Occupational barriers to accessing and adhering to antiretroviral therapy for female sex workers living with HIV in South Africa

Lauren E. Parmley, Carly A. Comins, Katherine Young, Mfezi McIngana, Deliwe Rene Phetlhu, Vijay Guddera, Happiness Mkhize, Harry Hausler, Stefan Baral, Sheree Schwartz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives While female sex workers (FSW) are nearly 14 times more likely to be living with HIV than non-FSW, less than 40% of FSW living with HIV are on antiretroviral therapy (ART). We sought to understand how the work environment influences ART access and adherence for FSW in preparation for the Siyaphambili trial. Methods FSW living with HIV (n=24) and key informants (n=15) were recruited to participate in semistructured in-depth interviews using maximum variation and snowball sampling, respectively. FSW were recruited on key variants including type of sex work venue, primary work time and history of ART use. Data were collected between September and November 2017 in Durban, South Africa. Interviews were audio-recorded, transcribed and translated. Data were then coded applying grounded theory in Atlas.ti. Results FSW experienced occupational barriers to adherence including work-related migration, substance use and theft of ART on the job. Fear of wage loss due to HIV disclosure to clients and brothel managers prevented some FSW from accessing ART at their clinic and taking medications while working. FSW employed coping strategies to overcome barriers including sharing ART with colleagues, carrying small supplies of ART and visiting the clinic prior to appointments for ART refills. Further, some FSW received adherence support from colleagues who were also living with HIV. Conclusions Considering these occupational pressures on FSW and supporting positive coping strategies are important when designing and implementing HIV treatment programmes. Findings suggest strengthening social cohesion and supporting differentiated care efforts to improve HIV outcomes among FSW living with HIV.

Original languageEnglish (US)
Pages (from-to)100-106
Number of pages7
JournalOccupational and Environmental Medicine
Issue number2
StatePublished - Feb 1 2020


  • HIV
  • adherence
  • antiretroviral therapy
  • female sex workers
  • sex work

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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