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: 19.45). 03/2012; 12(7):538-49. DOI: 10.1016/S1473-3099(12)70066-X
Source: PubMed

ABSTRACT 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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Available from: Kathryn E Muessig, Aug 03, 2015
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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 · 1.56 Impact Factor
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    • "Since then, research has been concentrated in this region to help stem the tide of HIV transmission for PWID (Booth et al., 2010, 2009, 2006a,b, 2004; Kruglov et al., 2008; Taran et al., 2011; Kyrychenko and Polonets, 2005; Booth, 2009). The HIV epidemic in Ukraine has been characterized by high rates of transmission among PWID, with other risk groups such as men who have sex with men (MSM) and female sex workers (FSWs) increasingly represented (Kruglov et al., 2008; UNAIDS, 2010; Baral et al., 2012). It is also very common for people to not know their HIV status in this region, with one study showing that up to 87% of PWID did not know their HIV status prior to the research (Booth et al., 2006b). "
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    ABSTRACT: Background The HIV epidemic in Ukraine is among the largest in Europe. While traditionally the epidemic has spread through injection risk behavior, sexual transmission is becoming more common. Previous research has found that women in Ukraine have higher rates of HIV and engage in more HIV risk behavior than men. This study extended that work by identifying risk factors that differentially predict men and women's HIV status among people who inject drugs (PWID) in Ukraine. Methods From July 2010 through July 2013, 2480 sexually active PWID with unknown HIV status were recruited from three cities in Ukraine through street outreach. The average age was 31 years old. Results Women, who made up twenty-eight percent of the sample, had higher safe sex self-efficacy (p < 0.01) and HIV knowledge (p < 0.001) than men, but scored higher on both the risky injection (p < 0.001) and risky sex (p < 0.001) composite scores than men. Risky sex behaviors were associated with women's HIV status more than men's. We also report results identifying predictors of risky injection and sex behaviors. Conclusions Gender-specific interventions could address problem of HIV risk among women who inject drugs in a country with a growing HIV epidemic. Our findings suggest specific ways in which intervention efforts might focus on groups and individuals who are at the highest risk of contracting HIV (or who are already HIV positive) to halt the spread of HIV in Ukraine.
    Drug and alcohol dependence 05/2014; 138. DOI:10.1016/j.drugalcdep.2014.02.012 · 3.28 Impact Factor
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