WUNRN
BURDEN OF HIV AMONG SEX WORKERS OF
LOW-INCOME & MIDDLE-INCOME COUNTRIES - REVIEW & ANALYSIS
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.