guyana csw 2000

Georgetown, Guyana female sex workers survey, 2000 : 

Georgetown, Guyana female sex workers survey, 2000 Presented by Caroline Allen, Behavioural Sciences Advisor Special Programme on Sexually Transmitted Infections Caribbean Epidemiology Centre

A project of Guyana National AIDS ProgrammeRed Thread Women’s Development ProjectCAREC-SPSTI : 

A project of Guyana National AIDS Programme Red Thread Women’s Development Project CAREC-SPSTI

Background: 

Background HIV seroprevalence surveys among FSWs in Georgetown 1989: 43% 1993: 25% 1997: 46% NAP has implemented FSW project since 1996. 1997: baseline 2000: follow-up Red Thread research across Guyana: discrimination, marginalization and desire for organization

Objectives: 

Objectives Evaluation of NAP FSWs project Comparisons with 1997 survey Updated information on risks affecting FSWs Updated HIV prevalence rate Provision of information/education to FSWs Design of interventions with FSWs

Research methods: 

Research methods NAP oversaw conduct of survey Red Thread trained FSWs as fieldworkers, using interactive methods, andamp; supervised fieldwork Saliva test for HIV antibodies Individual interviews to collect socio-demographic andamp;behavioural information Anonymous. Codes linked HIV test results andamp; interview data Samples collected and managed by NAP Testing, data entry andamp; analysis by CAREC

Fieldwork: 

Fieldwork 'Snowball' sampling in uptown and downtown Georgetown, based on mapping of 'hot spots' for sex trade Sample size = 299 Fieldwork conducted in daytime and night times Informed consent Prevention of 'double counting' FSWs were paid for participation

Characteristics of Respondents: 

Characteristics of Respondents 299 respondents. 20% uptown, 80% downtown Age range 16-50. Average and median age 29. Ethnicity: 47% Afro-Guyanese, 32% mixed, 19% Indo-Guyanese, 2% Amerindian 14% grew up outside Demerara, 4% live outside Demarara

Characteristics of Respondents: 

Characteristics of Respondents 50% had done sex work for 3 years or less (range 1-20 years) Proportion doing sex work for 2 years or less rose by 5% between 1997 and 2000 surveys 32% do other work: vending 24%, domestic 20%, other low skill 24%, skilled only 2%

Education level: 

Education level

Slide10: 

HIV seroprevalence: 

HIV seroprevalence 47 women (16% of n=299) were not tested because saliva sample was insufficient 12% of uptown sample, 35% of downtown sample tested positive for HIV antibodies

Slide12: 

Reproductive Health: 

Reproductive Health Average number of children 2.4 children born alive 2.7 pregnancies 4.2 46% ever had an abortion 35% had an abortion in the last year Women who had 4 or more pregnancies more likely not to have had abortion

Key indicators re sexual behaviour : 

Key indicators re sexual behaviour Number of sex partners per day/ night Maximum: range 1 to 20, mean 3.9, median 3 Minimum: range 0 to 13, mean 1.6, median 1

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour Condom use With clients, 84% 'always use', 16% 'sometimes', 1% 'never' Proportion who 'always use' with clients rose by 19% (from 65%) since 1997 Reported condom use during last intercourse with a client rose by 4% (from 87 to 91%) since 1997 Proportion who 'always use' condoms with regular sex partners rose by 25% (from 12 to 37%) since 1997

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour Condom use 37% always use condom with boyfriend, husband or regular partner 45% showed their condom to interviewer 9% had sex with the last client who refused to use condom

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour Perception of risk 66% thought they were at risk of HIV, 29% said no and 5% didn’t know 78% said they were worried about becoming infected with HIV/ AIDS, 22% said no and 1% didn’t know

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour Age at first sex Range 12 to 31, mean 16, median 16 Mean age significantly lower for HIV positive (15.6) than HIV negative (16.1)

Key indicators of sexual behaviour : 

Key indicators of sexual behaviour Age of partner at first sex 62.6% 'much older' 88 women gave actual ages of partners Age range 9 to 50, mean 23, median 21 On average 7 years older. Range from 7 years younger to 32 years older

Key indicators of sexual behaviour & Substance abuse : 

Key indicators of sexual behaviour andamp; Substance abuse

Key indicators of sexual behaviour& Substance abuse : 

Key indicators of sexual behaviour andamp; Substance abuse In the past 12 months 7% had exchanged sex for drugs 1% had injected themselves with drugs

Factors individually associated with HIV status: 

Factors individually associated with HIV status Statistical significance: pandlt;0.05 Location of interview Women interviewed downtown (poorer area) had higher rate of HIV Location of interview South Central 46%, Stabroek 26%, Sheriff St. 12% Age:HIV+women are older than HIV-women

Factors individually associated with HIV status: 

Factors individually associated with HIV status Maximum number of clients per day/ night:HIV+ women have more clients Minimum number of clients per day/ night:HIV+ women have more clients Where sex workers find their clients Street and brothel based workers have higher rate of HIV than those who find clients in discos and other places

Factors individually associated with HIV status: 

Factors individually associated with HIV status Nationality of clients: Workers with exclusively foreign clients have lower rates of HIV 'Race' of clients:Rates of HIV higher for those with 'all mixed race' clients (60%) than for those with clients of other ethnic groups(29%). No significant differences in HIV rates between groups of women with clients from the other ethnic categories. Socio Economic Status of clients:HIV prevalence lower for those with 'all rich' partners than for those with poorer clients.

Factors individually associated with HIV status: 

Factors individually associated with HIV status Condom use at last sex with client: HIV+ women less likely to have used a condom at last sex with a client Group sex HIV+ women more likely to do group sex

Factors individually associated with HIV status: 

Factors individually associated with HIV status Age at first sex HIV positive women have lower age at first sex than HIV negative women (consistently until age 19) Anal sex HIV positive women take anal sex more frequently

Factors individually associated with HIV status: 

Factors individually associated with HIV status Alcohol use: HIV positive women get high with alcohol more frequently Coke/ crack use: HIV positive women use crack cocaine more frequently Exchange of sex for drugs: Women who had exchanged sex for drugs were significantly more likely to be HIV positive (58.8% of these women)

Factors individually associated with HIV status: 

Factors individually associated with HIV status Length of time since last HIV test HIV positive women reported a longer average period since their last test (13 months) than HIV negative women (6 months), because HIV negative women want to monitor serostatus. Knowledge of last HIV test result HIV positive women more likely to claim they do not know the result of the last test or that they did not go back for the results.

Factors individually associated with HIV status: 

Factors individually associated with HIV status Syphilis 52.9% of those who had been treated for syphilis in the past year were HIV+. Vaginal ulcer 59.3% of those with ulcers were HIV positive Use of the GUM clinic 42.7% of those who attended the clinic were HIV positive,

Factors individually associated with HIV status: 

Factors individually associated with HIV status Attendance of meetings for Female Sex Workers (n=53)

IN SUM: HIV positive women are: 

IN SUM: HIV positive women are Less 'empowered' In poorer, downtown areas, with poorer andamp; Guyanese (not exclusively foreign) clients Did not use condom at last sex More likely to have sex with client who refuses condom Lower age at first sex Took risks: Cocaine use, alcohol, exchange of sex for drugs, anal sex, group sex

HIV positive women are: 

HIV positive women are More likely to have history of syphilis and vaginal ulcers More likely to use GUM clinic and to have attended FSW workshops

Reasons for optimism: 

Reasons for optimism HIV Prevalence Rates: Overall fall in HIV prevalence Condom Use: Increases in condom use since 1997