Proscovia Nabunya, MSW, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO
Edward Nsubuga, Master's Student, Washington University in St. Louis, MO
Samuel Kizito, MD, MS, Research fellow, Washington University in St. Louis, St Louis, MO
Josephine Nabayinda, Msc, Doctoral student, Washington University in Saint Louis, Saint Louis, MO
Ozge Sensoy Bahar, PhD, Research Assistant Professor, Washington University in Saint Louis, MO
Flavia Namuwonge, MBA, Doctoral Student, Washington University in St. Louis, MO
Jennifer Nattabi, MSW, Doctoral Student, Washington University in Saint Louis, St. Louis, MO
Susan Witte, PhD, LCSW, Professor, Columbia University, New York, NY
Fred Ssewamala, PhD, Professor, Washington University in Saint Louis, Saint Louis, MO
Introduction: Women engaged in commercial sex work (WESW) are among the key population with increasing rates of HIV infection. The risk of acquiring HIV is 30 times higher for WESW compared to the general population. WESW contribute a great deal to the transmission of HIV to the general population because of their risky behaviors, which include condomless sex, multiple sexual partners, drugs and alcohol use, among others. Access to healthcare services is critical in treating and preventing HIV among WESW and to the general population. However, with all the improvements in HIV health-related service delivery, WESW still finds it hard to access medical care. This study examined the factors associated with access to medical care among WESW participating in an HIV risk reduction intervention in southern Uganda.
Methods: Data from a longitudinal cluster randomized study involving 542 WESW (18-55 years), recruited from 19 HIV hotspots were analyzed. WESW were eligible if they were 18 years and above, exchanged sex for money or other goods and services in the last thirty days and reported one episode of unprotected sex. Data were collected at baseline, six, 12, 18 and 24-month follow-ups. Access to medical care was measured using six items related to seeking medical care in the past 12 months. Participants' responses were summed up to create a continuous outcome. A multilevel linear regression model was fitted to predict the correlates of access to medical care among WESW.
Results: Preliminary analyses indicated that WESW with more HIV knowledge (β = 4.659, 95% CI= 2.064, 7.254, p<0.001) and increased community satisfaction (β = 0.138, 95% CI= 0.068, 0.208, p<0.001) were more likely to access medical care. In contrast, older WESW (β= -0.063, 95% CI= -0.110, -0.016, p=0.010) and those with more asset ownership (β = -1.330, 95% CI= -2.191, -0.469, p=0.004), were less likely to access medical care.
Conclusions: Preliminary results show that intrapersonal and community-level factors were associated with decreased access to medical care among WESW in Uganda. These results point to the need to increase HIV knowledge among WESW and awareness of the importance of seeking medical care services, especially for WESW in low-resource settings.
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