News Release

Female sex workers in developing countries are around 14 times more likely to be infected by HIV than women in general population

Peer-Reviewed Publication

The Lancet_DELETED

A study published Online First by The Lancet Infectious Diseases shows that female sex workers in low-income and middle-income countries (LMIC) are around 14 times more likely to be infected by HIV than the general female population.. The Article is by Dr Stefan Baral, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, and colleagues.

Despite 30 years having elapsed since the start of the global HIV epidemic, understanding of the HIV burden among sex workers remains limited, even though these women are at heightened risk of infection due to increased exposure to behavioural, structural, and biological risk factors. In this new work, the authors did a meta-analysis of 102 studies representing almost 100,000 female sex workers in 50 countries.

The authors found that overall HIV prevalence in female sex workers in LMIC was 12%, with these women at a 14 times increased risk of infection compared with the general female population in those countries. In 26 countries deemed to have a medium or high background HIV prevalence, some 31% of the female sex workers were HIV positive and were 12 times more likely to infected than women from the general population. The region where risk of HIV infection increased most due to being a sex worker was Asia (29 times increased risk) compared a 12-times increased risk in Africa and Latin America.

"We identified consistent evidence of substantially higher levels of HIV among female sex workers compared with all women of reproductive age in low-income and middle-income countries in all regions with data," say the authors. "Although female sex workers have long been understood to be a key affected population, the scope and breadth of their disproportionate risk for HIV infection had to date not been systematically documented."

They conclude: "These findings suggest an urgent need to scale up access to quality HIV-prevention programming and services among female sex workers because of their heightened burden of disease and likelihood of onward transmission through high numbers of sexual partners as clients. In view of the high burden of HIV among female sex workers and recent biomedical advances related to treatment as prevention, improvement of linkages to antiretroviral treatment, and retention in care, ongoing prevention for sex workers already living with HIV is crucial…Considerations of the legal and policy environments in which sex workers operate, and the important role of stigma, discrimination, and violence targeting female sex workers globally will be required to reduce the disproportionate disease burden among these women."

In a linked Comment, Dr Kate Shannon of the Gender and Sexual Health Initiative, and Dr Julio S G Montaner, both of the British Columbia Centre for Excellence in HIV/AIDS and the University of British Columbia, Vancouver, BC, Canada, say: "As the epidemic matures in many settings, with some countries already reporting over 50% of sex workers living with HIV, comprehensive initiatives simultaneously targeting HIV prevention, ART access, and care are increasingly vital. As highlighted in a recent report by the UNAIDS advisory on sex work and HIV, removal of structural barriers (eg, criminalised laws and policies, violence) remains a necessary precondition to an effective HIV response in sex work worldwide."

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Dr Stefan Baral, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD, USA. T) +1 410 502 8975 E) sbaral@jhsph.edu

Dr Kate Shannon of the Gender and Sexual Health Initiative Vancouver, BC, Canada. T) +1 604 806-9459 E) kshannon@cfenet.ubc.ca


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