TY - JOUR

T1 - Global epidemiology of HIV among female sex workers

T2 - Influence of structural determinants

AU - Shannon, Kate

AU - Strathdee, Steffanie A.

AU - Goldenberg, Shira M.

AU - Duff, Putu

AU - Mwangi, Peninah

AU - Rusakova, Maia

AU - Reza-Paul, Sushena

AU - Lau, Joseph

AU - Deering, Kathleen

AU - Pickles, Michael R.

AU - Boily, Marie Claude

N1 - Funding Information: This Review was partly supported by the US National Institutes of Health ( R01DA028648 ), the Bill & Melinda Gates Foundation , and the United Nations Population Fund . KS is partially supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS . SAS is partially supported by a NIDA merit award ( R37 DA019829 ). For assistance with the report, we thank Jinghua Li, Nancy Stimson, Ursula Ellis, and Katherine Miller. Funding Information: Across both concentrated (India and Canada) and generalised (Kenya) epidemics, decriminalisation of sex work could have the largest effect on the course of the HIV epidemics, averting 33–46% of HIV infections over the next decade. Calls for removal of all legal restrictions targeting sex work have been supported by international policy bodies, including WHO, UNAIDS, UNDP, and the UN Population Fund, 1 and a recent unanimous decision by the Supreme Court of Canada. Ultimately, evidence must drive government responses in law and policy revisions to ensure the health and human rights of sex workers. Publisher Copyright: © 2015 Elsevier Ltd. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2015/1/3

Y1 - 2015/1/3

N2 - Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1-31) and 20% in Canada (95% UI 3-39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25-42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8-36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.

AB - Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1-31) and 20% in Canada (95% UI 3-39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25-42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8-36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33-46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.

UR - http://www.scopus.com/inward/record.url?scp=84920578578&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(14)60931-4

DO - 10.1016/S0140-6736(14)60931-4

M3 - Review article

C2 - 25059947

AN - SCOPUS:84920578578

VL - 385

SP - 55

EP - 71

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9962

ER -