social cohesion, social participation, and hiv related risk among female sex workers in swaziland...
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Social cohesion, social participation, and HIV related risk among female sex
workers in Swaziland
Virginia Fonner
Johns Hopkins Bloomberg School of Public Health
July 3, 2013
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Background
• Sex workers are disproportionately affected by HIV• Research and interventions among sex workers are lacking in
Swaziland• Social capital can potentially reduce HIV vulnerabilities by:
– Facilitating internal group-related mutual aid and support– Providing access to social and material resources
• Social capital is related to community empowerment, an intervention strategy recommended by WHO and endorsed by sex workers
• The concept of social capital is notoriously difficult to define and operationalize
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Conceptual Framework
Social Cohesion (mutual aid, trust, and solidarity among
sex workers)
Social Participation(engagement in community activities
outside of sex work)
Access to social and material resourcesCommunity support Social acceptanceCollective action
Communication/negotiation skillsHIV knowledge/awareness
Self-efficacy
Behavior change
Impact on structural and environmental
context
SOCIAL CAPITAL
Reduced vulnerability to
HIV
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Study Objective
• Assess relationships between social cohesion, social participation, and HIV-related risk among female sex workers in Swaziland
• HIV-related risk assessed through:– Behavioral outcomes (ex: condom use)– Biological outcomes (ex: HIV serostatus)– Social discrimination and exposure to violence– Collective action
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Methods
• Cross-sectional survey among women in Swaziland who reported selling sex in the past year
• 325 women recruited using respondent-driven sampling• Social cohesion: 9-item scale (α= 0.76) • Social participation: 4-item index accounting for levels of
participation in various social groups• Both social capital constructs were dichotomized for analysis• Logistic regression used to asses relationships of social
capital constructs and HIV-related risk
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Results
Outcome aOR*95% Confidence Interval
Consistent condom use in past week 2.10 1.26-3.51
Reported refusal of police protection 0.56 0.35-0.90
Participating in meetings to promote sex worker rights 2.02 1.23-3.32
Outcome aOR* 95% Confidence Interval
Received HIV test in previous year 2.27 1.31-3.92
Condom use with non-paying partners 1.72 1.03-2.88
Reported verbal or physical harassment 0.58 0.36-0.94
Social CohesionMedian score: 16 (range: 0-27)
Results(comparing high vs. low levels of cohesion)
Social ParticipationMedian score: 1 (range: 0-7)
Results(comparing high vs. low levels of participation)
* Adjusted for age, income, education, marital status, region, and RDS weights based on estimated population proportions of outcome variables.. Odds ratios compare participants with high vs. low social cohesion/participation.
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Conclusions
High levels of social cohesion and social participation are associated with protective behaviors related to HIV.
More research is needed to understand the social context of female sex workers in Swaziland, such as the extent to which sex workers are willing and able to collectivize and how sex workers are portrayed and treated by the larger community.
Building social capital could potentially improve access to resources, enhance social support, and change HIV-related behaviors among this population.
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The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP).
Acknowledgements: Co-Authors: Deanna Kerrigan, Zandile Mnisi, Sosthenes
Ketende, Caitlin Kennedy, Stefan BaralPartners: Swaziland National AIDS Program, USAID, PSI
Swaziland, Rock of Hope, JHU/R2PAll study participants
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