Uptake of STIs screening
This study found that the uptake of STI screening rate was at 32.1%. This is probably due to AFSWs attitudes including STI screening being embarrassing, painful, makes one worry and advising another AFSW to go for STI screening as well as health facility factors including provision of STI screening in the nearest health facility and availability of adolescent friendly clinic as these proved to be statistically significant variables which influenced uptake of sexually transmitted infection screening at different levels of analysis.
In a USA study among AFSWs, Roth et al. 2013, found out that 90% of AFSWs had not screened for STIs yet 88% of other women reported willingness to screen only if they were allowed to collect their own sample. This is in agreement with the 2010 US Federal and prostitution law report on FSWs in which it was stated that the prevalence of STIs was higher among FSWs than other women such as migrants, adding that it was due to neglect of screening uptake amidst high risk sexual behavior that results in worse sexual health outcomes.
Socio-demographic Factors And Uptake Of Sti Screening
Our study findings show that 241 (67.9%) of the respondents were in the age group of in 15-19years, older than other respondents in the age group of 10–14 years 114 (32.1%), possibly because currently AFSW 15–19 years are more exposed to independent life without any parenteral or guardian restrictions to movement, social networking and peer influence.
Majority of those who had screened were in the age group of 15–19 years, an indicator that older AFSWs were more likely to takeup STI screening than their counterparts in the age group of 10–14 years, and this may be possibly due to the fact thet they can easily access information that enables them undestand, that they are at risk of acquiring STIs by nature of their job than those aged 10–14 years. Our study also revealed that an AFSWs age (χ2:1.864, P = 0.172) was not found to influence STI screening uptake. This is supported by a Nigerian study carried out by Erin et al., (2013), in which female adolescents in transactional sex reported that they wanted to get information from parents and providers about STIs and its screening but parents did not provide it adding that given their discreet sexual behavior, frequent asking of their parents on this topic would lead to unexpected eventualities including dismissal from home. Contrary to this, Chakuvinga et al., (2017) found out that the AFSWs perceived themselves as young, not susceptible and therefore, not bothered about STI screening issues and the older sex workers found it difficult to discuss this with the young ones for them to clearly understand and change their perception hence this poor relationship affected STI screening uptake.
In this study, none of the socio-demographic factors had a significant relationship with the uptake of STI screening among AFSWs unlike in another Ugandan study carried out by Mbonye et al., 2013, whichrevealed that some socio-demographic factors including the age group, years of sex work practice and residence of an AFSW influenced their uptake of STI screening.
Attitudes Towards Sti Screening
In our study, majority 59.6% of the respondents reported that it was not too embarrassing to screen for sexually transmitted infections. This can be attributed to their past experience with uptake of STI screening. AFSWs who said STI screening wasn’t embarrassing were 3 times more likely to take-up STI screening than those who said uptake of STI screening was embarrassing. This is contrary with a USA study among AFSWs, in which Malla and Goyal, (2012) reported that participants (87%) indicated willingness to recommend self-sampling to a friend because they felt having a clinician collect a sample was awkward and embarrassing.
From this study findings, 81.6% of the respondents said screening for STIs will make one worry. This is true because of the uncertainty of the test result amidst the already known high risk job circumstances and exposure of these AFSWs. There was a significant relationship between being worried and uptake of STIs screening (χ2: 16.584, p = < 0.001) at 0.05 level of significance. AFSWs who said screening for STI will not make one worry were 4times more likely to take-up STI screening than those who said screening for STI will make one worry. This could be because they knew they were at risk of acquiring STI and were highly suspecting to have an STI, they were possibly therefore willing to take up STI screening for early diagnosis to be started on treatment just in case they had positive test result or to be advised on how to prevent themselves from acquiring STIs if given a negative test result.
Health Facility Factors And Uptake Of Sti Screening
In this study, 96.5% said STI screening services were available in Mukono district and majority 78.1% said that they had an adolescent friendly clinic at the nearest facility to where they lived. However, in this study, findings are that those who said they don’t have an adolescent friendly clinic in the nearest facility were 2 times more likely to take up STI screening than those who said the adolescent clinic was available. This is possibly due to the fact that the services are widely provided by the MOH through health facilities in outreaches or camps which are not consistently organized at specific facilities/adolescent friendly clinics near to where they live. In another high-prevalence cohort in India, Das, et al. (2011) reported that participants indicated that being screened for STIs outside of a clinic setting would provide a more feasible option for taking up STI screening. Similar to this was in Ethiopia, Adisababa where Cherie and Berhane (2012) reported that clinic systems were not usually oriented to providing youth with reproductive health screening especially for STIs. This frequently led to the perception that SRH services and the systems themselves were ‘not for youths’ which overlapped with barriers related to acceptability of services
In Uganda, non-government organizations have single handedly or have partnered with MOH to stage organized screening outreaches and camps not necessarily at health facilities that have targeted high risk groups. This is supported by this study findings in which most 55.2% of those that screened accessed screening services at non- clinical sites such as outreaches than at health facilities. In this current study, there was an association between availability of adolescent friendly clinic in the nearest health facility and uptake of STI screening (χ2: 12.985, p = < 0.001)
Failure to screen at adolescent clinic can also be attributed to the long distance that had to be travelled to reach the nearest health facilities with an adolescent clinic in relation to the providers who bring screening services nearer to targeted users.
The study revealed that 88.6% of the respondents said STI screening was provided at the nearest facility to where they lived. This can be true because the government of Uganda through the MOH has established and integrated reproductive health services including screening within existing health facilities to ease access and facilitate acceptability among even high risk and vulnerable groups such as AFSWs. In this current study, there was a significant relationship between provision of STI screening in the health facilities and uptake for STI screening (χ2: 18.714, p = < 0.001) at 0.05 level of significance at bivariate level as evidenced by a p value less than 0.05.On further analysis at multivariate level, those who said they don’t have STI screening at the nearest facility to where they live were 0.2times less likely to go for STI screening than those who said they have STI screening at the nearest facility to where they live. This corresponds with findings in Uganda where STI screening services are widely available even in some resource-limited settings, but not enough. Rapid diagnostic tests for STIs other than syphilis are not currently available and due to lack of a reliable source of funding for procurement. In addition, some of the screeners have inadequate training to provide screening services. This highly affects the health seeking behavior of high-risk populations turning up for screening (MOH 2018)