Prevalence and factors associated with sexually transmitted infections and engagement in HIV care among female sex workers in two large cities of Zimbabwe: Analysis of respondent-driven sampling surveys in 2023

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BACKGROUND: Female sex workers (FSWs) in Zimbabwe, where sexually transmitted infections (STIs) are managed syndromically, are at high risk of STIs and HIV. METHODS: We conducted a respondent-driven sampling (RDS) survey to assess the prevalence, engagement in HIV care and factors associated with STIs among FSWs in two cities of Zimbabwe. Participants self-completed an audio computer-assisted self-interview. Participants were offered HIV testing, and if positive, were tested for HIV viral load. Additionally, 45% were randomly selected and screened for syphilis, gonorrhoea (GC), chlamydia (CT) and trichomonas (TV). RDS-II weighted HIV and STI prevalence and 95% CIs were calculated. The HIV treatment cascade was determined for FSWs living with HIV. Factors associated with having at least one STI (GC/CT/TV) were determined using modified Poisson regression. RESULTS: We recruited 3006 FSWs from Harare and Bulawayo. HIV prevalence was 41.3% (95% CI 38.1% to 44.6%). Among FSWs living with HIV, 83.4% (95% CI 79.0% to 87.0%) reported being aware of their status. Of those aware, 97.3% (95% CI 94.4% to 98.8%) reported being on antiretroviral therapy (ART), and of those on ART, 93.1% (95% CI 89.3% to 95.7%) were virally suppressed. Overall, 90.1% (95% CI 86.6% to 92.7%) of FSWs living with HIV were virally suppressed. The prevalence of active syphilis was 4.4% (95% CI 3.2% to 6.0%), gonorrhoea was 13.4% (95% CI 11.3% to 15.9%), CT was 20.7% (95% CI 18.2% to 23.5%) and TV was 23.7% (95% CI 21.0% to 26.6%). Of the 598 FSWs with a current STI, 52.4% (95% CI 47.4% to 57.3%) did not have HIV infection. Factors associated with increased relative risk of having at least one STI, after adjusting for age and city, included being divorced/separated, living with HIV and reporting STI symptoms in the past year. CONCLUSION: While there have been huge gains in identifying and treating FSWs living with HIV, many STIs remain undetected, and a significant proportion of HIV-negative FSWs are affected by these infections, suggesting an urgent need for improved STI management including access to cheap point of care diagnostics.

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