{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T12:53:50Z","timestamp":1772715230536,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016766","name":"New Venture Fund","doi-asserted-by":"publisher","award":["015413-2021-08-01"],"award-info":[{"award-number":["015413-2021-08-01"]}],"id":[{"id":"10.13039\/100016766","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016766","name":"New Venture Fund","doi-asserted-by":"publisher","award":["022939-2023-12-11"],"award-info":[{"award-number":["022939-2023-12-11"]}],"id":[{"id":"10.13039\/100016766","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-049925"],"award-info":[{"award-number":["INV-049925"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph23030318","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:01:07Z","timestamp":1772636467000},"page":"318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Deaths of Female Sex Workers from HIV\/AIDS in Kenya, Nigeria, and the Democratic Republic of the Congo 2019\u20132023 and Barriers to Antiretroviral Therapy Adherence"],"prefix":"10.3390","volume":"23","author":[{"given":"Alexa","family":"Stefanko","sequence":"first","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"},{"name":"School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byron A.","family":"Foster","sequence":"additional","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"},{"name":"Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Willis","sequence":"additional","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Ezie","sequence":"additional","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"},{"name":"Silver Cross Hospital, Abuja 900211, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Perttu","sequence":"additional","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5752-2104","authenticated-orcid":false,"given":"Wendy L.","family":"Macias-Konstantopoulos","sequence":"additional","affiliation":[{"name":"Global Health Promise, Portland, OR 97201, USA"},{"name":"Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Tesfie, T.K., Yismaw, G.A., Yirsaw, B.G., Abuhay, H.W., Alemayehu, M.A., Derseh, N.M., Alemu, G.G., and Agimas, M.C. 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