HIV Seroprevalence, Incidence, and Viral Suppression Among Ugandan Female Bar Workers: A Population-Based Study.

Feng X, Nakigozi G, Patel EU, +14 more, Grabowski MK.

research-articleOpen access

AI summary — for doctors, generated from the abstract only

Ugandan female bar workers had roughly three times the HIV prevalence and incidence of other women in the same communities, while PrEP use remained very low.

What was studied

An analysis of five survey rounds (2011-2020) of the population-based Rakai Community Cohort Study in 36 inland and 4 Lake Victoria fishing communities in southern Uganda, comparing women reporting bar work with other women on HIV seropositivity, incidence and viral suppression.

Key findings

Among 23,556 women contributing 52,708 person-visits, 1,205 (5.1%) were female bar workers
Baseline HIV seroprevalence was 51.9% vs 18.5% (prevalence ratio 2.81, 95% CI 2.64-2.95)
HIV incidence was 2.49 vs 0.87 per 100 person-years (age-adjusted IRR 3.64, 95% CI 2.33-5.42)
Viral suppression among those with HIV was similar, but population prevalence of viremia was 1.69 times higher among bar workers (95% CI 1.38-2.08)
Of 179 HIV-negative bar workers surveyed in 2018-2020, 79.9% knew of PrEP but only 13.4% had ever used it and 2.8% were current users

Clinical relevance

The findings support prioritizing HIV prevention services, including oral and long-acting PrEP, for women working in bars, based on strong population-based cohort data from one Ugandan region.

Who should care

Infectious Disease

Limitations

Occupation was self-reported and may overlap with transactional sex; data come from specific Ugandan communities and may not generalize, and PrEP data covered only a small subgroup.

Bar work marks a group of Ugandan women at high HIV risk who are barely reached by PrEP.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Introduction

Prior studies have shown that some female bar workers (FBWs) may engage in sex work in Africa. However, population-level data on the HIV burden among FBWs in African settings are limited.

Methods

Data from 5 survey rounds (2011-2020) of the Rakai Community Cohort Study, a population-based HIV surveillance cohort in 36 inland agrarian/trading communities (HIV prevalence ∼12%) and 4 Lake Victoria fishing communities (∼40%) in southern Uganda, were analyzed. Women reporting bar work as a primary or secondary occupation were identified and compared with non-FBWs. Primary outcomes included HIV seropositivity, incident HIV infection, viral suppression (<200 copies/mL) among women with HIV, and population prevalence of viremia. Prevalence ratios and incidence rate ratios were estimated using Poisson regression with 95% confidence intervals (CIs).

Results

Among 23,556 female participants contributing 52,708 person-visits, 1205 (5.1%) self-identified as FBWs, who had significantly higher baseline HIV seroprevalence than non-FBWs (51.9% vs. 18.5%; prevalence ratio = 2.81; 95% CI = 2.64 to 2.95). There were 356 incident HIV infections over 39,228 person-years. HIV incidence among FBWs was 2.49 per 100 person-years compared with 0.87 among non-FBWs (age-adjusted incidence rate ratio = 3.64; 95% CI = 2.33 to 5.42). Although HIV viral suppression was similar among participants living with HIV regardless of FBW status, the population prevalence of HIV viremia was 1.69 times higher among FBWs (95% CI = 1.38 to 2.08). Among 179 HIV-seronegative FBWs surveyed during 2018-2020, 79.9% (143/179) were aware of preexposure prophylaxis, whereas only 13.4% (24/179) had ever used it, and 2.8% (5/179) were current users.

Conclusions

FBWs in Uganda experience a substantially higher HIV burden and acquisition risk compared with the general population. Prevention strategies tailored to the occupational context of bar work, including prioritization of HIV service delivery and access to oral and long-acting injectable preexposure prophylaxis, may substantially reduce HIV incidence among FBWs and their sexual partners.

DOI

10.1097/qai.0000000000003908

PMID

42358059

PMCID

PMC13566408

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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