Original research articleUtilization of contraception and abortion and its relationship to HIV infection among female sex workers in Tashkent, Uzbekistan
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.
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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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Contraceptive use among female sex workers in three Russian cities
2015, International Journal of Gynecology and ObstetricsCitation Excerpt :Individuals further marginalized through drug use, early initiation of sex work, and low levels of control over condom use could experience greater unmet contraceptive need than others do [5,9]. Control over working conditions probably relates to contraception and reproductive health; past evidence shows increased risk of abortion among FSWs working with a pimp or brothel, facing high client volumes, or who have experienced forced unprotected sex [8,14]. Understanding contraception patterns among FSWs is particularly crucial in Russia given its high national unmet need (17%) and unintended pregnancy rate (33%) [15].
Induced abortion and use of contraceptive methods among prostitutes in Almería (Spain)
2015, Gaceta SanitariaFertility-related research needs among women at the margins
2015, Reproductive Health MattersCitation Excerpt :While high rates of pregnancy incidence among female sex workers have been documented, much less is known about the outcomes of those pregnancies and engagement in care.63,78,79 Abortion is common among sex workers, though less is known about the safety of abortions or access to post-abortion care.70,80–82 Existing information suggests that many abortions are unsafe and complications common.83–85
Induced abortion, contraceptive use, and dual protection among female sex workers in Moscow, Russia
2013, International Journal of Gynecology and ObstetricsCitation Excerpt :Negative experiences and other barriers to care seeking should be considered because they may, in part, underpin the low levels of non-barrier contraceptive use. Recent evidence from Uzbekistan illustrates that FSWs with multiple abortions often undergo second-trimester abortions—further indicating barriers to accessing care [2]. Investigation among service providers is also necessary to understand their perceptions of pregnancy intentions and reproductive health needs among FSWs.
Central Asia: hotspot in the worldwide HIV epidemic
2010, The Lancet Infectious DiseasesCitation Excerpt :Trust Points across central Asia provide targeted prevention services for female sex workers. Greater condom use among female sex workers and their clients (80–90% with last new partner) compared with other respondents in studies in Kyrgyzstan and Kazakhstan suggest that some prevention messages are reaching these groups; however, only 60% of female sex workers used condoms consistently.38,48,52,84,85 In a Tashkent study, 31% of female sex workers used condoms consistently with clients, but only 11% of those married or cohabiting did so with their regular partners.28,38,75–77