Title

Let's Stick Together: community empowerment approach significantly impacts multiple HIV and sexual and reproductive health outcomes among female sex workers in Tanzania

Presenter

Deanna Kerrigan

Authors

D. Kerrigan^1,2, J. Mbwambo³, S. Likindikoki³, W. Davis⁴, A. Mantsios², S. Beckham², A. Leddy⁵, S. Aboud³, N. Galai²

Institutions

¹American University, Sociology, Washington, United States, ²Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, ³MUHAS, Dar es Salaam, Tanzania, United Republic of, ⁴American University, Washington, United States, ⁵UCSF, San Francisco, United States

Background: Female sex workers (FSW) are 13.5 times more likely to be HIV-infected than other women. They are also at risk for a number of other negative health outcomes and conditions, including gender-based violence and unintended pregnancies.
Methods: We conducted a community-randomized trial of a community empowerment model of combination prevention (Project Shikamana/Let''s Stick Together) among FSW in Iringa, Tanzania. We used time-location-sampling to enroll a cohort of 496 women, collecting survey data and conducting HIV screening and viral load assessments at 0 and 18 months. The intervention, targeting both HIV-infected and uninfected women, was anchored around the promotion of social cohesion and mobilization to address socio-structural constraints such as stigma, discrimination, violence and financial insecurity. We conducted an intent-to-treat analysis with logistic and GEE Poisson regression.
Results: Project Shikamana peer educators conducted 7,677 outreach sessions and distributed 81,463 condoms during the 18-month intervention period. Even without PrEP, participants in the intervention were significantly (62%) less likely to become infected with HIV at follow-up (OR .38; p=0.05); with an HIV incidence of 5.0% in intervention vs. 10.4% in control. Consistent condom use increased significantly in the intervention (RR 1.50; p=0.01) vs. the control (RR .97; NS). The intervention also had a significant impact on reductions in gender-based violence (RR: 0.80; p=0.05) and increases in modern family planning methods at follow-up (RR=1.48; p=0.02). The Shikamana women''s group has now been formally registered, established a community savings group, and started a local business to continue to support mobilization activities.
Conclusions: Project Shikamana is one of the first comprehensive models of community empowerment implemented and evaluated among FSW in Africa, which if taken to scale, holds significant promise to generate and sustain improvements in HIV-related outcomes, sexual and reproductive health, and the human and labor rights of this key population.

[Impact of Project Shikamana on HIV, GBV and Reproductive Health Outcomes among FSW in Tanzania]

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