DOI: 10.7910/dvn/24174
title: Tanzania (2013): HIV Biological and Behavioral Surveys among Female Sex Workers in Seven Regions. Round [1].

description: This report presents findings from the first round of an HIV Biological and Behavioral Survey (BBS) conducted from January through March 2013 among female sex workers (FSW) in seven regions across Tanzania: Dar es Salaam, Iringa, Mbeya, Mwanza, Tabora, Shinyanga and Mara. The primary objective of this project was to assess the prevalence of HIV and other sexually transmitted infections (STIs), and related risk factors among FSWs in Tanzania to provide an evidence base for targeted prevention and services for this group. This BBS was conducted by PSI/Tanzania in collaboration with National AIDS Control Program (NACP) and Muhimbili University of Health and Allied Sciences (MUHAS). The NACP's Biobehavioral Surveillance Survey (BSS) study in 2011 showed high prevalence of HIV among FSWs in Dar es Salaam, which provided the rational to extend the survey to other regions in Tanzania. Respondent driven sampling (RDS) was employed to sample FSWs. RDS is a sampling method based on chain-referral, designed specifically to generate probability-based samples of socially networked, hidden, or hard-to-reach populations, such as FSWs. For the purposes of this study, FSWs were defined as: women who have exchanged vaginal/anal sex in the past three months for money, are 15 years and older, and live and/or work in Tanz
ania. A total of 1869 FSWs were recruited from the seven regions. Data collection took place from March 2013 until September 2013 and all sites achieved the desired sample size in 2-3 months. The study involved the collection of behavioral data through a face-to-face interview, and the collection of biological specimens to test for HIV, syphilis and Herpes Simplex 2 (HSV2), after receiving informed consent. HIV and STI testing followed national counseling and testing guidelines, and participants who received positive test results were provided referral for treatment and services. Population estimates and corresponding 95% confidence intervals were adjusted for respondents' probability of recruitment and differential network sizes and were calculated using Respondent Driven Sampling Analysis Tool (RDSAT) Version 7.1.38. Recruitment graphics of recruitment chains were created using Netdraw 2.119. KEY FINDINGS I. Population Size of FSWs The cumulative size of the female sex worker population in the seven regions surveyed was estimated at 31,434, using the unique multiplier method. II. HIV and STI Prevalence HIV prevalence among FSWs across the seven regions is higher than that in the general population (among men and women age 15-49). In the general population, prevalence ranges from 4.2% in Mara to 9.1% in Iringa, whereas in FSWs it ranges from 14.0% in Tabora to 37.5% in Shinyanga. Syphilis prevalence among FSWs in the seven regions ranged from 2.0% to 11.1% in Mbeya and Shinyanga. Prevalence of HSV-2 infection ranged from 21.9% in Iringa to 70.0% in Shinyanga. Syphilis infection was significantly associated with higher HIV prevalence in Mbeya and Tabora, and with suggested statistical significance in Iringa and Mara. III. Condom use among FSWs Consistent condom use with a client, that is, always having used a condom during vaginal sex with a client in the past month, varied greatly by region, ranging from 4.7% in Mbeya to 54.8% in Mwanza. Condom use at last sex varied by partner type in every region surveyed. Over 80% use was reported with a paying client in Tabora, Shinyanga and Mwanza but only 34.8% in Iringa. Condom use at last sex with regular clients ranged from 37.3% in Iringa to 79.2% in Tabora and with casual paying partner from 34.4% in Iringa to 73.2% in Mwanza. Condom use at last sex with steady partners ranged from 17.4% in Shinyanga to 57.5% in Tabora and was lower than with paying clients in all regions except in Iringa where, at 43.5% it was higher than with any other type of partner. In all regions surveyed, over 70% of condom usage was attributable to the initiative or suggestion of FSWs and 84% (Iringa) to 98% (Mara) of FSWs used a socially marketed/PSI brand of condom at last sex. Between 43% (Dar) and 69% (Mwanza) of FSWs who did not use a condom at last sex, gave ÃÂÃÂÃÂÃÂclient objectionÃÂÃÂÃÂÃÂ as the main reason for non-use. IV. Alcohol and Drug Use Daily consumption of alcohol among FSWs across regions ranged from 25% in Tabora to 65% in Iringa. Drinking alcohol during sex work was common, with 70% or more FSWs from all regions surveyed reporting this. Prevalence of drug use (daily, occasional or weekly, in the past month) however, was low across regions, ranging from only 2% in Tabora to 21% in Mwanza. V. Violence and forced sex Reported experience of physical violence in the past six months ranged from 26% in Tabora to 58% in Dar es Salaam and of forced sex from 20% in Tabora to 53% in Dar es Salaam. Across regions, a high percentage of FSWs reported clients as perpetrators both of physical violence and of forced sex. VI. STIs and health seeking behavior The proportion of FSWs who had confirmed or suspected STIs in the one month before the survey ranged from 21% in Shinyanga to about 36% in Mara. While knowledge of STI services in the community ranged from 61% in Mwanza to close to 88% in Tabora, seeking treatment for STI symptoms was consistently lower in every r
egion. VII. HIV testing behavior The percentage of FSWs who had ever undergone an HIV test ranged from 40% in Mbeya to 77% in Tabora. This proportion was lower than that of women who had knowledge of VCT services in every region. Positive intentionality for HIV testing was high, ranging from 80% in Dar es Salaam to 98% in Mwanza and Shinyanga. VIII. Exposure to PSI Shosti Intervention Awareness of the PSI Shosti intervention among FSWs ranged from 11% in Tabora to 45% in Mwanza.