Characterizing HIV risk and vulnerability among commercial sex workers in Zaporizhzhya, Ukraine

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Rates of new HIV infection in Ukraine are among the highest in Europe, with the epidemic disproportionately affecting vulnerable populations, including commercial sex workers (CSW). HIV prevention programme coverage for CSW in Ukraine is generally high, but the Zaporizhzhya oblast remains underserved, despite its geographic proximity to the eastern and southern regions of the country, which are disproportionately burdened by HIV. In order to inform HIV prevention services in Zaporizhzhya, this study examines self-reported behaviours that shape HIV vulnerability and place CSW in Zaporizhzhya at increased risk for HIV infection.

A multistage, stratified cluster sampling approach identified a random sample of participants between 15 and 24 years old, who were actively practicing sex work at the time of recruitment. A team of field researchers conducted structured interviews with CSW participants to gather information about their sexual behaviours and drug use practices using a standard quantitative tool. In total, 124 CSW were interviewed, with mean age of 21.5 years. Most CSW indicated that their main source of income was from sex work, and less than half had ever been tested for HIV.

On average, participants reported 10.3 sexual partners per week, with 55.6% of CSW entertaining at least three clients per day. The majority (88.6%) of clients were occasional, with whom consistent condom use was reported among 76.8% of participants. Nearly all CSW (n = 95, 82.6%) reported alcohol consumption during sex with partners/clients in the past one-month. The use of intravenous drugs was common among drug-using participants (n = 26, 46.4%), but needle sharing was rare. Nearly half (n = 61, 49.2%) of CSW had experienced sexual violence, largely at the hands of clients. This study highlights numerous individual-level risk factors, as well as social and structural vulnerabilities for HIV faced by CSW in Zaporizhzhya.

Combination HIV prevention programmes that integrate behavioural, biomedical, and structural interventions are recommended to expand upon existing, local prevention efforts in Zaporizhzhya, and Ukraine more broadly.

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