Women at high risk of HIV infection in Kenya saw disproportionate reductions in economic security as well as reductions in risky sexual behavior during the COVID-19 pandemic, a new study found.
The study, published in JAMA network open, enrolled 1,725 women at high risk of HIV infection in rural Kenya and assessed their economic security, food security, health and sexual behavior during the pandemic.
“We asked a group of women who depend on sex work in rural Kenya about their experiences during the COVID-19 lockdown. These women saw a dramatic decline in economic opportunity, more than anywhere in the country, ”said study author Nolan Kavanagh, MPH, MD candidate at the University of Pennsylvania and lecturer at the University of Michigan infection. “It is an example of the unjust threat to well-being posed by the pandemic. The sexual activity of these women also declined, suggesting the pandemic could shape the HIV / AIDS epidemic in sub-Saharan Africa. “
The mean age of the women in the study was 29.3 years, and 68% said they had sex work as a source of income. Compared to an estimated 5.6% decline in the Kenyan economy during the pandemic, the women surveyed saw an almost 10-fold greater drop in income, according to the study.
“We expected the pandemic to stem economic opportunities, but we were shocked by the scale,” said Kavanagh. “The median income of the women we surveyed fell from $ 7.05 a week before the pandemic to $ 1.88 during the pandemic. Women who are dependent on sex work for their income have had to accept particularly sharp falls in income and employment and suffered from higher food insecurity. “
Among respondents surveyed, 1,385 (80.3%) said they had difficulty eating in the past month, and 1,500 (87%) said they were worried about having enough to eat at least once. Those who relied on transactional sex for income were 18.3% more likely to worry about enough food, and reported that employment fell 4.6 hours more than those who did not transactional sex.
The number of sexual partners decreased from an average of 1.8 before the pandemic to 1.1 during the pandemic, and the number of transactional sex partners decreased from 1.0 to 0.5
“Sex workers and other high-risk groups are particularly at risk during the pandemic,” said Kavanagh. “They are at higher risk of infection because of their work, but have less access to medical and social services. As healthcare providers, we can work to provide inviting spaces and advocate programs that protect them.
“In general, the paper highlights how our work as clinicians intersects with social and economic structures. It is no coincidence that the patients we see are affected by COVID-19. Rather, they become vulnerable through the way they support their families and through the resources that society has (not) made available to them. “
More research is needed to understand the long-term results associated with the pandemic, as the study only assessed results at a time and assessed the impact of COVID-19 at the onset of the pandemic. Long-term studies are also needed to determine whether changes in sexual behavior persist.
“Understanding how economic well-being and sexual behavior have changed over time can ensure that policy responses are timely and meet the needs of communities,” said Kavanagh. “From a political point of view, we need to ensure that populations traditionally excluded from social policy have access to services. Sex workers are more vulnerable today than ever. Likewise, when designing responses to the pandemic, policy makers must consider the health and economic equity of its effects. “
Previous research has found that people living with HIV or AIDS are at higher risk of developing and dying from COVID-19. A study published in Scientific reports found that people with HIV were 24% more likely to contract SARS-CoV-2 and 78% more likely to die from COVID-19.
Other research has found that non-HIV comorbidities are the leading causes of the severity of COVID-19 in people with HIV.