Introduction: Female sex workers (FSWs) face heightened health risks, particularly from HIV, which accounts for 8% of FSW deaths in low- and middle-income countries. Adherence to antiretroviral therapy (ART) remains suboptimal and few studies have explored drivers of ART non-adherence among FSWs who died from HIV in sub-Saharan Africa. Methods: Using a community knowledge approach methodology, data on HIV-related deaths among FSWs were collected from a convenience sample across Kenya, Nigeria, and the Democratic Republic of the Congo between 1 February 2022, and 28 February 2023. Participants were recruited through local sex worker organizations and non-governmental organizations. A structured questionnaire was used to collect demographic data, HIV treatment history, and reasons for ART non-adherence from participants about the deaths of FSWs they knew of personally. A qualitative descriptive analysis was used to code the interviews for reasons for ART non-adherence. Results: A total of 853 FSWs reported the deaths of 445 peers who had died from HIV/AIDS. The mean age at death was 27 years; 70.6% were mothers. Among the deceased, 95.1% were not taking antiretrovirals at the time of their death, and 90% had stopped using ART, rather than never initiating treatment. The most cited reasons for ART non-adherence were food insecurity (97; 22.9%), alcohol and drug use (44; 10.4%), depression (57; 13.5%), and stigma (24; 5.7%). Conclusion: HIV-related deaths among FSWs in these three sub-Saharan African countries are associated with food insecurity, mental health issues, substance use, and stigma. Improving access to ART alone is insufficient to reduce mortality.
Stefanko et al. (2026) studied this question.