Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers

1 July, 2018

CITATION: Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs

AIDS Patient Care & Stds. 31(7):290-296, 2017 07.

Chanda MM; Perez-Brumer AG; Ortblad KF; Mwale M; Chongo S; Kamungoma N; Kanchele C; Fullem A; Barresi L; Barnighausen T; Oldenburg CE. [free full text]


Zambia has a generalized HIV epidemic, and HIV is concentrated along transit routes. Female sex workers (FSWs) are disproportionately affected by the epidemic. HIV testing is the crucial first step for engagement in HIV care and HIV prevention activities. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. FSW peer educators were recruited through existing sex worker organizations for participation in a trial related to HIV testing among FSWs. We conducted five focus groups with FSW peer educators (N=40) in three transit towns in Zambia (Livingstone, Chirundu, and Kapiri Mposhi) to elicit community norms related to HIV testing. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier. Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.

"A lot of people are ignorant, like my sister has said, some know that there's HIV and AIDS but they don't want to test, to others its lack of information, they don't know anything about HIV and AIDS." (Female sex worker, Livingstone)

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HIFA profile: Neil Pakenham-Walsh is the coordinator of HIFA-Zambia and the HIFA campaign (Healthcare Information For All - ) and current chair of the Dgroups Foundation (, which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: