54% female sex workers are HIV positive — study

Fifty-four per cent (over half) of female sex workers in Uganda aged 35-49 years are living with HIV, a new study has revealed.

The HIV Bio-Behavioral Survey conducted among female sex workers in 12 districts discovered that the average (overall) prevalence, irrespective of age, is 33%, which is well above the national average of 5.8% among the adult population. This implies that three out of 10 female sex workers are living with HIV.

The survey was conducted in the districts of Arua, Busia, Buvuma, Fort Portal, Gulu, Jinja, Kampala, Lira, Masaka, Mbale, Mbarara and Tororo. A total of 7,947 female sex workers aged 18 to 49 years, as well as sexually exploited minors (SEM) aged 15 to 17 years were interviewed using Audio Computer-Assisted Self-Interviews (ACASI).

Mbarara worst hit

The same survey indicates that the HIV prevalence among female sex workers was highest in Mbarara at 54%, followed by Masaka at 45%, Fort Portal at 44% and Lira at 42%. Meanwhile, the prevalence was lowest in Mbale at 26% followed by Busia at 29%.

Worth noting, the HIV prevalence for greater Kampala (Kampala, Mukono and Wakiso districts) alone is 33%, which implies that three out of 10 female sex workers were found to have HIV.

Only one in four on treatment

It was also discovered that of the female sex workers who were found to be HIV positive, only one in four have ever been on treatment.

In addition, one in three female sex workers in Kampala missed taking their ARVs at least once in the last three months, according to the same study.

The findings were released during a national dissemination and data unit workshop at Makerere School of Public Health Auditorium early October 2024.

Explaining the key driver of the high HIV prevalence among commercial sex workers, the principal investigator of the survey, Dr Geoffrey Musinguzi said these are individuals with multiple and random sex partners.

For instance, in the survey data, each female sex worker on average would have sexual encounters with four men, which raises the risk of one of the male clients being HIV-positive. If the commercial sex worker is not on Pre-Exposure Prophylaxis (PrEP), it puts them at risk of acquiring the virus.

Musinguzi further noted that the data reveals that this type of population is always mobile.  

“At one time a female sex worker can go back to the general population given that some are married (wives) and their clients are husbands, so they can go back to their partners after acquiring HIV and they infect them,” he said.

Sex work has changed modus operandi

Musinguzi said there is a need to be innovative and put in place more strategies for reaching out to these female sex workers.

“Where are they? How can we be able to reach them, and using which strategies? Can we give them PrEP?” Musinguzingi said and added: Previously, female sex workers would operate in hotels and streets, but lately, there is a shift in how they operate and have changed strategy. Some of them conduct their sex work on phones, in their homes and in massage parlours hence the need to change strategy to reach them.

Mutumba said HIV epidemic control requires collaborative action, and urged all stakeholders, government agencies and non-state actors, civil society organisations, development partners and communities to strengthen partnerships and prioritize evidence-based solutions.

The survey was supported by the US Centres for Disease Control and Prevention (CDC).

Over sh27b invested

“We have invested more than $7m (about shillings 26 billion) in these studies since 2008 to date, to gain insights into HIV prevention and treatment strategies for key populations in Uganda,” the US Ambassador to Uganda, William Popp said.

Popp said the report will help identify individuals in key populations particularly vulnerable communities for HIV infection and transmission.

He further noted that having that information helps to develop the public health responses, making sure antiretroviral (ARV) medicines get to the people who need them, and Pre-Exposure Prophylaxis (PrEP) drugs to help people stay HIV-negative.

In addition, Popp said the report will also help the US Government understand how to best allocate resources that have been collectively invested in Uganda, but also the resources that Ugandan government through the health ministry invests in preventing and fighting HIV.

According to Popp, achieving all that starts with transparent and solid data. “The US government recognizes that a healthy population is the foundation for a country’s social and economic development. Therefore, every year we invest over $500m in Uganda’s health sector, the bulk of which goes to supporting HIV programmes through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).”

Key in designing policies

Makerere University School of Public Health dean Prof. Rhodah Wanyenze said it is important to collect data that tracks disease dynamics in the community to inform policies and programmes of the Uganda AIDS Commission.

“More than 15 years ago, this data has been able to inform the design of policies. For instance, the National Strategic plan for HIV has been based on the data that the Makerere University School of Public Health has released for the last 15 years,” she said. 

Prof. Wanyenze said commercial sex workers are at a very high risk of acquiring HIV given the nature of the work that they do and at the same time, they pose the risk of transmitting to other people.

The head of the AIDS Control Programme at the health ministry, Dr Robert Mutumba, said the report represents a critical stage in the ongoing efforts to achieve epidemic control through research surveillance and data-driven interventions targeting key and vulnerable populations.

“The findings from the survey will offer invaluable insights that will shape our response and bring us closer in achieving the global UN 95-95-95 targets,” he said.

Mutumba said the health ministry is focusing on utilising evidence generated from research to monitor disease trends and inform implementation of targeted programmes.

HIV burden

The 2024 Uganda HIV and AIDS Factsheet (Based on Data ending 31 s t December 2023) indicates that the National HIV prevalence among adults (15 to 49) stands at 5.1%, and this is a significant decline from 5.8% in 2020. The prevalence rate in men stands at 3.6% while that of women is at 6.6%.

The number of new HIV infections stands at 38,000 down from 52,000 in 2022. There has been a declining trend in AIDS-related deaths from 21000 in 2022 to 20,000 in 2023.

Estimated number of people living with HIV/AIDS stood at 1,492,407 by the end of December 2023.

Approximately 4,700 of the total new HIV infections were due to mother-to-child transmission countrywide, in 2023.

New infections arising from mother-to-child transmission of HIV continue to decline due to an aggressive PMTCT strategy. Vertical Transmission of HIV (+ breastfeeding) now stands at 5.04% in 2023.