Gender-based violence, social cohesion, and engagement in HIV care among female-sex workers in Iringa, Tanzania: A mixed methods approach

Johns Hopkins University, Baltimore MD

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Abstract

? DESCRIPTION (provided by applicant): Female sex workers (FSWs) in sub-Saharan Africa (SSA) are disproportionately affected by HIV and play a key role in ongoing transmission dynamics in the region. Gender based violence (GBV) may promote in HIV acquisition and transmission among FSWs and their sexual partners. Past studies have established the negative effect of GBV on sexual risk behaviors among FSWs in SSA. Our study addresses the limited knowledge regarding the effect of GBV on utilization of HIV care and treatment services among HIV-infected FSWs, and how social cohesion may influence this relationship. These behaviors are necessary for ensuring the health and wellbeing of the HIV infected individual, and reducing the risk of transmission to an HIV uninfected partner. Through a sample of HIV-infected FSWs from Iringa, Tanzania, the purpose of the proposed research is to investigate the relationship between GBV, social cohesion and engagement in HIV care among this population. Specifically, this study aims to assess the relationship between GBV and engagement in HIV care, and explore how social cohesion may modify this relationship. The proposed research will use quantitative baseline survey data from a parent NIMH/NIAID-sponsored community-based combination prevention study among FSWs. We will also conduct qualitative in-depth interviews to explore the perspectives and experiences of HIV-infected FSWs who have experienced GBV regarding the role social cohesion plays in access and retention in HIV care and treatment. Finally, through a parallel mixed methods design, we will assess how the quantitative and qualitative results converge in order to gain a comprehensive understanding of the role social cohesion plays in HIV service utilization among HIV-infected FSWs who have experienced GBV. The proposed research offers an opportunity to work with a strong mentorship team, comprised of faculty members who are leaders in their fields, to build skills in advanced data analysis, social theory and mixed methods, while simultaneously addressing NIMH's HIV research priorities and strategic goals. Findings will advance knowledge regarding the role of GBV in engagement in HIV care among FSWs and ultimately inform the development of integrated GBV and HIV treatment interventions among FSWs in SSA and globally.