Abstract
HIV testing uptake continues to be low among Female Sex Workers (FSWs). We synthesizes evidence on barriers and facilitators to HIV testing among FSW as well as frequencies of testing, willingness to test, and return rates to collect results. We systematically searched the MEDLINE/PubMed, EMBASE, SCOPUS databases for articles published in English between January 2000 and November 2017. Out of 5036 references screened, we retained 36 papers. The two barriers to HIV testing most commonly reported were financial and time costs—including low income, transportation costs, time constraints, and formal/informal payments—as well as the stigma and discrimination ascribed to HIV positive people and sex workers. Social support facilitated testing with consistently higher uptake amongst married FSWs and women who were encouraged to test by peers and managers. The consistent finding that social support facilitated HIV testing calls for its inclusion into current HIV testing strategies addressed at FSW.
Highlights
Early HIV testing is a public health priority especially among key populations such as female sex workers (FSWs) [1,2,3]: out of the estimated 33 million people living with HIV in the world, 19 million do not know their status [1]
A systematic review of community empowerment interventions in generalized and concentrated epidemics has shown their positive impact on HIV prevalence, estimated number of averted infections among SWs and adult population, and expanded coverage of ART [11]
This systematic review of barriers and facilitators to HIV testing amongst FSWs found that the two barriers to HIV testing most commonly reported are (1) costs, including transportation, formal/informal payments, and time, and (2) stigma, including fear of involuntary disclosure of HIV status/history of sex work, negative attitudes of healthcare workers, and discriminatory policies
Summary
Early HIV testing is a public health priority especially among key populations such as female sex workers (FSWs) [1,2,3]: out of the estimated 33 million people living with HIV in the world, 19 million do not know their status [1]. A systematic review of community empowerment interventions in generalized and concentrated epidemics has shown their positive impact on HIV prevalence, estimated number of averted infections among SWs and adult population, and expanded coverage of ART [11]. These previous studies did not systematically assess HIV testing approaches, but rather examined the combined effect of a variety of prevention activities.
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