They included blood samples for HIV and viral load testing. As the intervention had no significant impact on HIV care cascade outcomes, data were aggregated across study arms. Outcomes for all FSW improved significantly over time at all steps of the cascade, and the relative change over time was similar among older versus younger FSW for most cascade variables. Young FSW had improvements in care cascade outcomes, and proportionate improvements similar to older FSW, yet they remain less engaged in services overall.
This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Adolescents and young women who sell sex represent a substantial proportion of the FSW population.
Young FSW face structural barriers to positive sexual health outcomes including legal issues, stigma, discrimination and violence, as well as behavioral and biological barriers related to both youth and their engagement in sex work. This results in increased susceptibility to HIV infection and lower engagement in HIV services as compared to their older counterparts [ 3 β 5 ]. This significant HIV burden continues to influence the dynamic of country epidemics.
Studies have also demonstrated lower engagement in HIV services by younger FSW as compared to those who are older, including being less likely to use condoms, to engage in PrEP, to know their HIV status, to be on antiretroviral therapy ART , and to be virally suppressed [ 2 , 5 , 7 , 8 ]. Strategies include addressing structural barriers alongside delivery of behavioral and biomedical interventions, involving young FSW in program design and implementation, and taking into account specific contexts in which young women work.
In addition, strategies including peer led and age matched peer interventions, accessible confidential comprehensive clinic services, community support, and addressing structural drivers as well as sexual health needs have shown promise. However, there are few examples of successful programs targeting this population and rarely have programs been taken to scale. SAPPH-IRe was a cluster randomized trial to determine the effectiveness of an enhanced community-based intervention to increase uptake, retention in care and adherence to antiretroviral-based prevention and treatment among FSW.
