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Background: Sexually transmitted infections (STIs) remain a major public health problem worldwide, with the burden of these infections being high among female sex workers (FSWs), who are often not aware of their infection status. This study aimed to determine the factors that are associated with the number of STIs among FSWs in Ethiopia., Methods: A cross-sectional bio-behavioral study involving respondent-driven sampling (RDS) was conducted among 6,085 FSWs in 16 towns in Ethiopia. The hurdle Poisson regression model was fitted using STATA Version 16.2. The incident rate ratio and adjusted odds ratio with a 95% confidence interval were employed to show the strength and direction of the association. A p -value of ≤0.05 was used as a threshold for statistical significance., Results: At least one STI was identified in 1,444 (23.64%) of the FSWs. Age group 35-49 years [IRR = 2.32; 95% CI (1.43, 3.74)], forced first sex [IRR = 1.32; 95% CI (1.01, 1.74)], condom breakage [IRR = 1.32; 95% CI (1.01, 1.74)], and a history of depression [IRR = 1.55; 95% CI (1.12, 2.18)] increase the number of STIs. FSWs aged 25-34 years [AOR = 2.99; % CI (2.54, 3.52)] and 35 = 59 years [AOR = 8.05; % CI (6.54, 9.91)], who were selling sex for 5-10 years [AOR = 1.30; 95% CI (1.1, 1.55)], and above 11 years [AOR = 1.21; 95% CI (1.03, 1.43)] were more likely to get STIs., Conclusion: STIs are common in Ethiopia. The covariates age, educational status, monthly income, condom failure, age at the first sexual encounter, and long duration of sexual practice are significant predictors of STIs. Health interventions among FSWs need to include awareness generation about the prevention and control of STIs and address the determinants identified in this analysis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wariso, Ayalew, Barba, Bedassa, Ebo, Tura, Rameto, Belihu, Asfaw, Amogne, Negeri, Lulseged and Abrahim.)

Background: Syphilis is a highly contagious sexually transmitted infection posing a significant public health challenge, especially in developing countries, including sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. However, data on national syphilis prevalence estimates and the associated factors are scarce in Ethiopia. This, as well as our limited knowledge about the extent of clustering among female sex workers in the country, is a critical gap in information we aimed to fill through this analysis., Methods: The study was a cross-sectional, bio-behavioral survey conducted among female sex workers in six cities and ten major towns in Ethiopia. Participants were selected using a respondent-driven sampling method. Survey participants provided blood samples for syphilis, HIV, and hepatitis serological testing. Survey data were collected via an interviewer-administered questionnaire. In this analysis, we employed descriptive statistics to summarize data on the study variables. In addition, we used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the dependent variable (syphilis prevalence) while accounting for the clustering effect., Result: A total of 6085 female sex workers participated in the survey. Their median age [Interquartile Range (IQR) was 25 (8)] years, and a majority (96.1%) were in the 20-24-year-old age group. The prevalence of syphilis among female sex workers in Ethiopia's six cities and ten major towns was 6.2%. Being in the age group of 30-34 (AOR = 2.64; 95% CI = 1.40, 4.98) and 35-59 (AOR = 4.7; 95% CI = 2.5, 8.86), being divorced/widowed (AOR = 1.37; 95% CI = 1.03, 1.82), having no formal education (AOR = 3.38; 95% CI = 2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR = 2.77; 95% CI = 1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR = 1.80; 95% CI = 1.21, 2.69) were significantly associated with syphilis among female sex workers., Conclusion: The prevalence of syphilis among female sex workers was high. Being divorced/widowed or in the older age group and having a low level of education were significantly associated with an increased risk of syphilis. The high prevalence and associated factors identified need to be considered in planning comprehensive interventions to control syphilis among female sex workers in Ethiopia., (© 2023. The Author(s).)

Background: Female sex workers (FSW) remain a highly exposed group for HIV/STIs due to different factors including condom failure. In Ethiopia, pre-exposure prophylaxis (PrEP) has recently been introduced as an intervention strategy to prevent new HIV infections, but knowledge about FSWs' experiences of condom failure and PrEP use remains scarce. Therefore, this study explores FSWs' experiences concerning condom failure and their attitudes towards, and experiences of, PrEP uptake., Method: A qualitative study using in-depth interviews was conducted among FSWs in Addis Ababa. A manifest and latent content analysis method was applied to identify categories and emerging themes., Result: Seventeen FSWs (10 who started on PrEP, 1 who discontinued, and 6 who didn't start) were interviewed. FSWs described the reasons behind condom failure, the mechanisms they used to minimize the harm, and their attitudes towards PrEP use. FSWs struggled with the continuous risk of condom failure due to factors related to clients' and their own behavior. PrEP was mentioned as one the strategies FSWs used to minimize the harm resulting from condom failure, but PrEP use was compounded with doubts that deterred FSWs from uptake. FSWs' misconceptions, their lack of confidence, and PrEP side effects were also mentioned as the main challenges to start taking PrEP and/or to maintain good adherence., Conclusion: The demands and behavior of the clients and FSWs' own actions and poor awareness were factors that increased the exposure of FSWs to condom failure. In addition, the challenges associated with PrEP uptake suggest the need for user-friendly strategies to counteract these barriers and facilitate PrEP uptake., (© 2022. The Author(s).)