Eileen A. Yam

Induced abortion, contraceptive use, and dual protection among female sex workers in Moscow, Russia.

To describe abortion history and current contraceptive use among female sex workers (FSWs) in Moscow, Russia.

Demonstrating public health at work: a demonstration project of congenital syphilis prevention efforts in Bolivia.

Objectives: We introduced syphilis immunochromatic strip (ICS) tests into antenatal care (ANC) settings in Bolivia and evaluated feasibility, patient and provider acceptability, and introduction costs. We conducted complementary studies on related topics, strengthened quality of care, and aided the response to sensitive aspects of maternal/congenital syphilis control (e.g., partner notification). Goal: The goal of this study was to discuss our experience working with Bolivian stakeholders to document potential public health benefits of syphilis ICS test introduction in ANC settings. Study Design: We trained public health personnel and offered the Abbott Determine Rapid Syphilis TP test in 4 urban maternity hospitals and 37 rural clinics. Results: Using the ICS test, 11,618 women were tested for syphilis; 5% had positive results and 93.2% received treatment. Women and health personnel found the test acceptable and introduction costs were not prohibitive. Conclusions: Based on these findings, by mid-2006, the Bolivian Ministry of Health will offer the ICS tests in rural ANC settings.

Association between condom use and use of other contraceptive methods among female sex workers in Swaziland: a relationship-level analysis of condom and contraceptive use.

Objectives Nonbarrier modern contraceptive users often are less likely to use condoms, particularly with more intimate sex partners. We examine whether female sex workers (FSWs) in Swaziland who use nonbarrier contraception use condoms less consistently and whether this inverse association varies by relationship type. Methods In 2011, we conducted a survey among 325 Swazi FSWs using respondent-driven sampling. Each woman reported on condom use during sexual activity in the past month with up to 3 partner types (new clients, regular clients, noncommercial partners). We used a generalized estimating equation model to conduct a relationship-level multivariate logistic regression analysis of correlates of consistent condom use in the past month. We tested whether relationship type modified the effect of nonbarrier modern contraception on condom use. Results Each participant reported up to 3 observations, for a total of 892 measures of condom use in the past month. Compared with sexual activity with new clients, sex with regular clients and noncommercial partners was less likely to be protected by consistent condom use (adjusted odds ratio, 0.30 [95% confidence interval, 0.19–0.47] for regular clients; adjusted odds ratio, 0.15 [95% confidence interval, 0.09–0.24] for noncommercial partners). There was no significant association between condom use and nonbarrier modern contraceptive use. Conclusions These data highlight the need to provide condoms and condom-compatible lubricants and targeted education programs for FSWs and their male sex partners to encourage the consistent use of these commodities with all sex partners, irrespective of the use of other contraceptive methods.

Contraception and Condom Use Among Bolivian Female Sex Workers: Relationship-Specific Associations Between Disease Prevention and Family Planning Behaviors

We examined data from a clinic-based survey of 1,222 Bolivian female sex workers (FSWs) to assess whether use of nonbarrier modern contraception is associated with less consistent condom use with clients and noncommercial partners. Women who were using nonbarrier modern contraception were less likely than nonusers to consistently use condoms with noncommercial partners (AOR 0.393, 95% CI 0.203–0.759, p = .005). With clients, this inverse association did not hold. Public health professionals must consider both disease prevention and pregnancy prevention needs in this vulnerable population, and messages should be tailored to encourage dual method use with all partners.

Use of emergency contraceptive pills among female sex workers in Swaziland

Objectives Female sex workers (FSW) often have unprotected sex. Emergency contraceptive pills (ECP) are an important back-up method to prevent unwanted pregnancy among FSW. We examine ECP use among FSW in Swaziland. Methods Using data from a 2011 respondent-driven sampling survey of 325 Swazi FSW, we explored the association between individual characteristics and ever having used ECP. Results In weighted analyses, 27.5% of FSW had ever used ECP. Most (77.8%) had ever been pregnant, among whom 48.7% had had an unwanted pregnancy and 11.7% had had an abortion. Nearly half (47.5%) had experienced condom failure in the past month. Significant independent correlates of ECP use were younger age, higher education, higher income, having two or more children, and never having been married. Conclusions FSW who are older or of lower socioeconomic status may not have adequate access to ECP. By better addressing these womens family planning needs, the dual goals of preventing unwanted pregnancy and preventing vertical transmission of HIV can be achieved.

Pregnancy Experiences of Female Sex Workers in Adama City, Ethiopia: Complexity of Partner Relationships and Pregnancy Intentions

Research and programs for female sex workers (FSWs) tend to focus exclusively on HIV prevention, with little attention paid to how pregnancy affects their lives. We examine the circumstances surrounding pregnancy and childbirth among women selling sex in Ethiopia. In Adama City, researchers asked 30 FSWs aged 18 and older who had ever been pregnant to participate in in‐depth interviews. The women reported on pregnancies experienced both before and after they had begun selling sex. They identified some of the fathers as clients, former partners, and current partners, but they did not know the identities of the other fathers. Missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy. Abortion was common, typically with a medication regimen at a facility. Comprehensive sexual and reproductive health services should be provided to women who sell sex, in recognition and support of their need for family planning and their desire to plan whether and when to have children.

Pregnancy experiences of female sex workers in Adama City Ethiopia: workers in Adama City Ethiopia: complexity of partner relationships and pregnancy intentions.

Research and programs for female sex workers (FSWs) tend to focus exclusively on HIV prevention, with little attention paid to how pregnancy affects their lives. We examine the circumstances surrounding pregnancy and childbirth among women selling sex in Ethiopia. In Adama City, researchers asked 30 FSWs aged 18 and older who had ever been pregnant to participate in in‐depth interviews. The women reported on pregnancies experienced both before and after they had begun selling sex. They identified some of the fathers as clients, former partners, and current partners, but they did not know the identities of the other fathers. Missed injections, skipped pills, and inconsistent condom use were causes of unintended pregnancy. Abortion was common, typically with a medication regimen at a facility. Comprehensive sexual and reproductive health services should be provided to women who sell sex, in recognition and support of their need for family planning and their desire to plan whether and when to have children.

Family planning for HIV-positive girls and young women

e10 www.thelancet.com/hiv Vol 4 January 2017 The international HIV community has become increasingly attentive to the disproportionate disease burden borne by adolescent girls and young women, particularly in the epidemic’s epicentre in sub-Saharan Africa. In some southern African countries, young women are up to eight times as likely to be living with HIV compared to their male peers. This severe agesex disparity is often the result of deeply ingrained harmful social norms that perpetuate gender inequity in education, gender-based violence, early marriage and age-disparate sexual relationships, and gendered power dynamics that inhibit young women’s ability to negotiate safe sex. At the July 2016 International AIDS Conference in Durban, eff orts focused on primary HIV prevention among adolescent girls and young women were abundantly on display. These programmes and policies typically were aimed at providing age-appropriate preventive services and products (including condoms and biomedical prevention strategies), increasing HIV knowledge, and promoting gender-equitable norms. However, despite passionate calls to action to reduce gender and age related HIV risk, there was palpable silence about the importance of addressing the family planning needs of HIV-positive adolescent girls and young women. In an era of increased access to antiretroviral therapy, this is an unconscionable omission now that these girls and women can expect to live well into their reproductive years. Family planning must be meaningfully incorporated into HIV programmes and policies to achieve the dual aims of upholding women’s desires for and right to plan pregnancies, as well as minimising mother-to-child HIV transmission. Female childbearing intentions and desires are particularly variable and fl uid in the 15 years (age 10–24 years) encompassed adolescence. In this period, adolescent girls and young women are embarking on a host of transitions to adulthood—puberty, sexual debut, marriage, and motherhood. Those living with HIV, whether perinatally or sexually acquired, are faced with increasingly pressing decisions about the timing and spacing of pregnancy, and many questions about how to conceive safely. Their desire for children, and their accompanying need for either contraception or safer conception counselling and services, is extremely salient. Consider the cases of Lesotho and Zimbabwe—two countries with very high HIV prevalence. In Lesotho, 8% of adolescent girls (15–19-year-old) living with HIV wish to have children within the next 2 years, 35% do not wish to have children at all, and 58% wish to have children at some point in the future or are undecided. Among their Zimbabwean peers, far fewer do not want any children (14%), and a much larger proportion (79%) want children after 2 years or are undecided. Regardless of country context, most adolescent girls and young women living with HIV do not want to get pregnant in the foreseeable future, yet most aspire to become mothers someday. These are not incompatible goals. Starting well before they are sexually active, adolescent girls and young women living with HIV need comprehensive sexuality education that arms them with the knowledge to achieve several outcomes: prevention of unwanted pregnancy, prevention of sexually transmitted infection transmission (including HIV superinfection or onward transmission), and a healthy pregnancy and baby (when and if desired). As they age into adulthood, HIV-positive adolescent girls and young women undergo critical biological and social transitions that infl uence their reproductive desires and choice of sexual partners. These typical transitions to adulthood are complicated Family planning for HIV-positive girls and young women