Exploratory analysis of the potential impact of violence on HIV among female sex workers in Mombasa, Kenya: a mathematical modelling study

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dc.contributor.authorPickles, Michael
dc.contributor.authorMountain, Elisa
dc.contributor.authorBhattacharjee, Parinita
dc.contributor.authorKioko, Japheth
dc.contributor.authorMusimbi, Janet
dc.contributor.authorMusyoki, Helgar
dc.contributor.authorGichangi, Peter
dc.contributor.authorStannah, James
dc.contributor.authorMaheu-Giroux, Mathieu
dc.contributor.authorBecker, Marissa
dc.contributor.authorBoily, Marie-Claude
dc.date.accessioned2024-11-07T17:21:34Z
dc.date.available2024-11-07T17:21:34Z
dc.date.issued2024-10-15
dc.date.updated2024-11-01T04:30:33Z
dc.description.abstractBackground Understanding the frequency of violence experienced by female sex workers (FSWs) and how violence contributes to HIV transmission can help improve HIV programs. Methods Using recent recommendations for modelling structural factors and associated causal pathways, we developed a HIV transmission dynamic model for FSWs and their clients in Mombasa, Kenya, mechanistically representing three types of violence (sexual violence, SV; physical violence, PV; police assault and arrest, PAA). Each type of violence affects HIV transmission through key mediators (condom non-use, HIV testing). We parameterized the model using data from a cross-sectional study of FSWs aged 15–24 recruited from a systematic geographical mapping sampling frame in Mombasa, Kenya (Cheuk E et al., Frontiers in Reproductive Health 2(7), 2020). Using this model, calibrated (and cross-validated) to HIV epidemiological and violence outcomes, we estimated the incidence of violence episodes, the contribution of violence to the HIV epidemic measured by the transmission population-attributable fraction, and the potential impact of possible violence interventions. Results The median estimated incidence of PAA in 2023 among FSWs who had not previously experienced that type of violence was 0.20 (95% credible interval: 0.17–0.22) per person-year (ppy), about double the incidence of SV and PV (0.10 (0.09–0.11), 0.11 (0.09–0.12), respectively). The incidence of violence was higher among FSWs who had previously experienced violence: the incidence of recurrent PV was 2.65 (1.82–3.37) ppy, while the incidence of recurrent SV and PAA were 1.26 (0.80–1.67) and 1.37 (0.94–1.74 ppy, respectively. In this setting, we estimated that a median of 35.3% (3.4–55.8%) infections in FSWs and clients combined over the next 10 years may be due to all types of violence (and mediators), mainly through reduced condom use in FSWs who have ever experienced SV (34.6% (2.4–55.5%)). Interventions that prevent future violence without mitigating the effects of past violence may only prevent 8.8% (0.8–14.0%) infections over 10 years. Conclusions FSWs in Mombasa experience violence frequently. In this population, we find that addressing sexual violence, including mitigating the effects of past violence, is potentially important in reducing HIV transmission in this population. However, the wide uncertainty range shows longitudinal studies are needed to strengthen the evidence of the influence of violence on HIV risk behavior. We find that the recommendations for modelling structural factors provide a useful framework for describing the model.
dc.identifier.citationBMC Medicine. 2024 Oct 15;22(1):468
dc.identifier.doi10.1186/s12916-024-03670-y
dc.identifier.urihttp://hdl.handle.net/1993/38663
dc.language.isoeng
dc.language.rfc3066en
dc.publisherBMC
dc.rightsopen accessen_US
dc.rights.holderThe Author(s)
dc.subjectHIV
dc.subjectAIDS
dc.subjectStructural determinants
dc.subjectStructural interventions
dc.subjectMathematical modelling
dc.subjectCausal pathways
dc.subjectFemale
dc.subjectSex work
dc.subjectViolence
dc.subjectCondom use
dc.subjectAntiretroviral therapy
dc.subjectKenya
dc.titleExploratory analysis of the potential impact of violence on HIV among female sex workers in Mombasa, Kenya: a mathematical modelling study
dc.typeJournal Article
local.author.affiliationRady Faculty of Health Sciences::Max Rady College of Medicine::Department of Community Health Sciences
oaire.citation.issue468
oaire.citation.titleBMC Medicine
oaire.citation.volume22
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