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) Email addresses: jlamptey@ghanaids.gov.gh; katuahene@ghanaids.gov.gh ² Regional Institute for Population Studies (RIPS), University of Ghana-Legon, Email addresses: doboakye@gmail.com ; appiahmeg@gmail.com

Outline Background Methods Results Conclusion

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 90-90-90 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].

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.

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.

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

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

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.

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 14.0.

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”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 [0.59 - 1.16] 0.285 ≥ 31 1.15 [0.78 - 1.69] 0.484 Level of education No education (RC) Primary 0.99 [0.62 - 1.67] 0.974 Middle/JSS/JHS 0.97 [0.62 - 1.55] 0.915 Secondary and above 1.01 [0.61 - 1.68] 0.961 Type of sex work Roamer (RC) Seater 1.58 [1.13 – 2.20] 0.007*

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

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 [0.60 - 1.07] 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

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*

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.

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.

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”.

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)

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