The risk of contracting HIV is 14 times higher for female sex workers in low- and middle-income countries (LMIC) than for women in the general population, according to a study published Online First in The Lancet Infectious Diseases.
Three decades have passed since the global HIV epidemic started, yet the knowledge about HIV amongst sex workers is still limited, despite these women's increased risk of infection because of higher exposure to biological, behavioral and structural risk factors.
Dr. Stefan Baral, from the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, USA, and his team decided to perform a meta-analysis of 102 studies that included nearly 100,000 female sex workers in 50 countries.
They discovered an overall HIV occurrence in 12% of female sex workers in LMIC, and that sex workers were 14 times more likely to be infected with the virus as compared with the general female population in those countries. 31% of female sex workers in 26 countries categorized as medium or high background HIV prevalence tested positive to the virus, with the risk for infection in these female sex workers being 12 times higher compared with women from the general population.
The worst region in terms of infection risk for female sex workers was Asia, with an increased risk of 29 times, whilst the risk in Africa and Latin America was 12-fold as compared to the general female population.
The researchers concluded:
"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.
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. 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."
Linked Comment in The Same JournalDr. Kate Shannon of the Gender and Sexual Health Initiative, and Dr Julio S G Montaner from the British Columbia Centre for Excellence in HIV/AIDS and the University of British Columbia in Vancouver, BC, Canada, write in a linked comment:
"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 (e.g., criminalized laws and policies, violence) remains a necessary precondition to an effective HIV response in sex work worldwide."
Written by Petra Rattue