Nutritional status and associated factors among female sex workers living with HIV receiving antiretroviral therapy at drop-in centers in Northwest Ethiopia

Abstract

Female sex workers (FSWs) living with HIV may experience both undernutrition and overnutrition, which can adversely affect HIV-related health outcomes. Evidence regarding nutritional status and associated factors among HIV-positive FSWs remains limited in Ethiopia. This study aimed to assess the double burden of malnutrition at the population level and associated factors among HIV-positive FSWs receiving antiretroviral therapy (ART) in Northwest Ethiopia. A facility-based cross-sectional study was conducted from February 1 to March 1, 2023 among 422 HIV-positive FSWs receiving ART at five drop-in centers, with a response rate of 97.9%. Participants were selected using simple random sampling. Data were collected through structured interviews and anthropometric measurements. Nutritional status was categorized as undernutrition (BMI < 18.5 kg/m²), normal nutritional status (BMI 18.5–24.9 kg/m²), and overnutrition (BMI ≥ 25 kg/m²). Multinomial logistic regression was used to identify factors associated with nutritional status. Statistical significance was declared at p < 0.05. The prevalence of undernutrition was 13.8% (95% CI 10.5–16.9%) and overnutrition was 14.3% (95% CI 11.1–17.7%), indicating the presence of both forms of malnutrition within the study population. Undernutrition was less common among participants from households with fewer than five members (AOR = 0.27, 95% CI 0.07–0.98), those without depressive symptoms (AOR = 0.46, 95% CI 0.22–0.97), food-secure participants (AOR = 0.28, 95% CI 0.14–0.59), and participants who did not chew khat (AOR = 0.24, 95% CI 0.08–0.75). In contrast, participants consuming fewer than three meals per day had higher odds of undernutrition (AOR = 2.34, 95% CI 1.16–4.70). Regarding overnutrition, lower odds were observed among participants with inadequate dietary diversity (AOR = 0.31, 95% CI 0.14–0.69) and non-alcohol drinkers (AOR = 0.24, 95% CI 0.07–0.96), whereas higher odds were observed among food-secure participants (AOR = 2.78, 95% CI 1.22–6.35). HIV-positive FSWs receiving ART experienced both undernutrition and overnutrition at the population level. Nutritional status was associated with dietary, behavioral, psychosocial, and household-related factors. These findings may inform integrated nutritional and psychosocial support strategies within HIV care services.