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Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland

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. Background. Sex workers are disproportionately affected by HIV

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Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland

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  1. 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

  2. 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

  3. Conceptual Framework SOCIAL CAPITAL Social Participation (engagement in community activities outside of sex work) Social Cohesion (mutual aid, trust, and solidarity among sex workers) Impact on structural and environmental context Access to social and material resources Community support Social acceptance Collective action Communication/negotiation skills HIV knowledge/awareness Self-efficacy Reduced vulnerability to HIV Behavior change

  4. 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

  5. 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-itemindex 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

  6. Results Social Participation Median score: 1 (range: 0-7) Results (comparing high vs. low levels of participation) Social Cohesion Median score: 16 (range: 0-27) Results (comparing high vs. low levels of cohesion) * 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.

  7. 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.

  8. Acknowledgements: Co-Authors: Deanna Kerrigan, Zandile Mnisi,Sosthenes Ketende, Caitlin Kennedy, Stefan Baral Partners: Swaziland National AIDS Program, USAID, PSI Swaziland, Rock of Hope, JHU/R2P All study participants 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).

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