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AIDS Patient Care STDS. 2017 Jul;31(7):290-296. doi: 10.1089/apc.2017.0016. Epub 2017 Jun 5.

Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs.

Author information

1 John Snow, Inc. , Lusaka, Zambia .
2 Department of Sociomedical Sciences, Columbia University Mailman School of Public Health , New York, New York.
3 Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
4 John Snow, Inc. , Boston, Massachusetts.
5 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
6 Faculty of Medicine, Institute of Public Health, University of Heidelberg , Heidelberg, Germany .
7 Africa Health Research Institute , Mtubatuba, South Africa .
8 Francis I. Proctor Foundation, University of California , San Francisco, California.


Zambia has a generalized HIV epidemic, and HIV is concentrated along transit routes. Female sex workers (FSWs) are disproportionately affected by the epidemic. HIV testing is the crucial first step for engagement in HIV care and HIV prevention activities. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. FSW peer educators were recruited through existing sex worker organizations for participation in a trial related to HIV testing among FSWs. We conducted five focus groups with FSW peer educators (N = 40) in three transit towns in Zambia (Livingstone, Chirundu, and Kapiri Mposhi) to elicit community norms related to HIV testing. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier. Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.


HIV testing; Zambia; female sex workers

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