Women wants sex Spaulding

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Metrics details. High of unintended pregnancies—often leading to induced abortions—are reported among female sex workers FSWshighlighting a major unmet need for contraception. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy.

All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol.

FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Our demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience.

Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work. Peer Review reports. Female sex workers FSWs have a higher unmet need for contraceptives compared to women in the general population [ 12 ]—which is evident from the high rate of unintended pregnancies [ 3456 ], high abortion rates [ 4678 ] and a great desire to prevent future pregnancies [ 910 ].

In Tanzania, the incidence of unintended pregnancy among FSWs ranges from 12 to 18 per years of exposure [ 1112 ], although it is slightly lower than the incidence in other lower and middle income countries of 27 per years of exposure [ 7 ]. Although sexual and reproductive health SRH services, including contraceptives are an essential component of the comprehensive HIV prevention services for FSWs, there is a notable lack of synergy between provision of HIV prevention and SRH services in most programs [ 12 ].

Stigmatization, discrimination, policing and criminalization of sex work contribute to poor access to contraceptive services [ 691014 ]. Among users, long-acting revisable contraceptives Intra-uterine devices and Implants are less prevalent compared to injectables and oral contraceptive pills [ 1819 ].

Although both methods are effective, the latter are user-dependent and are prone to incorrect use, discontinuation and frequent switching [ 517 ]. Condom failure or condom breakage and non-use among FSWs are common because of physical or sexual violence and drug or alcohol intoxication during sex work [ 20212223 ]. Unintended pregnancies that result in live birth have socio-economic implications that may intensify HIV risk associated with sex work [ 303132 ].

Abortions are a common sought solution among FSWs to reduce the socio-economic repercussions of unintended pregnancy [ 47814 ]. Induced abortions are illegal in Tanzania [ 33 ]. This lack of clarity in the law and fear of prosecution pushes women with unintended pregnancies to seek abortions that are often unsafe and which are a major cause of maternal deaths [ 3435 ].

Although a of quantitative studies have reported factors associated with contraceptive use in this population [ 310193637 ], there is a limited attention to the nuances of how sex work its daily routine and experiences intensify these barriers. FSWs in low and middle income countries experience greater risk of repeat unintended pregnancies than women in the general public [ 7 ]. This study aimed to explore how sex work influences contraceptive use and how experiences of unintended pregnancy influence commitment to subsequently use contraceptives. Understanding experiences of unintended pregnancy and contraceptive use among female sex workers is important for informing appropriate interventions to address their SRH needs.

Sex work, generally defined as exchange of sex for money, goods or other favours [ 383940 ] is diverse and operates in various contexts. Some FSWs sell sex through formal organized groups in brothelsothers work independently, soliciting clients through mobile phones while others combine sex work with other occupations [ 4142434445 ]. FSWs may have different types of sexual partnerships including a regular clients —someone who pays to have sex with a sex-worker on a regular basis, i. Sex work, both selling and buying of sex and other sex-work related activities such as facilitating sales, brothel ownership or pimping are illegal and criminal according to the Tanzanian Penal Code [ 33 ].

Arrest, police violence, raids and extortion of sex workers are common in Tanzania. The study was conducted between January and July in Dar-es-Salaam, the business capital of Tanzania, which has the highest of FSWs in the country [ 46 ]. Participants had access to free medical consultation throughout the study. HIV testing was performed at enrolment and every three months for enrolled participants. Information on barrier methods, short and long acting reversible contraception was provided in groups and in one-to-one sessions during study visits.

Male condoms were available onsite and freely provided at each visit. Participants were referred to the FP clinic at Muhimbili National Hospital located within close proximity to the PrEPVacc study site to access pills, injectables, implants, and intrauterine devices.

All participants underwent urine testing for pregnancy at enrolment, at 6 and months follow-up visits. Participants who were pregnant were referred to ante-natal clinics of their choice. All informants in the qualitative study were sampled from the 32 women who had a positive urine pregnancy test at the time of enrolment into the PrEPVacc cohort between October and December The first author DF purposively sampled 18 women by considering demographic and phenomenal considerations to maximize diversity of the informants [ 48 ].

Young and older sex workers were selected to reflect variations in their years of experience in sex work as well as their sexual and reproductive health history. Parity and past contraceptive use were phenomenal considerations used in sampling. In-depth interviews were initially conducted with nine of the 18 sampled women who were willing to participate in the study. Three sampled participants could not be reached and six declined to be interviewed 2 were out of town, 1 had a new born baby and 3 reported to be busy. Those agreeing to participate were provided with a daytime interview appointment that was convenient for them.

During data collection two additional informants were included in the study making a total of 11 informants. One of them was a younger sex worker who had never been pregnant. She provided perspective on contraception and abortions from FSWs with no pregnancy experience. The other deviant case, a HIV positive woman, was included to explore the opinions from preceding informants who had suggested that HIV positive sex workers are less likely to use condoms, therefore more likely to get pregnant and that they were more likely to abort the pregnancy in fear of mother-to-child HIV transmission.

However, during the subsequent interviews this theme was found not to be consistent and therefore was not further pursued. Characteristics of the study informants are given in Table 1. At the time of the interviews, five participants were pregnant, three had terminated the pregnancy, two had recently given birth and one had not been pregnant the additional deviant case. Four women had never used any non-barrier contraceptive. Implants and IUDs were the most commonly used non-barrier contraceptives. We developed the interview guide with topics around sex work, contraceptive use and unintended pregnancy guided by the Health Belief Model [ 50 ].

Components of the Health Belief Model were applied to conceptualize how sex workers use a multidimensional approach to make decisions on using contraceptives and when dealing with unintended pregnancy [ 3151 ]. For instance, the interview guide included probes on how access to contraceptives versus side effects perceived barriers influence decisions to initiate or continue contraceptive use.

The guide also probed on how sex workers perceived their susceptibility to unintended pregnancy given that the decision to use condom was influenced by their partners, and if this perceived susceptibility influenced the decision on using dual contraceptives perceived benefit. Thereafter, the interview tool was revised based on the inputs from the team. During data collection, a meeting was held with researchers from the PrEPVacc cohort, to discuss emerging themes and to make decisions on further questions to be explored in subsequent interviews. In-depth interviews were used for data collection because they are regarded more suitable than focus group discussions for collection of sensitive, personal data [ 49 ].

During the interviews, respondents were encouraged to narrate their experiences and reactions upon receiving a positive pregnancy test during enrolment into the PrEPVacc cohort. Participants were asked to describe their thoughts on how pregnancy affected their sex work. The influence of peers, families and partners on unintended pregnancy was also explored. Follow-up questions probes were asked in order to give a chance to the informants to explain if the recent pregnancy had influenced their intentions to use contraceptives in the future.

Perceptions around induced abortions were explored among both women who had an abortion and those who had not. The interview guide was used in a flexible manner encouraging informants to speak in their own words to allow for new emerging ideas and unexpected information [ 49 ]. The interview guide evolved with subsequent interviews accommodating emerging themes based on responses provided by preceding interviews thereby increasing theoretical sensitivity [ 49 ]. As a result, later interviews were more focused and covered more concepts albeit risking more narrow and specific responses [ 4952 ].

For example, the interview with the first informant In-depth interview conducted in Januarycovered fewer concepts but provided a long and detailed narration of the issues whereas the interview with the tenth informant In-depth interview conducted in June covered more concepts but provided narrower responses.

In-depth interviews were conducted by the first author DFin Kiswahili. They were conducted in an isolated room at the PrEPVacc study site. The venue was familiar to the informants because they had visited the site for at least three occasions prior to the interview. Informants were also familiar with the research team including DF and PM who were part of the PrEPVacc study team and were involved in enrolment and follow-up interviews of participants in the cohort study. Data collected during enrolment and follow-up interviews included questions on the use and preference of contraceptives.

This provided a chance to explore contraceptive use among sex workers other than those already participating in the qualitative interviews. DF and PM took part in delivering pregnancy test to the women as part of the study visit procedure. This provided a first-hand experience on how women reacted to a positive pregnancy test result because the majority of them had not intended to become pregnant.

In all these encounters, personal notes were taken from observations relating to the study question and later used in the analysis process. All audio-recorded interviews were transcribed and thereafter translated into English by research assistants who were part of the PrEPVacc study. DF read all English transcripts, compared them with the audio files several times, revised any unclear areas, and wrote notes.

Women wants sex Spaulding

DF conducted initial line-by-line open coding in accordance with the grounded theory approach [ 495354 ]. Line-by-line coding allowed many codes to be generated on everything shared by the participants regardless of the relevance to the study questions [ 49 ]. Coding was performed using the Nvivo software Version Memos were written to describe the code, and its relevance to the research questions. In some transcripts, text was coded twice or more if the sentences contained more than one relevant aspect.

Selective coding was then performed by clustering open codes intogoing through the transcripts again and deciding which initial codes made the most analytic sense when grouped together [ 49 ]. Codes with similar meaning were merged and repetitive codes were deleted. Collating and codifying of the initial codes was done and some codes clustered and a label attached to the category.

DF also wrote memos on the throughout the analysis to describe how they related to the research question [ 54 ]. Transcripts were re-read and in certain instances codes that did not fit in a category were dropped to maintain focus on the research question [ 49 ]. An example of moving from text, open codes and selective codes to the category are given in Fig. In the later stage of the analysis, theoretical coding was performed to explain how the codes linked with each other in a particular category and between .

Women wants sex Spaulding

An overall core-category that captured most important findings of the analysis was selected and linked with the other. A model grounded in the data was constructed to illustrate how the codes, theand the core-category related with each other and with respect to the study research question. This study explored barriers to contraceptive use among female sex workers in Dar es Salaam and examined how their experiences of unintended pregnancies influenced future use of contraceptives. A model illustrating the core category and the main emerging from the theoretical coding described earlier was constructed and is illustrated in Fig.

Unintended pregnancy was considered an outcome of poor contraceptive behaviour, because sex work impeded good contraceptive behaviour. Sex workers regarded pregnancy as an unavoidable consequence of sex work given the nature of multiple partnerships and inconsistent condom use. Although FSWs were aware of contraceptives and had some knowledge on its effectiveness, they expressed frustration over poor access and adherence to contraceptive use. While condom use was generally desired by the sex workers who wished to protect themselves from not only pregnancy but also sexually transmitted diseases including HIV, they reported that waiving condom use was profitable.

Sex workers waived condom use with non-regular clients to get a higher pay. We put on condoms on them and we are very sure of it. But at the end of the act you find yourself wet. They break the condoms.

Women wants sex Spaulding

Sex workers mitigated inconsistent condom use by opting to use non-barrier contraceptives. However, they reported experiencing stigma from service providers in family planning clinics when seeking contraceptive services. The experience of stigma resulted in avoidance of health services and discouraging peers from seeking similar services. She the nurse started calling her fellow doctor to come and listen to what I was telling her…although I told her alone, in private…. She told all the doctors that I am a sex worker…. I told her, I will buy the Depo-Provera so as you can inject me.

Women wants sex Spaulding

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