Abstract
IntroductionFemale sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse.MethodsPopulation attributable fractions of HIV prevalence due to female sex work were estimated for 2011. A systematic search was conducted to retrieve required input data from available sources. Data gaps of HIV prevalence in FSWs for 2011 were filled using multilevel modeling and multivariate linear regression. The fraction of HIV attributable to female sex work was estimated as the excess HIV burden in FSWs deducting the HIV burden in FSWs due to injecting drug use.ResultsAn estimated fifteen percent of HIV in the general female adult population is attributable to (unsafe) female sex work. The region with the highest attributable fraction is Sub Saharan Africa, but the burden is also substantial for the Caribbean, Latin America and South and Southeast Asia. We estimate 106,000 deaths from HIV are a result of female sex work globally, 98,000 of which occur in Sub-Saharan Africa. If HIV prevalence in other population groups originating from sexual contact with FSWs had been considered, the overall attributable burden would probably be much larger.DiscussionFemale sex work is an important contributor to HIV transmission and the global HIV burden. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. These must be scaled up.ConclusionFSWs suffer from high HIV burden and are a crucial core population for HIV transmission. Surveillance, prevention and treatment of HIV in FSWs should benefit both this often neglected vulnerable group and the general population.
Highlights
Female sex workers (FSWs) are at high risk of human immunodeficiency virus (HIV) infection
The fraction of HIV infections in the general female population that is attributable to the occupational exposure of female sex work, i.e. adjusted for other risks in FSWs, is currently unknown
The objective of this work was to determine the proportion of HIV prevalence in the general female population that is attributable to occupational exposure in FSWs, and thereby (1) estimate the public health importance of this risk factor and (2) highlight the potential impact of preventive action targeted towards this occupational group
Summary
Female sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse. Sex work, defined here as ‘‘the provision of sexual services in exchange for money, goods, or other benefits’’ [2], is structured differently around the world, and comprehensively capturing this heterogeneous group of workers may be difficult. This is the case when they are stigmatized or even illegal, which might make FSWs reluctant to disclose their profession. The definition includes many women who sell sex occasionally or for benefits other than money (often called ‘indirect’ FSWs as opposed to ‘professional’, ‘brothel-based’ or ‘direct’ FSWs) and might not consider themselves as sex workers. The fraction of HIV infections in the general female population that is attributable to the occupational exposure of female sex work, i.e. adjusted for other risks in FSWs, (as opposed to total HIV in sex workers), is currently unknown
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
