This week saw the publication of the new Lancet series, an ongoing series of analyses of research in HIV with a focus on identifying those at risk and collating the data on prevention strategies. Previous parts of the series have looked at men who have sex with men (2012), and general prevention strategies (2008); however the latest part of the series is a detailed look at the burden of HIV prevention in sex workers.

The series is a detailed look at the studies detailing the HIV burden in sex workers who are female, male and transgender, and as such, gives a fairly broad look at the subject area. It identifies the barriers that are faced in attempts to reduce HIV incidence in this population, and it’s clear from the review that decriminalisation of sex work in order to reduce human rights violations and protect sex workers is a key part of the HIV prevention strategy. For many years, sex workers have been marginalised in attempts to prevent HIV, but it is obvious from the high disease burden in this group that sex workers need to be brought into the centre of HIV prevention strategies.

A particularly interesting part of the report concerning female sex workers comes from a representative of the Dutch police force, who discusses the change in legislation that has decriminalised sex work for those adults who are working voluntarily in this sector, allowing the police to focus their efforts on investigating human rights violations against sex workers and children who are working illegally. The fact that they are still unable to effectively target sex workers who are working illegally in the country remains a point of concern, but it’s hard to doubt that the decriminalisation does allow them to focus their efforts to protect those who chose to be employed in this way.

What’s also fascinating about the series is the study of male sex workers, and the findings that not all of these men identify as gay, potentially undermining public health strategies targeting this group that effectively make this assumption. The understanding of the driving factors behind the choice of these men who have become sex workers is paramount at identifying successful HIV prevention strategies. There’s also a short appendix of local terminology for male sex workers, which may be useful for those looking to work in sexual health abroad.

The inclusion of transgender individuals in the study makes for harrowing reading. Transwomen (the study does not include transmen) have a disproprotionate risk of HIV infection, 13.5 times the risk for natal women. The lack of research in this area, along with a lack of research into effective strategies to prevent HIV in this population undermines our efforts in this area, which is obviously not an acceptable situation to continue.