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- Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional surveyPublication . Dias, Sónia; Gama, Ana; Fuertes, Ricardo; Mendão, Luís; Barros, HenriqueObjectives Sex workers (SW) are key populations at an increased risk of HIV infection. This study aimed to characterise risk-taking behaviours and assess HIV prevalence among SW in Portugal. Methods A cross-sectional survey was conducted with 1040 SW using a participatory research approach. SW were recruited in sex-work locations and community-based organisation offices. Data were collected through a questionnaire with trained interviewers. An HIV rapid test was performed in 213 respondents. Results Reported HIV prevalence was 8%: 17.6% of man-to-woman transgenders, 7.4% of women and 5% of men. Of SW reportedly living with HIV, 52.2% reported ever injecting drug use. Inconsistent condom use with clients in the last month was higher among male SW (26.5%) and with non-paying partners in the last year was higher among women (71.3%). Among reported HIV-positive SW, the proportions of inconsistent condom use were high. In multivariate regression analysis, reported HIV infection remained significantly higher among transgenders (OR 6.4; 95% CI 1.7 to 24.3), those older (OR 5.1; 95% CI 1.3 to 21.1), working outdoors (OR 5.4; 95% CI 1.9 to 15.6), having ever used psychoactive substances (OR 4.1; 95% CI 2.2 to 7.7) and earning ≤€1000 per month (OR 2.6; 95% CI 1.2 to 5.9). Of those who had an HIV rapid test, 8.9% were reactive; 73.7% were unaware of their seropositivity. Conclusions The HIV infection burden in SW is high. Efforts to promote HIV testing must be sustained in order to reduce undiagnosed infection. The diverse risk profiles of SW must be addressed in targeted HIV interventions. Prevention interventions should be systematically implemented within most-at-risk subgroups of SW.
- Health Services Use and HIV Prevalence Among Migrant and National Female Sex Workers in Portugal: Are We Providing the Services Needed?Publication . Dias, Sónia; Gama, Ana; Pingarilho, Marta; Simões, Daniel; Mendão, LuísThis cross-sectional bio-behavioral survey conducted with 853 female sex workers (FSW) aimed to examine differences in use of HIV health services, testing and prevalence among migrant and national FSW. A quarter of undocumented FSW had never used National Health Service (NHS) and 15 % never tested for HIV, significantly more than nationals (p < 0.001 and p = 0.024, respectively). HIV infection was self-reported by 11.9 % of nationals, 1.8 % of documented and 0.8 % of undocumented migrants (p < 0.001). The HIV rapid test was reactive in 13.6 % of undocumented, 8.0 % of nationals and 2.3 % of documented. A higher proportion of migrants were unaware of their positive serostatus compared to nationals. Ever had HIV testing was less likely among undocumented, who never used the NHS and who didn't know where to go if suspected being HIV-infected. Promoting early diagnosis with linkage to care among migrant FSW should be supported, while developing health services better tailored to their needs.
- Implementation Process and Impacts of a Participatory HIV Research Project with Key PopulationsPublication . Dias, Sónia; Gama, Ana; Simões, Daniel; Mendão, LuísA participatory HIV research project was conducted with sex workers (SW) and men who have sex with men (MSM) to understand epidemiological HIV dynamics and associated sociobehavioural factors among these vulnerable groups. We examine the impact of this project, critically analysing the processes undertaken and focusing on the advantages and the challenges faced. A partnership was built through two Community Advisory Boards (CABs) and a Scientific Commission (SC). Regular meetings, workshops, and focus groups were conducted with CABs, SC, and partners to assess the processes and outcomes of the project implementation. This participatory research produced change processes with impacts at different levels: individuals, community organizations, health professionals, academics, and policy-makers. Advantages of the participatory process were encountered but also challenges, evidencing the dynamic and complex nature of each project's stage. This project showed that participatory research can work as an intervention. Indeed, it triggered a dynamic and interactive process of knowledge coproduction and translation into effective community-oriented health actions and policies. The participatory research reproduced an innovative alliance for HIV prevention and sexual health promotion responsive to local needs and priorities. Further efforts are needed to systematize and evaluate the processes and impacts of participatory health research.
- HIV Infection, risk factors and health services use among male-to-female transgender sex workers: a cross-sectional study in PortugalPublication . Gama, Ana; Martins, Maria Rosário Oliveira; Mendão, Luís; Barros, Henrique; Dias, SóniaMale-to-female transgender sex workers (TSW) have been identified as a key population at risk for HIV. This study examined risk behaviors and HIV prevalence among TSW, and described health services use. A participatory cross-sectional survey was conducted with 125 TSW recruited in locations and networks where sex workers congregate. HIV-risk behaviors were common among participants. Inconsistent condom use with clients in the previous month was reported by 12.0% of participants and was associated with Portuguese nationality, inconsistent condom use with non-paying partners and not been reached by HIV prevention programs in the previous year. Ever use of psychoactive substances was reported by 61.6% of participants and was associated with being non-employed, doing full-time sex work, having higher number of non-paying partners and having never used health services. Also, ever use of psychoactive substances was negatively associated with older age and Portuguese nationality. About 34% of the participants reported having not been tested in the previous 12 months; 20.2% never used the health services. Overall, 14.9% (95%CI: 8.0-21.0%) reported being HIV-positive. Of those, 22.2% (95%CI: 1.0-43.5%) had unprotected sex with clients in the previous month, 26.7% (95%CI: 1.3-52.0%) had unprotected sex with non-paying partners in the previous year, 13.3% (95%CI: 0.0-33.0%) had ever injected drugs, 60.0% (95%CI: 23.0-97.0%) reported a past STI and 33.3% (95%CI: 2.0-64.6%) had currently HIV/STI co-infection. The socioeconomic, relational or partnering, and structural contexts conducive to increased risk are warranting further investigation. This knowledge would be valuable to inform prevention programs. HIV interventions, including secondary prevention, should address specific needs of TSW. Outreach initiatives aimed to reach TSW who are difficult to access can play a role in promoting access to health services and reducing HIV infection and transmission.