2. HIV Testing Uptake Behaviour and Associated Context among Female Sex Workers in Ghana
Lamptey Jewel¹, Ottie-Boakye Doris², Appiah Margaret², Atuahene Kyeremeh1
¹ Ghana AIDS Commission (GAC)
addresses:
² Regional Institute for Population Studies (RIPS), University of Ghana-Legon,
addresses: ;

3. Outline
Background
Methods
Results
Conclusion

4. Background - 1
The uptake of HIV testing is fundamental in accessing HIV prevention, treatment, care and support services [WHO/USAID, 2015].
In 2016, the United Nations Political Declaration on Ending AIDS recognized the contribution of increasing access to and uptake of HIV testing in the achievement of the targets [UNAIDS, 2017].
Young people and Key populations such as Female Sex Workers (FSWs) usually have considerably lower access to the uptake of HIV testing services; and hence are less likely to access accompanying services covering HIV treatment, care and support [USAID, 2017].

5. Background - 2
HIV prevalence among Female Sex Workers in Ghana continues to be relatively higher than the general population.
Early diagnosis and treatment of HIV have been the most strategic method for HIV prevention.

6. Background - 3
In Ghana, routine HIV Testing services offered at drop-in- centers and during outreach sessions to Female Sex Workers (FSWs) play a key role in early diagnosis and treatment of HIV.
Yet, the extent of behaviour and context in the utilization of HIV testing service among FSWs in Ghana is less explored and remains unclear.

7. Background - 4
Study Objective
This study examines HIV testing coverage, describes behaviour, and investigates the associated context among FSWs in Ghana.

8. Methods - 1
The study site
The ten (10) regions in Ghana
Data Source
2015 Ghana Bio-Behavioural Survey (BBS) among Female Sex Workers (FSWs) and their Non-Paying Partners.
3,094 FSWs aged 16 years and above with HIV testing status, behaviour and contextual factors as variables of interest.
Figure 1: Study area

9. Methods - 2 Ethical Clearance
FHI 360’s Protection of Human Subject Committee (PHSC) and
Noguchi Memorial Institute for Medical Research (NMIMR) ethical review boards.
Informed Consent were also obtained from study participants.

10. Methods - 3 Statistical methods
For statistical techniques, both descriptive and inferential (Chi-square test and the binary logistic regression) analytical methods were employed presented in graphs, charts and tables.
All statistical analyses were done with STATA Version

11. Methods - 4
Measurement of uptake of HIV testing service
two(2) indicators-“have ever had HIV test and had had the testing in the past year”

12. Results – 1 Background Characteristics of Study population
Socio-demographic factors - Distribution of FSWs by Age group in Ghana, 2015

13. Results – 2 Background Characteristics of Study population
Socio-demographic factors - Level education among FSWs in Ghana, 2015

14. Results – 3 Background Characteristics of Study population
Behavioural factors - Type of Sex work among FSWs in Ghana, 2015

15. Results – 4 Background Characteristics of Study population
Behavioural factors- Experienced genital sores in the past year among FSWs in Ghana, 2015

16. Results – 5 Background Characteristics of Study population
Behavioural factors - Ever been screened for STIs among FSWs in Ghana, 2015

17. Results – 6 Background Characteristics of Study population
Behavioural factors–Average number of clients per Week among FSWs in Ghana, 2015
Average clients per week = 8

18. Results – 7 Background Characteristics of Study population
Behavioural factors – Usual work of Clients of FSWs in Ghana, 2015

19. 1 in 14 FSWs has ever engaged in anal sex
Results – 7
Background Characteristics of Study population
1 in 14 FSWs has ever engaged in anal sex
Behavioural factors –The practice of Anal Sex among FSWs in Ghana, 2015

20. Results – 8 Background Characteristics of Study population
Behavioural factors – Self-Perceived Risk of HIV among FSWs in Ghana, 2015

21. Results – 9 Background Characteristics of Study population
Behavioural factors – Sources of obtaining condoms among FSWs in Ghana, 2015

22. Results –10 Background Characteristics of Study population
Behavioural factors – Had contact with health peer educators in the past year by
FSWs in Ghana, 2015

23. Results – 11 Background Characteristics of Study population
Behavioural factors – Perceiving any of the Client having HIV virus among FSWs
in Ghana, 2015

24. Results – 12 Background Characteristics of Study population
Contextual factors – Coerced by Client not to use Condom during sex in the last 3 moths
among FSWs in Ghana, 2015

25. 1 in 2 FSWs had HIV testing uptake
Results – 13
Coverage of HIV Testing Uptake in the past year among FSWs in Ghana
1 in 2 FSWs had HIV testing uptake

26. Results – 13 Factor Adjusted Odds Ratio [95% CI] P-value* Age group
Factors Associated with reported HIV Testing Uptake among FSWs in Ghana - 1
Results – 13
Factor
Adjusted Odds Ratio [95% CI]
P-value*
Age group
< 25 (RC)
1.00
25-30
0.83 [ ]
0.285
≥ 31
1.15 [ ]
0.484
Level of education
No education (RC)
Primary
0.99 [ ]
0.974
Middle/JSS/JHS
0.97 [ ]
0.915
Secondary and above
1.01 [ ]
0.961
Type of sex work
Roamer (RC)
Seater
1.58 [1.13 – 2.20]
0.007*

27. Results – 14 Factor Adjusted Odds Ratio [95% CI] P-value
Factors Associated with reported HIV Testing Uptake among FSWs in Ghana - 1
Results – 14
Factor
Adjusted Odds Ratio [95% CI]
P-value
No. of partners/week
< 5 (RC)
1.00
5-10
0.86 [0.62 – 1.21 ]
0.393
≥ 11
1.20 [0.86 – 1.69]
0.281
Practice of Anal sex
Yes (RC) No
1.30 [0.71 – 2. 38]
0.386
Self-Perceived risk of HIV
No risk
Low risk
1.43 [1.03 – 1.97]
0.031*
High risk
1.05 [0.74 – 1.47]
0.793

28. Results – 15 Factor Adjusted Odds Ratio [95% CI] P-value*
Factors Associated with reported HIV Testing Uptake among FSWs in Ghana - 2
Results – 15
Factor
Adjusted Odds Ratio [95% CI]
P-value*
Ever screened of STIs
Yes (RC)
1.00 No
0.80 [ ]
0.134
Experienced genital sores in the past year
0.76 [0.56 – 1.04]
0.083**
Perceived client infected with HIV virus
0.94 [0.64 – 1.37]
0.743

29. Results – 16 Factor Adjusted Odds Ratio [95% CI] P-value*
Factors Associated with reported HIV Testing Uptake among FSWs in Ghana - 2
Results – 16
Factor
Adjusted Odds Ratio [95% CI]
P-value*
Coerced by client not to use condom
Yes (RC)
1.00 No
1.03 [0.75 – 1.42]
0.845
Source of obtaining condom
Pharmacy (RC)
Peer educator
1.43 [1.04 – 1.95]
0.025*
Other
0.84 [0.58 – 1.23]
0.378
Had contact with peer educator
0.68 [0.51 – 0.91]
0.009*

30. Conclusion
The existence of HIV testing gap among FSWs with 1 in 2 FSWs having had HIV test in the past year.
Existence of sub-population’s variations – inequality by type of sex work, perceived level of HIV risk, source of accessing condoms, and contact with peer educator in relation to HIV testing uptake.
Nationally representative snap-short of HIV testing uptake among FSWs from the perspective of some socio-demographic, behaviroual and contextual factors in Ghana.

31. Recommendations - 1
Intensification of the activities of peer educators (PE)-
-through capacity building;
-and mainstreaming of the PE model in promoting HIV testing
services is crucial.
The continuous need in devising promising strategies and innovative ways in educating, promoting, and encouraging regular access to and uptake of HIV testing especially among the roamer type of FSWs as well as the general population is crucial.
-Eg: use of the social media and smart phones as part of future
interventions, interventions and the integrating STI screening with HIV
testing services.

32. Recommendations - 2
Efficient and continuous monitoring and evaluation of HIV programs;
Use of phenomenological methods to unravel other contextual factors that may be associated with the uptake of HIV testing service among FSWs in Ghana in the quest to meet the SDG 3 to “end the epidemics of AIDS”.

33. Acknowledgements
Study Participants and Institutions involved in the data collection
Co-authors
Jewel Lamptey
Margaret Appiah
Atuahene Kyeremeh
Organizers of the 4th National HIV and AIDS Research Conference (NHARCON 2018)
Funders of the 4th National HIV and AIDS Research Conference (NHARCON 2018)

34. THANK YOU FOR YOUR ATTENTION !