Abstract: "I Expected Little, Although I Learned a Lot": Perceived Benefits of Participating in HIV Risk Reduction Sessions Among Women Engaged in Sex Work in Uganda (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Schedule:

Friday, January 13, 2023

Valley of the Sun B, 2nd Level (Sheraton Phoenix Downtown)

* noted as presenting author

Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, MO

Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Josephine Nabayinda, Msc, Doctoral student, Washington University in Saint Louis, Saint Louis, MO

Susan Witte, PhD, LCSW, Professor, Columbia University, New York, NY

Joshua Kiyingi, MSTAT, Doctoral Student, Washington University in St. Louis, St. Louis, MO

Larissa Jennings Mayo-Wilson, PhD MHS, Associate Professor, University of North Carolina at Chapel Hill, NC

Prema Filippone, PhD, LCSW, New York University, New York, NY

Lyla S. Yang, MSW, Graduate Research Assistant, Columbia University, New York, NY

Janet Nakigudde, PhD, Lecturer, Makerere University, Uganda

Yesim Tozan, PhD, Assistant Professor, New York University, NY

Fred Ssewamala, PhD, William E. Gordon Distinguished Professor, Washington University in Saint Louis, St. Louis, MO

Background: The global HIV burden remains a public health concern. Women engaged in sex work (WESW) are at higher risk of acquiring HIV compared to the general adult population. Uganda reports high rates of HIV prevalence among WESW. While WESW in Uganda have long been the subject of surveillance studies, they have not been targeted by theory-informed HIV prevention intervention approaches. In this study, we explored the perceived benefits of an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda.

Methods: As part of a larger randomized clinical trial, we conducted semi-structured in-depth interviews with 20 WESW selected using a stratified purposive sampling. All interviews were conducted in Luganda, language spoken in the study area, and audio-recorded. They were transcribed verbatim and translated to English. Thematic analysis was used to analyze the data.

Results: WESW’s narratives focused on: 1) condom use; 2) alcohol/drug consumption; 3) PrEP use; 4) “handling” customers; and 5) "massaging” customers. WESW agreed that male condom was one of the important learning points for them and planned to continue using them while female condoms were received with mixed reactions. Many women appreciated receiving information about the risks of consuming alcohol and drugs, and discussed how they reduced/ eliminated their consumption. PrEP information was appreciated though identified by fewer WESW. Handling a client was discussed as a helpful strategy for safer sex through improved ability to convince customers to use condoms or avoiding sex. Massaging was also beneficial to avoid penetrative sex, but similar to female condom, massaging also yielded mixed perceptions.

Conclusions and Implications: WESW found the intervention beneficial and described ways in which it improved their ability to engage in safer sex and stay healthy. The fact that WESW identified other strategies beyond condom use as helpful underlines the importance of adopting a comprehensive approach to behavioral interventions targeting HIV prevention even when combined with other interventions. Additionally, WESW’s narratives suggest that incorporating the tenets of social cognitive theory and harm reduction approaches in HIV prevention among this population can result in risk behavior change.