Grant: Project Grant

THE ISSUE: Climate change increases the frequency of extreme weather events (EWE), including floods and drought, profoundly impacting global regions such as sub-Saharan Africa that also have the world's highest HIV prevalence. Female sex workers (FSW) are disproportionately affected by HIV, yet are understudied in the growing literature that shows EWE may increase HIV acquisition risks via changes in migration and transactional sex. OUR IDEA: We focus on FSW in Kampala, Uganda, to identify pathways from EWE-related factors to HIV prevention outcomes with a focus on pre-exposure prophylaxis (PrEP). OUR APPROACH: This 4-year mixed-methods study is a collaboration with the Ugandan Ministry of Health's specialized FSW clinics and drop-in centres in Kampala. We will examine: 1) monthly weather variability and HIV prevention service use; 2) effects of structural drivers (e.g., extreme weather) on resource insecurity (water, food); 3) effects of resource insecurity on PrEP cascade outcomes (motivation, access, effective use), including mediating pathways through migration, stigma and violence; and 4) opportunities for EWE-informed PrEP interventions for FSW. This innovative, timely study charts a new direction in HIV research by examining EWE and HIV prevention among FSW. Phase 1: IDENTIFY: develop and pilot survey, interview guide; time series methods. Phase 2: UNDERSTAND: prospective longitudinal bio-behavioural survey with FSW in Kampala at 3 timepoints with data collection during different seasons (rainy, dry), followed by qualitative interviews. Phase 3: MOBILIZE: Knowledge user engagement and decision-making authority in Uganda and globally; community dialogue; policy think tank; multiple dissemination strategies for distinct audiences. IMPACT: New knowledge of temporal and mechanistic pathways from EWE-related factors to PrEP outcomes among female sex workers in an HIV and climate-affected context, and empirically validated conceptual model to inform interventions.