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Language: English Spanish. FSWs had higher odds to be HIV infected if they had lower income, were older, injected drugs, experienced violence, and solicited poltava pltava highways. Inconsistent condom use with clients was reported by FSWs who solicited clients at railway stations, via media, through previous clients and other FSWs, and sex highways reported lower consistency of condom use.
Furthermore, inconsistent condom use was related to younger age, alcohol use, having fewer clients, not being covered poltava HIV prevention, and experiences of violence. El usoinconstantede condones con sus clientes fue reportado por sex El presente estudio se expande sobre el escaso conocimiento de loscorrelatos de la epidemia del VIH y el uso inconstante de condones entre TDS en Ucrania.
Human immunodeficiency virus HIV is a significant public health eex in Ukraine. Onlyout of those have been tested and linked to care [ 2 ]. High-risk behaviors remain to be the most significant predictors of HIV risk in Ukraine. While HIV cases among people who inject drugs PWID dominated during the previous decade, heterosexual transmission has been the predominant attributed route of transmission among newly registered HIV cases since [ 4 ].
Effective HIV prevention strategies need to follow the changing nature of epidemics. An estimated 80, or 0. Taran et al. That study also reported higher odds of HIV infection for participants who paid for sex services. Furthermore, every third female injection drug user admitted being sdx poltava transactional sex suggesting that this particular subpopulation may both contract and spread HIV through shared needles and sex with clients [ 8 ].
Because HIV acquisition through heterosexual contacts becomes increasingly common, prevention work must be more sensitive to the settings in sex women practice sex work. Such research focusing on service locations ppoltava often programmatically useful and can enhance HIV prevention efforts [ 910 ]. Several studies focused on environments in which sex services were provided. In fact, international studies described over 80 sex work arrangements, such as streets, brothels, clubs, via escort, through plltava, brothels, lodges, dhabas, and highways [ 10 — 12 ].
Similarly to these findings, researchers found that Ukrainian FSWs worked at brothels, streets, clubs, hotels, parlors, homes, in escort services, and on-line [ 13 ]. Several studies examined the link between sex work locations and health and behavior sex of Ukrainian FSWs.
In one qualitative study, FSWs reported that in less sheltered locations such as highways and railway stations there was a greater risk for physical violence from customers who can beat FSWs, tie them, cut their face, and force polfava use, anal and group sex, and sex without a condom [ 14 ]. Every second FSW reported experiences of violence in another study carried sex in one Ukrainian city [ 13 ].
Other researchers used in-depth interviews with 45 Ukrainian FSWs [ 15 ]. In that study, Opltava, who worked on the highways, reported higher po,tava use, more violence victimization, and lower frequency of medical checkups than their poltava from more sheltered locales. Clearly, such contextual correlates sex HIV among FSWs as expo-sure to violence at work, work locations, and substance use may influence FSW's ability to use condoms even when women have access to condoms.
In addition to work locations, prior research found that women who were new to sex work lacked knowledge about HIV prevention practices and had weaker beliefs about their ability to enforce these practices during sex work [ 16 ]. Older age poltavva another factor associated with higher prevalence of HIV, syphilis infections, unprotected sex, and injection drug use [ 1718 ].
The HIV epidemic affects different territories of Ukraine unequally. Large, predominantly South-Eastern cities of Ukraine, such as Odessa, Dnipro, Donetsk, Mykolaiv oblasts, and Crimea, carry the highest burden of disease [ 21 ].
Cities that are mainly located in the Central Ukraine e. Territories in the Western e. Some researchers [ 22 ] believe that high industrialization of South-Eastern Ukrainian cities may esx complicated their economic restructuring and led to elevated rates of rates of substance use and HIV. Additionally, at the beginning of epidemics, there was a high rate of HIV transmission among PWID, and the Southern regions of Odesa and Poltaba were particularly vulnerable because of the wide availability of injection drugs that were either locally manufactured or imported through several large seaports located in these regions.
The assessment of individual and contextual factors can be helpful in building a better understanding of the Ukrainian FSW's health status and risky sex behaviors. For this study, we performed a secondary analysis of cross-sectional Integrated Biological and Behavioral Survey IBBS data collected from FSWs in Ukraine in using an interviewer-administered questionnaires and blood samples.
Following a pilot study that helped to determine which sampling polatva would be the most appropriate for each participating city, three sampling methods were used to recruit FSW participants. RDS was used to recruit participants in the cities that had a vast network of mobile, interacting with non-governmental organizations FSWs who worked at different places and were willing to recruit their peers to the study.
The RDS sampling method is based poltva social network theory and it is used to recruit hard-to-reach populations, such as FSWs [ 23 ]. Poltava this study, the seed participants had to poltava certain criteria. Participating women had to be between 14 and 24 years of age, be acquainted with least seven other FSWs that could be recruited to the study, and work at different venues in the city.
For the RDS sample, the seed was required to be connected to a large network of FSWs at least seven peers to ensure continuous recruitment after the first stage. To balance out sex age distribution of participants, the upper age was limited to 24 years because the sex study revealed greater willingness of older FSWs to engage in the study.
Also, study team encouraged FSWs from various venues as well as clients and non-clients of NGOs, to participate in the study. Women who worked at different venues in the city were more likely to spread recruitment coupons to wider networks.
Although the pilot study poltava that FSWs tended to solicit clients in one principal location, there was still some mobility both within the same-type and across different-type locales.
All seed participants were given three uniquely coded coupons to recruit three polttava participants from their personal networks. The new recruits were sex to attend a nominated RDS site, taking along their coded coupons. These new participants were, in turn, provided with recruitment coupons to share within their networks. This peer-to-peer participant recruitment process continued until the desired sample ses was achieved. TLS sampling method begins with compiling, using a random number approach, a list of sites where FSWs provide their services or solicit clients.
KI were the representatives of NGO or poltava persons who had access to poltqva groups and ensured the recruitment of the required number of respondents. All other participants received UAH Pretest and posttest consultations and the survey of respondents were provided by the certified representatives of Poktava centers or NGOs. Two outcome variables were chosen for this study. The HIV status was determined in the biological poltava of ssex study. How often have you used the condom during  sfx sex,  vaginal sex,  anal sex?
All other FSWs were classified as inconsistent condom users. Several items from the questionnaire part of the study were examined as potential predictors of HIV status and condom use with clients. Age included such categories as young 14—21 years oldmiddle 22—35 years oldolder age 36—62 years old.
FSWs answered a question about the number of clients during last 30 days, and poltava this variable was categorized into quin- tiles. Then they were asked to name one main place where sex solicit clients.
Data obtained by the respondent-driven sampling approach are typically analyzed with a statistical software package called RDSAT. However, RDSAT has limited abilities for cross-tabulation or multivariate analysis as required for the objectives of this paper. RDSAT is capable of generating individualized weights that can be used in multivariate analyses.
However, there is divided opinion regarding the utility of such weights and findings generated with them are to be treated with caution [ 23 ]. Therefore, it was impossible to use weights generated for different methods in one analysis. Thus, all analyses were performed with SAS 9. Consequently, the results should be treated as if they were derived from a convenience sample. Modified Poisson regression models with cluster-robust error variances [ 24 ] were used to assess predictors of inconsistent condom use among FSW.
Crude and adjusted models were run for both outcomes. Multivariable regression models were adjusted for all covariates significantly associated with both the exposure and outcome in the bivariate analysis. The best fit model was identified using a backward elimination building approach.
Model fit was assessed using a Chi- square goodness of fit test. Every second woman experienced violence during sex work. Positive HIV status was confirmed in 5. Inconsistent condom use with clients during last 30 days was reported by Table 1 presents results of binary logistic regression analyses for HIV status.
Both unadjusted and adjusted ORs are shown in the tables to visualize the attenuation effect attributable to confounding by other variables entered in the model. In the multivariate model place of client solicitation, age, income level, the region of work, current injection drug use and exposure to violence remained the significant predictors of positive HIV status.
Soliciting clients at highways increased odds of HIV by 1. An experience of violence during sex work increased the odds of HIV by 1. The Poisson regression with robust error variance estimates suggested that several predictors were associated with inconsistent condom use among FSWs Table 2.
Specifically, FSWs who completed vocational schools had 1. Those FSWs, who had a basic level of education 9 years and lessonly had lower prevalence inconsistent condom use PR 0. Ever experiencing violence only slightly increased prevalence of inconsistent condom use in this study PR 1.
A higher number of clients more than 50 and an older age more than 35 years old were associated with less risky sexual behavior PR 0. Very young FSWs 14—21 years old had slightly higher risks of using condoms with their clients inconsistently PR 1. Income category was also associated with risky sexual behavior. While alcohol consumption by FSWs was associated with inconsistent condom use with clients, injection drug use was not.
FSWs working poltava railway stations and high- ways were more likely poltava use condoms inconsistently PR 2. Our findings suggest that 5. Possible reduction of prevalence may be attributed to differences in sampling procedures, effective prevention efforts [ 1 ] or mortality of the FSWs. Additionally, every third woman sex this study reported inconsistent condom use.
With so many Ukrainian FSWs not using condoms regularly, understanding factors that correlate with this risky behavior becomes imperative. Our findings suggest that several socio-demographic characteristics were linked with FSWs HIV-positive status and inconsistent condom use. This finding can be explained by the fact that older women could simply have a longer exposure to risky behaviors since a considerable number of Ukrainian FSWs do not use condoms.
Next, in our study, women's risk of testing HIV-positive was related to lower income.
Contrary to our expectation, however, the risk of contracting HIV was not significantly different among more educated FSWs and FSWs who spent fewer years in educational systems. However, our findings indicated that women with vocational education were less likely to use condoms consistently. These results warrant an increased in HIV and condom use education among students of these educational institutions.
Our study supported the hypothesis that HIV-positive status would be significantly related to living in geographic regions with high prevalence of HIV. Still, our findings indicate that those FSWs who live in regions with a middle-level prevalence of HIV are most likely to use condoms inconsistently. Women from high HIV prevalence cities also had slightly elevated risk for inconsistent condom use; however, the risk was somewhat smaller than in middle HIV-prevalence cities.
This finding may be explained by the longer history of HIV prevention programs and wider coverage with condom distribution programs in high prevalence region. Place of solicitation of clients is another environmental factor that we included in our model. Our results suggest that women who worked on the highways were more likely to be HIV infected. Soliciting clients at railway stations and on the highways was also significantly related with inconsistent condom use.
The finding that the FSWs working at railways and highways are less likely to use condoms consistently can be explained by the fact that these locations are often locales of choice of the lower tier FSWs [ 15 ] who have a higher risk of being abused and may pay less attention to personal health [ 14 ]. Additionally, women who solicited clients via the Internet, previous clients and through other FSWs were also less likely to use condoms in a consistent manner.
It is a troubling finding given the limited opportunities to reach out to these women with traditional prevention services as well as the fact that this group of FSWs is rapidly growing [ 13 , 15 ]. Overall, these findings highlight the importance of changing social and geographic environments for prevention of HIV and risky sex behaviors.
The knowledge of high-risk settings can help use scarce resources in a more optimal way. The number of clients served is another correlate that we believed would be significantly related to FSWs positive HIV status, and inconsistent condom use [ 20 ].
There was no significant relationship between the number of clients served and women's HIV-positive status. However, women who served over 51 clients during past 30 days had a lower risk for inconsistent condom use. One possible explanation for this finding may be that women who attempt to provide services to vast numbers of clients are more likely to keep higher standards of safety. Still, additional research is needed to understand better what characteristics diminish the risk of inconsistent condom use in this group.
Substance use had an intricate relationship with the dependent variables in this study. The relationship between IDU and inconsistent condom use was present in the bivariate model but disappeared in the model that included all other variables.
As for the risk of inconsistent condom use, frequent alcohol consumption had the highest adjusted odds-ratios, followed by providing sex services at the railway stations. FSWs at these locations often share alcohol drinks with their clients, and it is possible that alcohol use leads to cognitive disinhibition and prioritizing immediate biological cues over long-term consequences of unprotected sex.
Of particular concern was a finding that exposure to violence during work was a strong predictor of both inconsistent condom use and the positive HIV status. Not only it violates women rights but also serves as a power mechanism that drives the HIV risks. For example, abuse can effectively limit women's ability and freedom to negotiate condom use or regulate the number and type of clients. Also, it is possible that abuse can instigate or exacerbate injecting drugs as a mechanism to cope with emotions caused by abuse, which, in turn, can increase the HIV risks.
In addition to the influence of violence, our findings also suggested that FSWs, who were not clients of the NGOs, had a higher risk for inconsistent condom use. This finding underscores the importance of the continued provision of prevention services through the non-governmental sector.
Tailoring interventions requires a comprehensive understanding of the local sex industries that operate within country-specific cultural frameworks and legislative systems [ 11 ]. This study makes a significant contribution to the global knowledge of factors associated with HIV and sex risk behaviors by utilizing a large sample of FSWs, who provide services in a difficult-to-reach and relatively unstudied context of Ukraine.
To our knowledge, this is the first study, which reported prevalence and correlates of HIV and inconsistent condom use among FSWs in Ukraine. Although this study brings important evidence about programmatically important correlates of HIV-positive status and condom use, several limitations need to be kept in mind when interpreting these findings. Information bias is possible in this study due to insincere answers of FSWs to some sensitive questions like illicit substance use or condom use.
Some FSWs may have been afraid of repercussions related to spreading STDs, potentially criminal behavior in Ukraine, and overreported the rates of condom use. As in any study of potentially stigmatic behaviors, some participants of the present study could have provided biased and socially desirable answers. Due to the cross-sectional design of this study, we were not able to make any definite causal inferences.
Some study participants were aware of their HIV-positive status at the time of the survey, which may also have influenced their current behaviors, including condom use and using services of NGOs.
Nonetheless, characteristics found to be significantly associated with HIV status and inconsistent condom use in a cross-sectional study can provide insightful hypotheses about risk factors and socio economic determinants of HIV.
Although the developers of RDS methodology claim it to produce unbiased estimates, it could not be used in all cities in Ukraine. Hence, the most accessible part of the target population is more likely to be sampled. So, conclusions may not be validly generalized to the entire population of FSWs in Ukraine. Although quantitative studies allow estimating the magnitude of the association between a variety of characteristics and condom use, they fail to see a more in-depth picture of risk behaviors and their possible causes.
Future studies employing mixed methods approach would lead to the clearer picture of circumstances when risky sex occurs. Conflict of Interest Author O. Iakunchykova declares that she has no conflict of interest. Author V. Burlaka declares that he has no conflict of interest. Ethical Approval All procedures performed in this study were in accordance with the ethical standards of the Helsinki declaration and its later amendments or comparable ethical standards.
The study protocol was approved by Commission of professional ethics of sociologist of Sociological Association of Ukraine and by Commission for medical ethics of Institute of Epidemiology and Infectious Diseases named after L. Gromashevsky of Academy of Medical Sciences of Ukraine. Informed Consent All respondents have signed the informed consent after the detailed description of the study purposes and procedure.
Human and Animals Rights This article does not contain any studies with animals performed by any of authors. National Center for Biotechnology Information , U. AIDS Behav. Author manuscript; available in PMC Aug 1. Olena P. Author information Copyright and License information Disclaimer.
Iakunchykova ude. Copyright notice. See other articles in PMC that cite the published article. Participants Following a pilot study that helped to determine which sampling method would be the most appropriate for each participating city, three sampling methods were used to recruit FSW participants.
Respondent-Driven Sampling RDS RDS was used to recruit participants in the cities that had a vast network of mobile, interacting with non-governmental organizations FSWs who worked at different places and were willing to recruit their peers to the study. Measures Outcome Variables Two outcome variables were chosen for this study. Predictors Several items from the questionnaire part of the study were examined as potential predictors of HIV status and condom use with clients. Data Analysis Data obtained by the respondent-driven sampling approach are typically analyzed with a statistical software package called RDSAT.
TV-advertisements 0. Open in a separate window. Results of Poisson Regression Predicting Inconsistent Condom Use with Clients The Poisson regression with robust error variance estimates suggested that several predictors were associated with inconsistent condom use among FSWs Table 2. Study Strengths and Limitations Tailoring interventions requires a comprehensive understanding of the local sex industries that operate within country-specific cultural frameworks and legislative systems [ 11 ].
References 1. Ukraine harmonized AIDS response progress report. Reporting period: January, —December, Search: Boy or man Girl or woman. Dating goal: Friendship Serious relationship Sex and intim.
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