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A Systematic Review of HIV Prevalence among Female Sex Workers in Low and Middle Income Countries Stefan Baral, Chris Beyrer, Kathryn Muessig , Tonia Poteat , Andrea L Wirtz , Michele R Decker, Susan G Sherman, Deanna Kerrigan The johns hopkins bloomberg school of public health. Background.

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  1. A Systematic Review of HIV Prevalence among Female Sex Workers in Low and Middle Income CountriesStefan Baral, Chris Beyrer, Kathryn Muessig, Tonia Poteat, Andrea L Wirtz, Michele R Decker, Susan G Sherman, Deanna KerriganThe johns hopkinsbloomberg school of public health

  2. Background • Sex workers are at increased vulnerability to HIV infection through risks mediated by multiple factors • Biological • Untreated STIs • Behavioral • Numbers of sexual partners • Structural • Criminalization and human rights violations

  3. Primary Aim • We sought to systematically review and meta-analyze the literature on HIV infection among female sex workers from low and middle income countries (LMIC) • Inclusion criteria • Any study design measuring HIV incidence or prevalence among female sex workers in LMIC, including peer-reviewed and publically available reports where sampling, testing and analytical methods documented

  4. Systematic Review Protocol • Search strategy • Published January 1, 2007 to June 25, 2011 in English, French, Spanish • PubMed, EMBASE, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine • Following search terms • Prostitute [MeSH] or “sex work” or “sex work*” or “female sex worker” or “commercial sex worker” AND HIV [MeSH] or AIDS [MeSH] or “HIV” OR “AIDS”. • Title search • Completed by two reviewers with a third acting as tie-breaker • Duplicate titles removed and excluding non-scientific journals. • Abstract review • Completed by two reviewers with a third acting as tie-breaker • Full text review and data abstraction • Completed by two abstractors with a third acting as tie-breaker

  5. Methods • Meta-Analysis • Characterize increased odds of living with HIV for female sex workers compared to other women per country/region • Sex worker HIV Prevalence • All estimates from a country were pooled and weighted by sample size to achieve prevalence estimate • Background HIV Prevalence • UNAIDS data from Women 15+ living with HIV as numerator in each country • Denominator calculated using US Census Bureau Data for women 15-49 • Heterogeneity tests done using DerSimonian-Laird Q statistic • Random effects modeling

  6. Systematic Review Results

  7. Results of HIV Prevalence among FSW

  8. Results in Asia

  9. HIV Prevalence among Asian FSW

  10. Asia Meta-analysis

  11. Results in Eastern Europe/Former Soviet Union

  12. HIV Prevalence among EE/FSU FSW

  13. Results in Latin America and the Caribbean

  14. HIV Prevalence among LAC FSW

  15. HIV Prevalence among LAC FSW

  16. Results in Middle East/North Africa

  17. MENA HIV Prevalence among FSW

  18. Results in Sub-Saharan Africa

  19. HIV Prevalence among SSA FSW

  20. SSA FSW Meta-analysis

  21. Map of HIV prevalence among female sex workers in low-income and middle-income countries, 2007-2011 • Pooled OR for HIV infection among female sex workers compared to other women of reproductive age (15-49) • 13.49 (95% CI 10.04-18.12)

  22. Limitations • Data available for 50/145 LMIC meeting inclusion criteria • 2/3 of LMIC do not have HIV prevalence data on sex workers available in public domain indicating need for systematic data • Significant heterogeneity of study results • Some heterogeneity addressed by sub-level analyses by region • However, pooling even at regional level masks wide geographic variations within a country or region such as within India • Background rates among women may include HIV infections among female sex workers • Sensitivity analyses completed removing infections attributable to FSW from background

  23. Conclusions • Three decades into the HIV pandemic, epidemiological data characterizing risk status and needs of sex workers remains limited • Global policy environment limits comprehensive assessments of HIV prevention and service delivery needs of sex workers across settings • In all epidemic types and contexts, the burden of HIV is much greater among female sex workers as compared to the general population • Particularly, in the generalized epidemics of Sub Saharan Africa, female sex workers represent an underserved and higher risk population group • These data represent a call for action to invest in and address the needs of sex workers to prevent HIV, including evidence-based comprehensive HIV prevention strategies which protect and promote their human rights

  24. Acknowledgements • JHSPH Data Review • Madeleine Schlefer • World Bank • Robert Oelrichs • Iris Semini • NdellaNjie • UNFPA • Jenny Butler • NSWP • Ruth Morgan Thomas Funded by the World Bank and UNFPA

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