High HIV Prevalence among Female Refugee Sex Workers in Kampala, Uganda, Linked to Behavioural and Structural Risks
Abstract:
Female sex workers bear a disproportionate burden of HIV globally, yet little is known about HIV epidemiology among refugee sex workers in urban African settings. This study estimated HIV prevalence and examined behavioral and structural factors associated with HIV among female refugee sex workers in Kampala, Uganda. We conducted a cross-sectional study of 686 female refugee sex workers recruited through hotspot-based outreach and peer-referral networks in February and March 2026. Participants completed structured questionnaires and underwent HIV testing in accordance with national guidelines. Overall HIV prevalence was 21.0% (144/686; 95% CI: 18.1–24.3). HIV prevalence increased with age (χ² = 11.52, p = 0.003) and duration in sex work (χ² = 7.86, p = 0.02). In multivariable models, inconsistent condom use (APR = 1.87, 95% CI: 1.42–2.46), higher client volume (APR = 1.52, 95% CI: 1.12–2.05), alcohol use before sex (APR = 1.32, 95% CI: 1.04–1.67), exposure to work-related violence (APR = 1.39, 95% CI: 1.08–1.80), and police harassment (APR = 1.28, 95% CI: 1.00–1.63) were associated with HIV infection. These findings align with previous evidence that condomless sex, violence, alcohol use, stigma, and punitive work environments increase HIV vulnerability among female sex workers. Female refugee sex workers in Kampala face a substantial HIV burden driven by intersecting behavioral and structural vulnerabilities. Interventions addressing violence, substance use, and condom negotiation may reduce HIV risk in this population.References:
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