LAUSR

OBJECTIVES To compare reproductive health and high risk behaviors in female sex workers (FSW) and single mothers (SM) in Zambia's two largest cities, Lusaka and Ndola. METHODS FSW were invited from known community hot spots and sexually active HIV- SM were referred from infant vaccination services for free and anonymous screening and treatment for HIV and other sexually transmitted infections (STI) and long acting reversible contraception (LARC). A subset completed an interviewer-administered survey. RESULTS From 2012 to 2016, 1893 women (1377 FSW and 516 HIV- SM) responded to referrals. HIV prevalence was 50% in Lusaka and 33% in Ndola FSW. Positive syphilis serology (RPR) was found in 29-31% in HIV+ FSW and 9-12% of HIV- FSW and SM. Trichomonas was more common in Ndola (11%-12%), compared with Lusaka (3%-7%). ART use among HIV+ FSW was 9-15%. In all groups, consistent condom use (8 11%) and modern contraceptive use (35 - 65%) were low. Low literacy and reported coercion at first sexual intercourse was common in both FSW and SM, as was alcohol use during sex among FSW. CONCLUSIONS Zambian FSW and single mothers (SM) have low condom use and high HIV/STI and unplanned pregnancy risk. Many FSW and half of SM are >=25 years of age and thus too old for HIV prevention services targeting "adolescent girls and young women" (AGYW, aged 15-24). Tailored and targeted reproductive health services are needed to reduce HIV, STI and unplanned pregnancy in these vulnerable women.