Elsevier

Contraception

Volume 74, Issue 4, October 2006, Pages 318-323
Contraception

Original research article
Utilization of contraception and abortion and its relationship to HIV infection among female sex workers in Tashkent, Uzbekistan

https://doi.org/10.1016/j.contraception.2006.04.006Get rights and content

Abstract

Objective

This study aimed to describe reported contraceptive and abortion utilization and their relationship to human immunodeficiency virus (HIV) infection among female sex workers (FSW) in Tashkent, Uzbekistan.

Methods

For this cross-sectional study, women were recruited through outreach workers affiliated with Istiqbolli Avlod. Participants completed a self-administered questionnaire and underwent HIV testing.

Results

Of 448 participants, the majority (86.2%, n=386) used contraception; 39.6% reported inconsistent use. Methods most frequently utilized were condoms (50.9%) and intrauterine devices (16.1%). One fourth (24.3%, n=109) reported multiple (≥3) prior abortions. Inconsistent contraceptive users were more likely to be infected with HIV (AOR=2.72, 95% CI=1.19–6.22), but such infection was not related to a specific contraceptive method, including condoms, or utilization of abortion.

Conclusions

Inconsistent contraceptive use is common and may be a predictor of HIV infection among Tashkent FSW. Factors preventing consistent contraceptive use may be related to HIV risk and require further study in this population.

Introduction

Female sex workers (FSW) are a core risk group for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) [1], [2], [3]. Additionally, many FSW are, as women of reproductive age, at risk for unintended pregnancy. Prior FSW-directed health research and programming have largely focused on STI diagnosis and treatment, with a few reports documenting low contraception and high abortion rates among FSW [4], [5], [6].

In Uzbekistan, a former Soviet Republic with a government-subsidized health system with divided STI and family planning care, the 2004 total fertility rate was 2.7 births and contraceptive prevalence was 68% [7]. These statistics have changed significantly in the last decade, reflecting a successful national contraceptive campaign and unfavorable socioeconomic conditions for supporting large families [8]. However, in the same interval, STI rates, particularly those of gonorrhea and syphilis, have dramatically increased, and HIV infection, initially tied to injection drug use in this region, has emerged in populations whose sole risk factor for transmission is sexual contact [8], [9].

Currently, in Uzbekistan, the number of women participating in sex work has been steadily increasing due to bleak economic prospects, despite the risk of detainment [10], [11]. FSW are less likely to present to public health clinics due to fears of being reported to the authorities while private health care providers are often not an option due to prohibitive costs, potentially contributing to the rising STI and HIV rates [12]. We have already detected a 10% HIV prevalence among participants in this study, significantly related to injection drug use, street-based sex work, exchanging drugs for sex and number of STI treatments in the previous 3 months [13]. However, other aspects of reproductive health, such as contraceptive utilization, have not been described among FSW in Uzbekistan. This study describes reported contraceptive and abortion utilization and their relationship to HIV infection among FSW in Tashkent, Uzbekistan.

Section snippets

Materials and methods

This cross-sectional study was conducted in Tashkent, Uzbekistan, between April 2003 and March 2004. Women were recruited through Istiqbolli Avlod, a nongovernment organization assisting victims of human trafficking, by associated outreach workers familiar to the FSW community. Inclusion criteria were age 18 years or older, sex work within the last month and the ability to provide written informed consent.

Participants completed a questionnaire detailing sociodemographic information and HIV/STI

Results

There were 448 women participating in the study, with a mean age of 27.0±6.2 years (range, 18–45 years) and who had engaged in sex work for an average of 6.8 years. Sex work tended to follow sexual debut by 2.5 years, with relatively young ages for both debut (mean, 17.6±2.76 years; range, 12–28 years) and initiation of sex work (mean, 20.1±4.10 years; range, 13–33 years). The majority of women had undergone at least one induced abortion (60.0%; n=269), and 26.5% had a previous second-trimester

Discussion

To date, there are few published reports describing contraceptive utilization and other reproductive health outcomes, with the exception of STI, among FSW. We found that FSW in Tashkent employ contraception at a higher rate (85.0%) than the general population of reproductive-aged Uzbek women (68%) and other FSW populations [5], [6], [7]. However, only one third of women in this study utilized female-controlled methods requiring a visit to a medical provider. Of these, the IUD was most

Acknowledgments

We thank Mr. Ilkhom Kasymov and Dr. Adkham Mamatkulov for their assistance with study conduction and Ms. Oksana Subotova for her assistance with translation and data entry. We also thank Steffanie Strathdee, Ph.D., and Ward Cates, Jr., M.D., M.P.H., for their comments on manuscript preparation. Finally, we are grateful to the women who participated in this study for their time and trust. This study was supported by the U.S. Military HIV Research Program at the Walter Reed Army Institute of

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