Online Program

Most at-risk: Sex workers and non-sex workers who use alcohol and drugs living with or at-risk for HIV in South Africa

Wednesday, November 4, 2015 : 11:10 a.m. - 11:30 a.m.

Wendee M. Wechsberg, PhD, MS, Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC
Irene Doherty, MPH, PhD, Substance Abuse Treatment Evaluations & Interventions, RTI International, Research Triangle Park, NC
Jackie Ndirangu, MSC-GH, Substance Use, Gender, and Applied Research Program, RTI International, Rockville, MD
Tracy Kline, PhD, Stat Epi, RTI International, Durham, NC
Nat Rodman, MA, Research Computing Division, RTI International, Durham, NC
Brittni Howard, BA, Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC
William A. Zule, DrPH, Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC
Background: More people live with HIV in South Africa than anywhere else in the world.  Many disadvantaged women who use alcohol and other drugs (AODs) also conduct sex work to survive and are at greater risk for HIV.

Methods: A clustered randomized experiment funded by NIDA (R01 DA032061) in Pretoria, South Africa targets disadvantaged women who use drugs or alcohol.  The experimental group receives an evidenced-based woman-focused intervention to reduce sex risk, victimization, and alcohol and drug use and case management for linkages to HIV care, substance abuse treatment and other health needs.

Results: The study enrolled 641 women.  At baseline, 54% tested positive for HIV, 20% of whom were newly diagnosed.  37% of women reported sex work (SW) in the previous 6 months; 66% were living with HIV compared to 47% (p<0.0001) of non-sex workers (NSW).  Substantially more SW than NSW used cocaine (21% vs 11%, p=0.001) and marijuana (40% vs. 27%, p<0.0001), heavy alcohol use did not vary (47%).  Physical abuse from current partners was more prevalent among SW (22%) than NSW (13%). Most SW (68%) and few NSW (18%) reported condom use at last sex. Among women who knew they had HIV at baseline, 61% had received HIV care and 17% reported ever taking ART.

Conclusion: HIV prevalence is high among women in Pretoria who also report poly-drug use. Sex workers report higher levels of AOD use and also have higher levels of HIV demonstrating a most-at-risk group needing a gender-focused intervention and health services.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Public health or related research
Social and behavioral sciences

Learning Objectives:
Compare the differences in alcohol and other drug use among sex workers and non sex workers along with how the woman-focused intervention addresses barriers to treatment for these most-at-risk women. Explain the intersecting risk behaviors and contextual factors in South Africa where higher HIV prevalence is found among sex workers.

Keyword(s): Women and HIV/AIDS, Sex Workers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI of this study and have worked in South Africa since 2001. I developed the proposal and intervention, and I have been responsible for the implementation. This abstract is based on my plans for my first baseline paper from this study. It has not been presented anywhere. I have a PhD and years of experience conducting research in the realm of HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5106.0: HIV/AIDS in Africa