Publications
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Keynejad, Roxanne C.; Gaifém, Francisca; Nikolić, Ivana; Belay, Sewhareg; Amare, Hiwot Hailu & Abera, Hiwot
[Show all 9 contributors for this article]
(2026).
From housing to home and belonging: structural violence, ontological (in)security and women's mental health.
Frontiers in Sociology.
11.
doi:
10.3389/fsoc.2026.1612133.
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Women's mental health is profoundly shaped by structural violence through housing, which impacts their experience of home and sense of belonging. This Perspective advances an integrative sociological framework across a continuum from the most concrete manifestation of shelter (housing) through symbolic representations of home, to the psychological experience of belonging to a place. We synthesize evidence for relationships between unstable, unsafe housing, abusive homes, social dislocation, and mental ill-health. Drawing on interdisciplinary scholarship, we specify how housing insecurity erodes community, relationships, and safety, generating ontological insecurity that amplifies vulnerability to interpersonal violence. We show that these dynamics are bidirectional: mental health conditions can impede access to resources and secure housing, reinforcing insecurity, while housing adversity is associated with worsened mental health. An intersectional lens reveals that minoritised women experience compounded harm through migration status, precarity, and policy regimes that limit protection and support. Our framework connects macro-level structures (national and international policy), meso-level institutions (welfare, health, and housing services), and micro-level lived experience, demonstrating how structural conditions become embodied as mental health symptoms. This Perspective situates ontological (in)security as central to the relationships between shelter, place, and women's mental health, identifying actionable leverage points for change. We argue for gender-sensitive, integrated interventions that expand access to safe, stable housing, co-locate mental healthcare with rights-based and anti-discrimination services, and address feedback loops between shelter, place, and mental health. By foregrounding housing as a key conduit of structural violence, this Perspective advances sociological understanding of how belonging and mental health are co-constituted and offers directions for research and policy to improve women's health and flourishing.
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Lie, Anne Kveim; Gebremariam, Mekdes; Lichtwarck, Hanne Ochieng; Mmbaga, Elia & Miltenburg, Andrea Solnes
(2024).
Kortvarig hospitering må planlegges nøye.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
144(15).
doi:
10.4045/tidsskr.24.0376.
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Lichtwarck, Hanne Ochieng; Massawe, Emmanuel Peter; Mmbaga, Elia & Moen, Kåre
(2024).
What can PrEP do for female sex workers? Unpacking the “effectosphere” of biomedical HIV prevention in Dar es Salaam.
Social Science and Medicine.
ISSN 0277-9536.
358.
doi:
10.1016/j.socscimed.2024.117245.
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Lichtwarck, Hanne Ochieng; Mbotwa, Christopher Hariri; Kazaura, Method Rwelengera; Moen, Kåre & Mmbaga, Elia
(2023).
Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: A socioecological approach.
BMJ Global Health.
8(12).
doi:
10.1136/bmjgh-2023-013662.
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Mbotwa, Christopher H; Kazaura, Method Rwelengera; Moen, Kåre; Lichtwarck, Hanne Ochieng; Leshabari, Melkizedeck T & Metta, Emmy
[Show all 7 contributors for this article]
(2023).
Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania.
Digital Health.
9.
doi:
10.1177/20552076231170507.
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Background
Mobile health (mHealth) applications have been reported to be effective in promoting access and adherence to health services. However, knowledge about their effect on retention in HIV preventive services among at-risk populations in sub-Saharan Africa is limited.
Objective
We aimed to evaluate the effect of the Jichunge mHealth application on retention in HIV pre-exposure prophylaxis (PrEP) services among female sex workers in Dar es Salaam, Tanzania.
Methods
We used respondent-driven sampling to recruit female sex workers eligible for PrEP and who owned a smartphone. All study participants were provided with a smartphone application (Jichunge app) aiming to promote PrEP use through medication reminders, easy access to PrEP information, online consultations with a doctor and/or peer educator, and online discussions between PrEP users. The effect of optimal use of the Jichunge app on retention in PrEP services at 1-month was modelled using log-binomial regression.
Results
A total of 470 female sex workers with a median age of 26 (interquartile range: 22–30) years were recruited. Overall, 27.7% of female sex workers were retained in PrEP services at 1 month. Retention was twice as high among optimal users of the app than among sub-optimal users (adjusted risk ratios = 2.00, 95% confidence interval (CI): 1.41–2.83, p < 0.001).
Conclusion
The optimal use of the Jichunge mHealth application was significantly associated with higher retention in PrEP services among female sex workers in Dar es Salaam.
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Lichtwarck, Hanne Ochieng; Kazaura, Method; Moen, Kåre & Mmbaga, Elia
(2022).
Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania.
International Journal of Environmental Research and Public Health (IJERPH).
ISSN 1661-7827.
doi:
10.3390/ijerph20010698.
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Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.
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Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga & Kazaura, Method Rwelengera
[Show all 9 contributors for this article]
(2021).
Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach.
Journal of Medical Internet Research (JMIR).
ISSN 1439-4456.
doi:
10.2196/23204.
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Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed.
Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to PrEP among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania.
Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW.
Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs.
Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.
Trial Registration: The trial registration number is PACTR202003823226570
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Lichtwarck, Hanne Ochieng; Patel, Davina Kaur; Almashhadani, Mohammed Taleb Mohammed; Spjeldnæs, Amanda Hylland & Lie, Anne Kveim
(2024).
Antirasisme og inkluderingsarbeid - to sider av samme sak.
Dagens medisin.
ISSN 1501-4290.
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Spjeldnæs, Amanda Hylland; Patel, Davina Kaur; Lichtwarck, Hanne Ochieng; Givan, Kathleen Alexandra; Gravdahl, Oline Friestad & Lengle, Emma Joanna
(2023).
Legeopprop for sivilbefolkningen på Gaza.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
143(17).
doi:
10.4045/tidsskr.23.0713.
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Lichtwarck, Hanne Ochieng; Kazaura, Method Rwelengera; Mmbaga, Elia & Moen, Kåre
(2021).
Sex worker stigma among female sex workers initiating PrEP in Dar es Salaam
Preliminary analysis from baseline data collection in the PREPTA study.
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Introduction: Female sex worker stigma is an understudied social determinant of health. In the context of HIV/AIDS studies have found that FSW stigma can pose a barrier both to access prevention and treatment services.
Methods: We did a baseline survey of 471 FSW in Dar es Salaam initiating pre-exposure prophylaxis (PrEP). The participants were recruited using respondent driven sampling. Interviews covered several topics of relevance to PrEP, including a 13 point item 4 item validated FSW stigma scale where statements reflected perceptions and experiences of being a FSW. Additionally we did qualitative interviews with 25 FSW.
Results: Median stigma scale score was 30 (IQR 27-35), a lower score compared to another study conducted in a different region of Tanzania. A majority of respondents expressed agreement with four of the five positively phrased statements such as “You like your job as a sex worker” (73.4% either agreed or completely agreed). Additionally a majority indicated disagreement with seven of eight negative phrased statements such as “Working as a sex worker makes you feel like a bad person” (66.6% either disagreed or completely disagreed). Qualitative data indicated that several of the women had experienced or felt stigma related to their profession and one participant explained that this could for instance impede participation in research. However, several expressed that they saw sex work as any other work and had become self-assured as people able to sustain themselves and in many cases their family members.
Discussion: These preliminary findings shows a nuanced picture of these sex workers own perspectives related to their work, stigma and themselves, and opposes a view of FSW as victims devoid of agency and self-assurance.
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Lie, Anne Helene Kveim; Jensen, Terje; Lichtwarck, Hanne; Storaas, Jon; Torjussen, Erik & Havnes, Ingrid Amalia
(2015).
Å sette brukeren i sentrum – allerede som student :.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
135(14),
p. 1236–1237.
doi:
10.4045/tidsskr.15.0702.
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Lichtwarck, Hanne Ochieng; Moen, Kåre & Mmbaga, Elia
(2024).
Pre-Exposure Prophylaxis Use among Female Sex Workers in Dar es Salaam, Tanzania: a Mixed-Methods Study.
Universitetet i Oslo.
ISSN 9788234804564.
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Sex-workers in low-and middle income countries, including in Tanzania, are at increased risk of HIV. Pre-exposure prophylaxis (PrEP) taken as a daily oral drug is efficacious in preventing HIV. However, studies have shown suboptimal engagement with services providing PrEP. This thesis aimed to provide some of the first evidence on PrEP usage among female sex workers in Tanzania, including perceptions and experiences with PrEP and estimate disengagement with services and potential influencing factors, including harmful alcohol use. A total of 470 HIV negative female sex workers (≥18 years) living in Dar es Salaam were recruited through respondent-driven sampling. They were surveyed at baseline when initiating PrEP and their attendance was registered at first clinical follow-up (month 1). Qualitative interviews were also conducted with 40 female sex workers who were former or current PrEP users or who intended to start PrEP. Almost three quarters (74.6%) of the women did not attend the first follow-up appointment, and this was independently associated with mental distress. Older age and having more clients were protective factors for disengagement with PrEP services. Harmful alcohol use was prevalent (37.3%) and independently associated with experiences of arrest, gender-based violence and mobility. Harmful alcohol use was not associated with disengagement. PrEP had multiple and diverse effects, referred to as the “effectosphere” of PrEP. Despite high disengagement, PrEP could lead to empowerment and human flourishing by enabling a sense of freedom and confidence which could promote health, economic opportunities and social relations. However, PrEP could also expose sensitive information leading to stigma, arguments, create fear of harms and medicalize aspects of life. The findings indicate that PrEP is relevant for female sex workers, but PrEP needs to be integrated into holistic HIV prevention strategies that takes into account their complex social circumstances.
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Cavallo, Simon; Lichtwarck, Hanne Ochieng; Moen, Kåre & Mmbaga, Elia
(2022).
Prevalence of substance use and its association with sexual behaviours among men who have sex with men in Dar es Salaam, Tanzania.
Universitetet i Oslo.
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Published
Feb. 13, 2020 8:30 AM
- Last modified
Aug. 20, 2024 11:07 AM
