Baral S, Beyrer C, Muessig K, et al.. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis

Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
The Lancet Infectious Diseases (Impact Factor: 22.43). 03/2012; 12(7):538-49. DOI: 10.1016/S1473-3099(12)70066-X
Source: PubMed


Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age.
We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age.
Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99,878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6-12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0-18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2-31·3; 8627 of 28,075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1-14·8).
Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed.
The World Bank, UN Population Fund.

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    • "While there are almost no data specifically addressing WWUDs in Southeast Asia, some regional reports focus on SWs and their substance use, unmet addiction treatment needs, psychosocial vulnerabilities, and related health risk behaviors (Couture et al., 2012; Tran et al., 2005). For example, a 2012 Malaysian study found HIV prevalence to be several-fold higher in SWs (10.7%) compared to the general female population (0.15%) (Baral et al., 2012), with similar reports in Thailand (Manopaiboon et al., 2013), China (Wang et al., 2009), and Cambodia (Couture et al., 2012; Couture et al., 2011). Lower income and engagement in SW increases the likelihood of WWUDs experiencing IPV (El-Bassel et al., 2011; Shannon et al., 2008; Wechsberg et al., 2008; El-Bassel et al., 2001; Meyer, Springer, & Altice, 2011; Singer, 2009), which in turn elevates HIV risk through traumatic and risky sexual encounters, extradyadic relationships, and fear and powerlessness to negotiate condom use (El-Bassel et al., 2011; El-Bassel et al., 2001; Meyer et al., 2011). "
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    ABSTRACT: Background: Substance use and HIV are syndemic public health problems in Malaysia. Harm reduction efforts to reduce HIV transmission have primarily focused on men with substance use disorders. Objectives: To explore HIV risk behaviors, substance use, and social factors associated with poor health outcomes among women who use drugs in Malaysia. Methods: A cross-sectional survey of 103 drug-using women in Kuala Lumpur, Malaysia were recruited to assess their medical, psychiatric and social comorbidity as well as their engagement in nationally recommended HIV testing and monitoring activities. Results: One-third reported having ever injected drugs, with most (68.2%) having recently shared injection paraphernalia. Sex work (44.7%) and infrequent condom use (42.4%) were common as was underlying psychiatric illness and physical and sexual violence during childhood and adulthood. Most women (62.1%) had unstable living situations and suffered from an unmet need for social support and health services. HIV prevalence was high (20%) with only two thirds of women eligible for antiretroviral therapy having received it. Suboptimal HIV testing and/or monitoring was positively associated with interpersonal violence (AOR 2.73; 95% CI 1.04-7.14) and negatively associated with drug injection (AOR 0.28; 95% CI 0.10-0.77). Conclusions/importance: Women who use drugs in Malaysia demonstrate considerable medical, psychiatric and social co-morbidity, which negatively contributes to optimal and crucial engagement in HIV treatment-as-prevention strategies. Mental health and social support may be key targets for future public health interventions aimed at drug-using women in Malaysia.
    Addictive behaviors 09/2015; 53. DOI:10.1016/j.addbeh.2015.09.013 · 2.76 Impact Factor
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    • "Despite evidence globally of the heavy HIV burden among sex workers (SWs; Baral et al., 2012), as well as other poor health outcomes, including violence (K. Deering et al., 2014), SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support (Guidance Note on HIV and Sex Work, 2009; Rekart, 2005; Risks, Rights and Health, 2012). "
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    ABSTRACT: Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as "An Evaluation of Sex Worker's Health Access" (AESHA; January 2010-July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17-5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17-4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09-2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19-0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09-0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.
    AIDS Care 11/2014; 27(4):1-8. DOI:10.1080/09540121.2014.978730 · 1.60 Impact Factor
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    • "Worldwide, the prevalences of unintended pregnancy, induced abortion, spontaneous abortion, sexually transmitted infections (STIs), and HIV infection are higher in female sex workers (FSWs) than in the general population [1] [2] [3] [4] [5] [6] [7]. High rates of childhood sexual abuse [8] [9], adolescent involvement in the sex industry [10] [11], and adolescent illicit drug use [12] [13] have been linked to inconsistent condom use and HIV infection among FSWs [10]. "
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    ABSTRACT: Objective: To explore experiences during childhood and adolescence that influenced reproductive and sexual health among women who had entered the sex industry in adolescence. Methods: A qualitative study was conducted using information provided by 25 female sex workers (FSWs) from Tijuana, Mexico, who reported entering the sex industry when younger than 18 years. In-depth, semi-structured interviews were conducted with all participants between January 31, 2011, and July 8, 2011. Results: Four interrelated themes that shaped health experiences early sexual abuse, early illicit drug use, ongoing violence, and limited access to reproductive and sexual health care were identified. Participants reporting these experiences were at risk of unintended teenaged pregnancy, spontaneous abortion or stillbirth, and untreated sexually transmitted infections. Conclusion: Programs and policies that address social, structural, and individual vulnerabilities during adolescence and adulthood are required to promote reproductive and sexual health among FSWs in Tijuana, Mexico.
    International Journal of Gynecology & Obstetrics 10/2014; 128(2). DOI:10.1016/j.ijgo.2014.08.014 · 1.54 Impact Factor
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