Chapter 14 - Preventing HIV among sex workers

Abstract

This chapter provides an overview of the epidemiology, HIV risk, and vulnerability among sex workers and addresses the intervention gaps. In every region of the world sex workers are a critical group in the HIV transmission dynamics, and effective interventions with sex workers are an important component of comprehensive HIV control strategies. Sex workers are both at high risk because of multiple sexual partners, and highly vulnerable because of environmental and structural barriers that prevent them from accessing prevention services and having control over their activities. There is extensive global experience in HIV prevention among sex workers, and an essential package of proven effective interventions has been defined. Most interventions in sex workers, however, despite being effective, have had little impact on HIV transmission dynamics in countries simply because they are implemented on such a small scale that most sex workers who need prevention services do not have them available. Addressing this “prevention gap” is the major challenge in HIV prevention in sex workers. The relative importance of core groups to the spread and maintenance of HIV within the population will change over time, decreasing as HIV levels become higher in the general population. The high levels of STIs and HIV among sex workers underline the importance of continuing interventions among sex workers and their clients. High HIV prevalence levels have been found among sex workers all over the world where they face multiple risks, including multiple sexual partners, low levels of condom use and high STI prevalence. In addition, sex workers are often not in a position to control these risk factors, because of the environment and context in which they live.