An Examination of the influence of social network characteristics on access to HIV preventive and curative services among female sex workers in Nairobi

Abstract

Achieving universal health coverage is long-term, and political and technical knowledge is needed for this to happen. Even with the availability of Human Immunodeficiency Virus (HIV) services, Female Sex Workers (FSW) find it hard to access these services. The study examined the utilization of social networks to improve health services access among female sex workers. It explored how the type of relationship between a peer educator and the peer, and that of a peer-to-peer, influences the acceptability of services. This retrospective cohort study thus analyzed routine program data at 10 Drop-In Centres and one integrated public health facility. All seeds/recruiters participating in the intervention between October 2021 and September 2022 were included in the study. That is 17 peer educators and 1,153 peers (867 high-risk HIV negative and 286 HIV positive) who referred 3,498 social network members for HIV services. A data extraction form was used to collect information from the Social Network Strategy Register, HIV Testing and Counseling, Laboratory Register for verification of results and Kenya EMR (Electronic Medical Records) to verify linkage to PrEP (Pre-Exposure Prophylaxis) and ART (Antiretroviral Therapy) and subsequent continuation. A descriptive analysis was done presenting percentages, frequencies, and mean. The chi-square test and odds ratio were used for categorical data, presenting the p-values and rate ratios. The mean age of the seed was 33 years. Out of the 3,498 social network members referred for services, 5% (180) were newly diagnosed with HIV of whom 178 were linked to ART (99% linkage). Of the 3318 HIV Negative social network members 64.4 % (2127) were linked to PrEP. An association between age group and linkage to PrEP was established at a p-value of 0.037, with the less than 20 years linkage of social network members to PrEP having the highest proportion. In addition, there was an association between the type of relationship between the seed and social network member and linkage to PrEP with a p-value of <0.01. Compared to the peereducator- to-peer cohort, the peer-to-peer cohort had 0.388 times greater odds of linking their social network member to PrEP. An association between the type of relationship and HIV case identification was established at a p-value of <0.01. The peer educator’s cohort had 3 times greater odds of identifying a positive to the peer-peer cohort. The social network influence at play for the peer-to-peer cohort is based on the similarities between the peers and the strength of their relationship. On the other hand, the mechanism of influence between peer educators and peers is based on the leadership role they play and their credibility among their peers Understanding how female sex workers overcome obstacles to accessing healthcare services is important in coming up with practical strategies that would support their participation in their care and monitoring the effectiveness of the national HIV response.