also open during the week for walk-ins and staffed by counselors who offered HIV counseling and testing and peer educators who gave education and distributed condoms. Further details on the intervention and characteristics of the baseline cohort as well as the main outcomes of the trial have been previously published [ 2324 ]. Time-location sampling at entertainment venues bars, hotels, etc.

The total baseline Prostitutes Iringa included participants, with in the intervention community. Two of the participants were missing data on program exposure, so were dropped from the multivariable Prostitutes Iringa but included in other analyses. Further information on the recruitment and sampling methods are described elsewhere [ 23 ]. The primary outcome was self-reported current family planning use measured at the month follow-up survey.

Participants were asked if they currently used various modern contraceptive methods including injectable, implant, oral pill combined or progesterone onlytubal ligation, or male or female condoms as birth control. These represent a complete list of modern FP methods available in Tanzania at the time. Program exposure was measured at the month follow-up survey. Family planning program exposure was defined as attendance of Prostitutes Iringa seminar, workshop, or meeting specifically about FP.

Additionally, the baseline survey captured historical FP use e. The month follow-up also asked participants about their reproductive histories numbers of lifetime pregnancies and living children; current pregnancy status; current pregnancy intentions, intendedness of most recent pregnancy; and age at first pregnancy and use of ANC services sought ANC for recent pregnancy; location of care.

Since formative qualitative work previously indicated that some FSW were not accessing ANC services because they were not accompanied by Prostitutes Iringa for couples HIV testing [ 10 ], the survey also Prostitutes Iringa if participants were accompanied by a male partner, told to bring a partner, or did not or could not access Prostitutes Iringa due to inability to bring a partner.

For Table 5to simultaneously evaluate the Prostitutes Iringa of various factors on the outcome, we have applied modified Poisson regression models with robust standard errors. This method had been proposed as an alternative Prostitutes Iringa logistic regression for binary data in Prostitutes Iringa where the proportion of the outcome is high, Prostitutes Iringa is the case for family planning in our cohort [ 25 ]. All participants gave oral informed consent before Prostitutes Iringa.

Over half of participants were Prostitutes Iringa, divorced, or widowed. Just over half of participants were living with HIV. Of those not currently pregnant, about a fifth were currently trying to become pregnant. Participants used an array of FP methods. Community, number of clients a week, and history of FP use were significantly associated with current FP use Table 4.

Of the participants in the intervention community, two had missing data on program exposure. The adjusted relative risk of current FP use among FSW who reported ever attending the Shikamana center compared to those who never attended the Shikamana center was aRR 1.

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This study provides an overview of the reproductive health profile of this population of FSW. Among the study population, reproductive histories and fertility preferences did not significantly Prostitutes Iringa by HIV status, which indicates unmet service needs for both FSW who are uninfected prevention of HIV, prevention of unwanted pregnancy and FSW who are infected safer conception, prevention of unwanted pregnancy, prevention of transmission to partners.

Community study arm Prostitutes Iringa, number of clients a week, and history of FP use were significantly associated with current FP use. Further, the study provides insights on the potential impact of involvement in a community empowerment HIV prevention intervention — an intervention with a very limited one seminar FP component — on FP use.

The odds of current Prostitutes Iringa use among FSW was higher among those who reported ever attending the Shikamana DIC, compared those who had not, and was higher among those who reported ever Prostitutes Iringa the FP-related workshop, than those who had not.

Other qualitative research in Tanzania have also found that health providers may deny services Prostitutes Iringa women and adolescents attending antenatal care without a partner [ 2728 ]. While male participation in ANC care is valuable, the lack of male accompaniment should not constitute an additional barrier to receiving services. The interpretation and implementation of such polices and guidelines at the facility level should be investigated to ensure that all pregnant people receive appropriate care.

Many factors may explain FP use and Prostitutes Iringa. In this study, community of residence, average number of clients a week, and history of FP use were significantly associated with current FP use. Comprehensive interventions that meet the reproductive health needs of key populations such as FSW are needed to address unmet need for family planning [ 330 ]. Furthermore, very few participants reported dual use of both a modern contraception method and condom use. Condom use was much higher in a Prostitutes Iringa study conducted in Kenya where a total of Little is known about fertility preferences Prostitutes Iringa FSW and other marginalized groups of women [ 333435 ].

In this study, about a fifth of participants Prostitutes Iringa living with and without HIV were currently trying to get pregnant. However, Prostitutes Iringa lacked information on safe conception practice [ 8 ]. Another study conducted in Swaziland, Burkina Faso, and Togo found that nearly a fifth of FSW reported that Prostitutes Iringa were currently trying to conceive [ 18 ]. Fertility preferences may adversely impact HIV prevention and treatment efforts such as higher risk of unprotected sex [ 36 ], and treatment interruptions among those living with HIV [ 34 ].

Oral informed consent was received from all participants.

Exposure to the community empowerment program — both in terms of ever attending the Shikamana center as well as ever attended the FP-specific session — were associated with greater odds of current FP use. This finding suggests that community empowerment models of HIV care provision may also positively impact family planning behaviors, potentially through developing sexual and RH knowledge, improving access to condoms and encouraging their use, and reducing barriers to health care seeking in general.

The potential for empowerment to improve family Prostitutes Iringa outcomes has been documented in two recent literature reviews among the general population of women, though findings have been variable, with Prostitutes Iringa showing an effect and others not [ 3738 ].

A review on the potential effectiveness and feasibility of integrating FP into HIV services Prostitutes Iringa that integrated programs were often associated with higher modern method of contraceptive prevalence and knowledge, though findings were mixed [ 19 ]. There are some limitations inherent in this analysis. The specific FP questions assessed here were only measured at follow-up.

As such, we were unable to determine whether FP use increased from baseline to follow-up. Furthermore, we were only able to estimate the cross-sectional association between exposure to Prostitutes Iringa empowerment program and current family planning use at follow-up.

Thus, we cannot determine causality of community empowerment on family planning use; it may be that women who were more likely to use family planning were more likely to be involved in the drop-in-center activities. That said, we were able to control for ever use of family planning in the regression models, suggesting that FP use did come before intervention exposure. Further Prostitutes Iringa with clear temporality is warranted to determine the true association.

This study Prostitutes Iringa a secondary analysis of a larger study; thus, the study was not powered on the outcome, so interpretations should be cautious. As with all self-report data, responses may be subject Prostitutes Iringa social desirability bias. For example, FP use and program exposure may have been over-reported.

The time-location sampling methods may limit the generalizability of these findings to venue-based FSW. Future research designed to assess these outcomes could overcome some of these limitations.

Community empowerment-based interventions have been shown to be effective at Prostitutes Iringa consistent condom use and reducing HIV infection. This study indicates that other health outcomes, such as modern family planning use, may also be impacted by these interventions, especially when family planning is part of a comprehensive empowerment-based program. More attention is needed on integration of family planning into interventions tailored for sex workers and other marginalized groups, Prostitutes Iringa implementation research to test and develop best practices that serve the needs of the communities.

Encyclopedia of AIDS. New York: Springer; Chapter Google Scholar. Prostitutes Iringa characteristics and behavioral risk factors of Prostitutes Iringa sex workers in sub-saharan Africa: a systematic review. AIDS Behav. Meeting the reproductive health needs of female key populations affected by HIV in low- and middle-income countries: a review of the evidence. Stud Fam Plan. Article Google Scholar. Contraceptive use and unplanned pregnancy among female sex workers in Prostitutes Iringa.

Afr J Reprod Health. An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in cote d'Ivoire. J Acquir Immune Defic Syndr. Article PubMed Google Scholar. Pregnancy experiences of female sex Workers in Adama City, Ethiopia: complexity of partner relationships and pregnancy intentions. Project SOAR.

Washington, DC: Population Council; Google Scholar. Female sex workers' experiences with intended pregnancy and antenatal Prostitutes Iringa services in southern Tanzania. Health of female sex workers and their children: a call for action. Lancet Glob Health. As mobility Prostitutes Iringa often correlated with age and is a common reason for participants being lost to follow-up and a common challenge for surveillance [ 12 ], it is likely that the estimates presented here underestimate recent mobility for sex work among FSWs in Iringa at follow-up.

Future research should ensure consistent measurement of GBV across time Prostitutes Iringa, and may need Prostitutes Iringa include GBV Prostitutes Iringa other perpetrators, such as Prostitutes Iringa or community members. In addition, there remains a need for future research to understand the nuanced relationships between mobility and GBV.

Future research should examine the relationship between these typologies of mobility and GBV. An intermediate step would be to integrate other aspects of mobility, at least destination, frequency, and duration, into standard data collection instruments administered Prostitutes Iringa FSWs as characteristics of mobility can vary.

A qualitative investigation of mobility trajectories could elaborate on or identify emergent mobility typologies for FSWs. Previous research in north-western Tanzania, for example, used qualitative, ethnographic methods to identify typologies of women and men living and working in a Prostitutes Iringa community that described their unique risks for HIV and other infections [ 34 ].

Finally, findings presented here may not be representative of the experiences of all FSWs in Tanzania. Analyses were conducted using baseline and follow-up data from Project Shikamana, a community-randomized trial conducted in two communities in Iringa.

While Project Shikamana included activities focused on violence prevention, there were no significant reductions in violence found in adjusted models, suggesting the need for more comprehensive approaches Prostitutes Iringa address the socio-structural factors that influence GBV in Prostitutes Iringa context.

Drawing on baseline and follow-up data from a community randomized controlled trial in Iringa, Tanzania, this study examined the longitudinal relationship between recent mobility for the purposes of sex work and experiences Prostitutes Iringa GBV from a client or partner. Evidence of a significant increased risk of violence among mobile FSWs as compared to their non-mobile counterparts suggests that Prostitutes Iringa to reduce GBV among FSWs must acknowledge the unique needs of Prostitutes Iringa FSWs who are mobile for sex work.

Public health programs must identify ways—using digital technologies, for example—to engage mobile FSWs. The authors would like to acknowledge the participants who generously shared their perspectives and experiences with the research team. Browse Subject Areas?

Click through the PLOS Prostitutes Iringa to find articles in your field. Abstract Female sex workers are highly mobile, which may influence their risk of experiencing physical and sexual violence. Introduction Female Prostitutes Iringa workers FSWs experience increased risk of physical and sexual violence globally [ 12 ].

Study design and sampling To examine the longitudinal relationship between sex work-related mobility and experience of GBV, this study drew on baseline and month follow-up data collected as part of Project Shikamana. Measures The outcome of interest was any recent experience of physical or sexual GBV from any sexual Prostitutes Iringa, defined as Prostitutes Iringa self-reported experience of either physical or sexual violence within the past six months from a new or regular client or non-paying partner.

Results Table 1 shows sex work-related mobility, socio-demographic characteristics, living situation, and work environment-related variables by recent experience of physical or sexual GBV at baseline and follow-up.

Download: Prostitutes Iringa. Table 1. Table 2. Discussion In this sample of FSWs from Iringa, Tanzania, FSWs with recent mobility for sex work had a higher risk of recent physical or sexual GBV when compared to those with no recent mobility for sex work after adjusting for socio-demographic characteristics and aspects of their living situations and work environments.

Limitations This study extends Prostitutes Iringa cross-sectional analyses [ 21 ] to examine longitudinal correlates of any recent experience of GBV. Conclusions Drawing on baseline and follow-up data from a community randomized controlled trial in Iringa, Tanzania, this study examined the longitudinal Prostitutes Iringa between recent mobility for the purposes of sex work and experiences of GBV from a Prostitutes Iringa or Prostitutes Iringa.

Acknowledgments The authors would like to acknowledge the participants who generously shared their perspectives and experiences with the research team.

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The interpretation and implementation of such polices and guidelines at the facility level should be investigated to ensure that all pregnant people receive appropriate care. Download PDF.