Introduction HIV infection and pregnancy are both common among female sex workers (FSW), indicating the need for prevention of mother-to-child transmission (PMTCT) among FSW.
Methods FSW were enrolled into studies in Swaziland, Burkina Faso and Togo using respondent-driven sampling. Women completed interview-administered socio-behavioural surveys and HIV counselling and testing. This secondary analysis describes contraceptive use and attempted pregnancy among reproductive-aged FSW (16–49 years). Robust Poisson regression with generalised estimating equations to account for clustering within recruitment networks was used to separately estimate associations between current unmet contraceptive need and attempted pregnancy among FSW.
Results Overall 1666 FSW were enrolled, 1372 (82.4%) of whom had ever been pregnant. In Togo and Burkina Faso, 83 FSW reported a prior HIV diagnosis and having a child, of which 12.1% (10/83) reported a child known to be HIV-positive. Twenty-five per cent of FSW had an unmet need for contraception; 9% of FSW employed dual contraception, including highly effective non-barrier methods and consistent condom use. Consistent condom use varied substantially by partner type and was higher with clients than non-paying partners. Nineteen per cent (n=313/1666) of FSW were trying to conceive. HIV-positive, undiagnosed FSW were more likely to be trying to conceive as compared to HIV-negative FSW; among 98 HIV-positive women trying to conceive, 25.5% were on antiretroviral therapy.
Conclusions FSW have varying reproductive goals and contraceptive usage. Efforts to improve coverage of comprehensive family planning – including efforts to increase HIV testing and engagement in treatment among FSW trying to conceive – are necessary for PMTCT.
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Funding This work was supported by Project SEARCH, which was funded by the United States Agency for International Development under contract GHH-I-00-07-00032-00, and by the President's Emergency Plan for AIDS Relief.
Competing interests None declared.
Ethics approval Swaziland Scientific and Ethics Committee, the Health Research Ethics Committee of Burkina Faso, the National Ethics Committee of Togo and the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional data related to sex work may be available from Swaziland, Burkina Faso and Togo upon request. Those interested in working with these data should contact Stefan Baral at firstname.lastname@example.org.
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