Nuvunga Samuel, Banze Áuria Ribeiro, Muleia Rachid, Langa Denise Chitsondzo, Sacarlal Jahit, Baltazar Cynthia Semá
Field Epidemiology Training Program (FETP), National Institute of Health, PO Box 264, Maputo, Mozambique.
Instituto Nacional de Saúde (INS), Maputo, Mozambique.
BMC Public Health. 2025 May 30;25(1):1995. doi: 10.1186/s12889-025-23114-3.
Female sex workers (FSWs) remain disproportionately affected by HIV due to a combination of structural, social, and behavioral factors, including stigma, limited access to health services, gender-based violence, and legal barriers. In Mozambique, where sex work is informal and highly marginalized, monitoring trends in service uptake is essential to guide responsive and equitable HIV interventions. This study analyzes changes in access to and use of HIV prevention services among FSWs between 2011 and 2019.
We conducted a secondary analysis of cross-sectional bio-behavioral survey (BBS) data collected among FSWs in 2011 and 2019 in three Mozambican urban centers. Standardized questionnaires were used to collect behavioral and biological data, including indicators of HIV prevention service access. Participants were recruited using Respondent-Driven Sampling (RDS). Logistic regression was applied to assess time trends and identify factors associated with service uptake.
A total of 1,240 FSWs participants were recruited in 2011 and 1,530 in 2019. Between 2011 and 2019, there was a significant increase in HIV prevalence (from 11.9 to 24.5%). The proportion of participants accessing HIV prevention services more than doubled (from 21.4 to 52.3%), alongside marked improvements in HIV testing uptake (68.0-83.1%) and consistent condom use with clients (74.1-86.3%). Multivariate analysis showed that age ≥ 25, moderate HIV risk perception, and experiences of sexual violence were positively associated with access to prevention services in 2019. In contrast, alcohol use and physical assault were negatively associated with service use. Determinants of access shifted over time; for example, while secondary education was positively associated with service access in 2011, it was negatively associated in 2019.
There has been substantial progress in access to and use of HIV prevention services among FSWs in Mozambique over the past decade. Nonetheless, the rising HIV prevalence and persistent disparities related to age, education, economic vulnerability, and exposure to violence signal the need for more comprehensive, context-specific, and equity-focused strategies. Reinforcing peer-led outreach, integrating gender-based violence response, and addressing risk misperception are critical to strengthening Mozambique's HIV prevention continuum for this key population.
由于结构、社会和行为等多种因素的综合作用，包括耻辱感、获得医疗服务的机会有限、基于性别的暴力和法律障碍，女性性工作者（FSW）受艾滋病毒影响的比例仍然过高。在莫桑比克，性工作是非正规且高度边缘化的，监测服务利用趋势对于指导针对性强且公平的艾滋病毒干预措施至关重要。本研究分析了2011年至2019年间女性性工作者获得和使用艾滋病毒预防服务的变化情况。
我们对2011年和2019年在莫桑比克三个城市中心收集的女性性工作者横断面生物行为调查（BBS）数据进行了二次分析。使用标准化问卷收集行为和生物学数据，包括艾滋病毒预防服务获取指标。采用应答驱动抽样（RDS）招募参与者。应用逻辑回归来评估时间趋势并确定与服务利用相关的因素。
2011年共招募了1240名女性性工作者参与者，2019年为1530名。2011年至2019年间，艾滋病毒感染率显著上升（从11.9%升至24.5%）。获得艾滋病毒预防服务的参与者比例增加了一倍多（从21.4%升至52.3%），同时艾滋病毒检测接受率（从68.0%提高到83.1%）和与客户始终坚持使用避孕套的比例（从74.1%提高到86.3%）也有显著改善。多变量分析表明，2019年年龄≥25岁、中度艾滋病毒风险认知以及性暴力经历与获得预防服务呈正相关。相比之下，饮酒和身体攻击与服务利用呈负相关。获取服务的决定因素随时间而变化；例如，虽然2011年中等教育与获得服务呈正相关，但在2019年则呈负相关。
在过去十年中，莫桑比克女性性工作者在获得和使用艾滋病毒预防服务方面取得了重大进展。尽管如此，艾滋病毒感染率上升以及在年龄、教育、经济脆弱性和遭受暴力方面持续存在的差距表明，需要制定更全面、因地制宜且注重公平的战略。加强同伴主导的外展服务、整合基于性别的暴力应对措施以及解决风险认知错误对于加强莫桑比克针对这一关键人群的艾滋病毒预防连续服务至关重要。
