Female sex workers in low- and middle-income countries are nearly 14 times more likely to be infected by HIV compared to the rest of country's population, according to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health. The findings suggest an urgent need to scale up access to quality HIV prevention programs in these countries. The study was published online in The Lancet Infectious Diseases.
"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 not been systematically documented," said Stefan Baral, MD, MPH, MBA, lead author of the study and associate director of the Bloomberg School's Center for Public Health and Human Rights. "In addition to antiretroviral treatment and ongoing HIV prevention for sex workers, 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."
For the study, Johns Hopkins conducted a meta-analysis of 102 previous published studies representing almost 100,000 female sex workers in 50 countries. Overall, HIV prevalence in female sex workers in low- and middle-income countries was found to be about 12 percent, which equated to an increased risk of infection for sex workers 14 times that of other women in these countries. In 26 countries where background levels of HIV were considered "medium" to "high," approximately 31 percent of the female sex workers were found to have HIV and were 12 times more likely to be infected compared with women from the general population. Sex workers in Asia had a 29 percent increased risk for HIV infection compared to other women, which was the greatest disparity among the regions studied. Sex workers in Africa and Latin America were 12 times increased risk compared to other women in these regions.
This analysis was conducted as part of a larger project entitled, "The Global Epidemics of HIV among Sex Workers: Epidemiology, prevention, access to care, costs, and human rights" led by Johns Hopkins researchers Deanna Kerrigan, PhD, MPH, and Chris Beyrer, MD, MPH. The larger project assesses not only the epidemiology of HIV among sex workers in low- and middle-income countries, but also documents the current state of HIV prevention interventions and the social context surrounding sex work in different settings, and uses mathematical modeling and cost-effectiveness analysis to assess the potential impact and resources necessary to scale up of comprehensive HIV prevention, treatment and care services among sex workers.
"Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis" was written by Stefan Baral, Chris Beyrer, Kathryn Manning, Tonia Poteat, Andrea L. Wirtz, Michele R. Decker, Susan G. Sherman, and Deanna Kerrigan.
Funding for the research was provided by the World Bank and the U.N. Population Fund.