HIV Seroprevalence, Incidence, and Viral Suppression Among Ugandan Female Bar Workers: A Population-Based Study
Year: 2026
Type: article
Abstract: Background: Prior studies have linked female bar and sex work in Africa. However, population-level data on HIV burden among female bar workers (FBWs) in African settings are rare. Methods: We used five survey rounds of data collected between 2011 and 2020 from the Rakai Community Cohort Study, a population-based HIV surveillance cohort in 36 inland agrarian and trading communities (HIV prevalence ~12%) and four Lake Victoria fishing communities (~36%) in southern Uganda. Women reporting bar work as a primary or secondary occupation were identified and compared to non-FBWs. Primary outcomes included laboratory-confirmed HIV seropositivity, incident infection, viral suppression (<200 copies/ml) among women with HIV, and population prevalence of viremia. Prevalence ratios (PRs) and incidence rate ratios (IRRs) were estimated using Poisson regression models with 95% confidence intervals (95%CI). Findings: A total of 23,556 female participants contributed 52,708 person visits. Overall, 1,205 (5.1%) women self-identified as FBWs. FBWs had significantly higher baseline HIV seroprevalence compared to non-FBWs (51.9% vs. 18.5%,PR=2.81, 95%CI=2.64-2.95). 356 HIV incident events occurred over 39,228 years of participant follow-up. Incidence among FBWs was 2.49/100 person-years versus 0.87/100 person-years among non-FBWs (age-adjusted IRR=3.64,95%CI=2.33-5.42). While HIV viral suppression was similar among participants living with HIV regardless of FBW status, the population prevalence of HIV viremia among FBWs was 1.69 times higher compared to non-FBWs, adjusting for age and community type (95%CI=1.38-2.08). Among 179 HIV seronegative FBWs surveyed in 2018-20, 79.9% (143/179) were aware of PrEP, while only 13.4% (24/179) had ever used it, and just 2.8% (5/179) were current users. Interpretation: FBWs in Uganda experience substantially higher HIV burden and acquisition risk compared to the general population. Tailored prevention strategies like prioritizing their HIV service delivery may reduce HIV incidence among FBWs and their partners. Funding: National Institute of Allergy and Infectious Diseases, National Institutes of Health.
Authors: Xinyi Feng, Gertrude Nakigozi, Eshan U. Patel, Caitlin E. Kennedy, Slisha Shrestha, Fred Nalugoda, Godfrey Kigozi, Robert Ssekubugu, Larry W. Chang, Andrea L. Wirtz, Arthur G. Fitzmaurice, Hadijja Nakawooya, Grace Kigozi, Ronald M. Galiwango, Steven J. Reynolds, Joseph Kagaayi, Aaron A. R. Tobian, M. Kate Grabowski
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: Johns Hopkins University, U.S. President’s Emergency Plan for AIDS Relief, National Institutes of Health, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, Johns Hopkins Bloomberg School of Public Health, Center for AIDS Research, Johns Hopkins University, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, NHLBI Division of Intramural Research
Awards: Evaluating Demand Generation (Stylish Man) for HIV/Family Planning Services Rakai, G1572340776, G1606856145, The Problem With Male Sexual/Repro Health:Qualitative/Quantitative Study, Uganda, G201659893, ART diversion in Rakai, Uganda, G2205726600, G2483435703, G2591216802, G2672645366, G3049339887, G3086911920, G3175806859, The role of penile bacteria and inflammation in HIV susceptibility; Rakai, Uganda, PROVISION OF COMPREHENSIVE HIV/AIDS SERVICES AND DEVELOPING NATIONAL CAPACITY TO, G4123103834, G462800458, Structural and Social Transitions Among Adolescents in Rakai (SSTAR), G5007658255, Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda, G6002302656, G653582874, G7178514535, ARV effects on HIV epidemiology and behaviors in Rakai, Uganda, Male Circumcision and Use of Foreskin Tissues for HIV Prevention in Uganda, G8093593548, G890594366, G8962735637, G9000038650, G9000177979, G9000196816, G9000293880, G9000331724, The Johns Hopkins Center for AIDS Research (JHU CFAR)
OpenAlex ID: W4408767065