THAC0501 - Oral Abstract Session
High and disproportionate burden of HIV among female sex workers in low- and middle-income countries: a systematic review and meta-analysis
Presented by Deanna Kerrigan (United States).
S. Baral1, C. Beyrer1, K. Muessig2, T. Poteat1, A. Wirtz1, M. Decker3, S. Sherman4, D. Kerrigan5
1Center for Public Health and Human Rights, JHSPH, Epidemiology, Baltimore, United States, 2Johns Hopkins School of Public Health, International Health, Baltimore, United States, 3Johns Hopkins Bloomberg School of Public Health, Population, Family, and Reproductive Health, Baltimore, United States, 4Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 5Johns Hopkins Bloomberg School of Public Health, Health, Behavior, and Society, Baltimore, United States
Background: Female sex workers (FSW) have long been known to be a most-at-risk population (MARP) for HIV secondary to biological, behavioral, and structural risk factors. However, three decades into the HIV pandemic, there remains a limited understanding of the burden of HIV among these women.
Methods: This study included a systematic review of HIV prevalence data among FSW from low and middle income countries published between January 1st, 2007, and June 25, 2011. In addition, meta-analyses were completed using the Mantel-Haenzel method with a random-effects model characterizing an odds ratio (OR) for the HIV prevalence among FSW compared to that of all reproductive-age women.
Results: Data from 102 studies representing 99,878 female sex workers across 50 countries were included in the analyses. The overall HIV prevalence was 11.8% (95% CI 11.6-12.0) with a pooled OR for HIV infection of 14.1 (95% CI 10.5-19.0) with wide intraregional ranges in the pooled HIV prevalence and OR for HIV infection. In 25 countries with medium and high background HIV prevalence, 32.0% (95% CI 31.0-32.1) of 27009 women were HIV-positive and the OR for infection was 11.9 (95% CI 9.3-15.2).
Conclusions: These findings highlight that though there is a dearth of data characterizing HIV risk among FSW, where studied, burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programming including considerations of the legal and policy environments in which sex work operate, and the critical role of stigma, discrimination and violence targeting FSW.
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