Correlates of HIV and Inconsistent Condom Use Among Female Sex Workers in Ukraine

Introduction: It is estimated that some 50,000 women, including 15% underaged, provide sex services to support their families in Ukraine. While HIV cases among people who inject drugs (PWID) had dominated in the beginning of HIV/AIDS epidemics in Ukraine, heterosexual transmission grew to be an attributed route of transmission among newly registered HIV cases since 2008. Hence, female sex workers (FSWs) became a group with one of the highest risks of HIV transmission. Yet, little is known about sociodemographic characteristics and work circumstances of FSWs in Ukraine. Based on literature from other countries, we hypothesized that women’s HIV-positive status and inconsistent condom use will be associated with lower socio-economic status, higher client load and substance use, exposure to violence, and client solicitation on highways and railway stations.

Methods: Following informed consent procedure, the International HIV/AIDS Alliance in Ukraine collected cross-sectional data from 4806 FSWs in 25 cities of Ukraine in 2013 using an interviewer-administered questionnaire and the collection of blood samples.

Results: The prevalence of HIV among FSWs was 5.6%. Results of multivariate logistic regression revealed that FSWs had higher odds to be HIV infected if they had lower income (OR 2.33, CI 1.42-3.80) and were older (OR4.61, CI 2.38-8-94), served more than 100 clients during part month (OR2.05, CI 1.08-3.86), injected drugs (OR 4.80, CI 3.41-6.75), had experience of violence during sex work (OR 1.45, CI 1.09-1.93), and solicited clients on highways (OR 1.64, CI 1.03-2.60). Inconsistent condom use with clients was reported by 34.5% of FSWs. FSWs who solicited clients at railway stations (OR 5.12 CI 3.34-7.86), via media (OR 1.91 CI 1.47-2.46), through previous clients and other FSWs (OR 2.53, CI 1.84-3.39), and on highways (OR 1.75, CI 1.39-2.21) reported lower consistency of condom use. Furthermore, inconsistent condom use was related to younger age (OR 1.69, CI 1.30-2.19), alcohol use (OR 4.20, CI 2.92-6.04), having less than 50 clients per month (OR 1.85, CI 1.14-3.00), not being a client of any NGO dealing with HIV prevention (OR 1.87, CI 1.62-2.16) , and experiences of violence during sex work (OR 1.19, CI 1.38-1.64).

Conclusions: The present study aimed to expand on the rather limited knowledge of correlates of the HIV and inconsistent condom use among FSWs in Ukraine. Although the study design does not permit inferences about causes and effects, it provides valuable information about women’s life and work circumstances that co-occur with higher frequency of HIV and unsafe sex practices. These results can be used in prevention interventions that aim to target the most at risk groups of FSWs.