Mechanisms of action of a community-led HIV prevention and treatment programme for female sex workers in Zimbabwe: a mixed-method analysis
- 1London School of Hygiene & Tropical Medicine
Abstract
BackgroundCommunity-led interventions for female sex workers (FSW) can improve HIV prevention and treatment outcomes by lowering self-stigma and strengthening social cohesion to improve service uptake. In Zimbabwe, the AMETHIST intervention trial integrated peer-led microplanning with self-help groups for FSW and demonstrated improved HIV treatment outcomes. We investigated the role of social cohesion and self-stigma in explaining these findings.
MethodWe conducted a mixed-method analysis of data collected during AMETHIST. We re-analysed qualitative data from interviews and group discussions to identify narratives linking self-stigma, engagement with microplanners and/or self-help groups and HIV service use. We analysed quantitative data from endline respondent-driven sampling surveys for differences in self-reported measures of social cohesion and self-stigma between trial arms, and between those who did and did not participate in intervention activities or access services.
ResultsIn both arms, FSW self-reported engaging with peer supporters, participating in self-help groups and accessing HIV services. Qualitative narratives suggested peer support and group participation could reduce self-stigma and support service uptake. Lower levels of self-stigma were seen in the intervention arm (58.6% vs 63.2%; aOR 0.77; 95% CI 0.61-0.86). Social cohesion exceeded 50% across the whole sample, but was not associated with study arm, nor with engagement in intervention-related activities.
DiscussionAlthough qualitative data suggested some FSW felt their uptake of services was influenced by intervention components, quantitative analyses did not suggest either variable was on the causal pathway to the outcomes of the intervention. A limitation may have been the measurement of these complex constructs and the high levels of social cohesion across both study arms.
Contributions to the literature- Community-led, empowerment-based interventions are the cornerstone of effective HIV responses for sex workers. The hypothesised mechanisms of improved social cohesion and self-efficacy through which these work to increase HIV services uptake are less well understood. - Our study contributes to evidence on the social mechanisms through which community based interventions work to improve HIV outcomes among female sex workers in Zimbabwe - Our study found that female sex workers who more frequently accessed HIV services were more likely to report higher levels of social cohesion, but was unable to establish whether this was a mechanism along the pathway between intervention engagement and improved HIV outcomes Our study indicated that reductions in self-stigma through peer-led community-based support are important for HIV programme implementation; increasing the uptake of HIV services and improving HIV outcomes
Related
- ‘Tizz Time’: a School-Based Trauma-Informed Violence Prevention Programme
- Assessing the impact of a sugar prevention programme on caries
- Development and content validation of a risk-stratified nursing intervention programme for the prevention of healthcare-associated infections
- Adaptive Governance and Community Agency in Crisis: A Qualitative Study of Stakeholder Engagement in Seke District, Zimbabwe
- A baseline cross-sectional survey of women's and household-level health indicators in Tsakare Community, Mount Darwin District, Zimbabwe: findings to inform targeted public health interventions.
BibTeX
@misc{busza2026mechanisms,
title = {{Mechanisms of action of a community-led HIV prevention and treatment programme for female sex workers in Zimbabwe: a mixed-method analysis}},
author = {J. Busza and H. Jones and P. Matambanadzo and T. Hove and S. Chabata and T. Kujeke and M. Makamba and G. Madimutsa and F. Machingura and F. Cowan and J. Hargreaves},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.08.26365041},
url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26365041v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Mechanisms of action of a community-led HIV prevention and treatment programme for female sex workers in Zimbabwe: a mixed-method analysis
AU - J. Busza
AU - H. Jones
AU - P. Matambanadzo
AU - T. Hove
AU - S. Chabata
AU - T. Kujeke
AU - M. Makamba
AU - G. Madimutsa
AU - F. Machingura
AU - F. Cowan
AU - J. Hargreaves
PY - 2026
DA - 2026/10/08
PB - medRxiv
DO - 10.64898/2026.10.08.26365041
UR - https://www.medrxiv.org/content/10.64898/2026.10.08.26365041v1
AB - BackgroundCommunity-led interventions for female sex workers (FSW) can improve HIV prevention and treatment outcomes by lowering self-stigma and strengthening social cohesion to improve service uptake. In Zimbabwe, the AMETHIST intervention trial integrated peer-led microplanning with self-help groups for FSW and demonstrated improved HIV treatment outcomes. We investigated the role of social cohesion and self-stigma in explaining these findings. MethodWe conducted a mixed-method analysis of data collected during AMETHIST. We re-analysed qualitative data from interviews and group discussions to identify narratives linking self-stigma, engagement with microplanners and/or self-help groups and HIV service use. We analysed quantitative data from endline respondent-driven sampling surveys for differences in self-reported measures of social cohesion and self-stigma between trial arms, and between those who did and did not participate in intervention activities or access services. ResultsIn both arms, FSW self-reported engaging with peer supporters, participating in self-help groups and accessing HIV services. Qualitative narratives suggested peer support and group participation could reduce self-stigma and support service uptake. Lower levels of self-stigma were seen in the intervention arm (58.6% vs 63.2%; aOR 0.77; 95% CI 0.61-0.86). Social cohesion exceeded 50% across the whole sample, but was not associated with study arm, nor with engagement in intervention-related activities. DiscussionAlthough qualitative data suggested some FSW felt their uptake of services was influenced by intervention components, quantitative analyses did not suggest either variable was on the causal pathway to the outcomes of the intervention. A limitation may have been the measurement of these complex constructs and the high levels of social cohesion across both study arms. Contributions to the literature- Community-led, empowerment-based interventions are the cornerstone of effective HIV responses for sex workers. The hypothesised mechanisms of improved social cohesion and self-efficacy through which these work to increase HIV services uptake are less well understood. - Our study contributes to evidence on the social mechanisms through which community based interventions work to improve HIV outcomes among female sex workers in Zimbabwe - Our study found that female sex workers who more frequently accessed HIV services were more likely to report higher levels of social cohesion, but was unable to establish whether this was a mechanism along the pathway between intervention engagement and improved HIV outcomes Our study indicated that reductions in self-stigma through peer-led community-based support are important for HIV programme implementation; increasing the uptake of HIV services and improving HIV outcomes
ER -