A meta-analysis in The Lancet Infectious Diseases offers a global picture of the heightened risks of HIV borne by female sex workers in low- and middle-income countries. The analysis includes 112 papers and national reports, extracted from 19,180 relevant studies, and covers 50 low- and middle-income nations. A table gives, for each of the 50 countries, an estimate of the relative burden of HIV disease in the female population that is borne by sex workers, expressed as an odds ratio, and the percentage of HIV infections that occur among female sex workers. In addition, pooled figures are given for regions, where sufficient data is available: i.e. for Asia, Latin America and sub-Saharan Africa (though not for Eastern Europe or the Middle East, for which sufficient data was lacking).
Globally, the odds ratio for a female sex worker being infected as against any female is 13.5, and the overall HIV prevalence for female sex workers is 11.8%. Discussion is devoted largely to the differences between regions (i.e. Asia etc.) and the possible impact of recent and ongoing programs.
Asia is distinguished by a relatively large pooled odds ratio: 29.2 as opposed to 12 and 12.4 for Latin America and sub-Saharan Africa respectively, indicating a remarkably heavy burden of female HIV borne by sex-workers Asia. The cases of Latin America and sub-Saharan Africa differ from each other in respect to the general prevalence of HIV in the population, though female sex-workers appear to bear a similar proportion of it (OR 12 and OR 12.4 respectively). Thus, the prevalence of 5.2% for sex workers in Latin American has to be set against relatively low background prevalence in the female population as a whole, while the figure of 36.9% for sub-Saharan Africa reflects vastly higher levels of general prevalence.
There is some rather piecemeal discussion of recent interventions affecting female sex-workers in these regions. The authors point out the effects of such interventions could take time to show up in the data. Nevertheless the overall impression is given of a problem that has in all the regions so far proved extremely refractory in the face of a number of serious and large-scale interventions. For example, following the scale-up of the Avahan and Sonagachi HIV prevention programs across India, female sex workers still carry more than a 50-times increased odds of HIV infection.
Needless to say, the authors recommend a scale-up of access to quality HIV-prevention programming and services among female sex workers on account of their heightened burden of disease, and the likelihood of onward transmission through high numbers of sexual partners.
Stefan Baral, Deanna Kerrigan et al., “Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis”, The Lancet: Infectious Diseases, published online 15th March, 2012
Papers on related issues published in STI journal:
Michele R. Decker, Stefan D. Baral, Chris Beyrer et al., “Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers”, published Online First: 27th January 2012
C. T. Bautista, J. K. Carr et al., “Seroprevalence of and risk factors for HIV-1 infection among female commercial sexworkers in South America”, 2006:82:311-316
N. Makyao, S. Kamazima et al., Oral Sessions epidemiology: oral session 8: STIs and HIV in female sex workers: 01-S08.01: High HIV prevalence within a generalised epidemic; condom use, violence, and sexually transmitted infections among female sex workers in Dar es Salaam, Tanzania, 2011:87:A40-A41
Nurholis Majid, Robert Magnani et al., “Syphilis among female sex workers in Indonesia: need and opportunity for intervention”, published online first: 3rd June 2012