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How Can Programmes Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis


Fearon, Elizabeth; Phillips, Andrew; Mtetwa, Sibongile; Chabata, Sungai T.; Mushati, Phillis; Cambiano, Valentina; Busza, Joanna; Napierala, Sue; Hensen, Bernadette; & Baral, Stefan D., et al. (2019). How Can Programmes Better Support Female Sex Workers to Avoid HIV Infection in Zimbabwe? A Prevention Cascade Analysis. Journal of Acquired Immune Deficiency Syndromes, 81(1), 24-35. PMCID: PMC6467580


BACKGROUND: 'HIV prevention cascades' have been proposed to support programmes by identifying gaps in demand for, access to and capability to adhere to HIV prevention tools, but there are few empirical examples to guide development. We apply a prevention cascade framework to examine prevention coverage and factors associated with condoms and/or PrEP adherence among female sex workers (FSW).
SETTING: Seven sites across Zimbabwe.
METHODS: Seven respondent-driven sampling (RDS) surveys from the intervention sites of a pragmatic cluster-randomised trial in Zimbabwe in 2016 were analysed, and 611/1439 women testing HIV-negative included. We operationalised key components of an HIV prevention cascade including demand, supply and capability to adhere to two tools for HIV prevention: condoms and Pre-Exposure Prophylaxis (PrEP). We used adjusted logistic regression to identify determinants of adherence to condoms and PrEP in turn, examining the effect of adherence to one tool on adherence to the other.
RESULTS: There were 343/611, 54.7%, women reporting adherence to condoms and/or PrEP, leaving almost half uncovered. While women were aware that condoms prevented HIV and reported good access to them, only 45.5% reported full adherence to condom use. For PrEP, a new technology, there were gaps along all three domains of demand, supply and adherence. Alcohol use decreased adherence to PrEP and condoms. Younger and newer entrants to sex work were less likely to take PrEP every day.
CONCLUSION: HIV prevention programming among FSW in Zimbabwe could consider increasing awareness of PrEP alongside supply, alcohol use interventions, and approaches to engaging younger women.


Reference Type

Journal Article

Year Published


Journal Title

Journal of Acquired Immune Deficiency Syndromes


Fearon, Elizabeth
Phillips, Andrew
Mtetwa, Sibongile
Chabata, Sungai T.
Mushati, Phillis
Cambiano, Valentina
Busza, Joanna
Napierala, Sue
Hensen, Bernadette
Baral, Stefan D.
Weir, Sharon S.
Rice, Brian
Cowan, Frances M.
Hargreaves, James R.