Female Sex Workers Population Research Articles

Drivers of HIV Infection Among Cisgender and Transgender Female Sex Worker Populations in Baltimore City: Results From the SAPPHIRE Study.

To determine and compare risk factors for HIV infection among cisgender female sex workers (CFSWs) and transgender female sex workers (TFSWs). Baseline data from a cohort study (SAPPHIRE) of street-based CFSW and TFSW in Baltimore, MD. Women were queried about individual (eg, drug use), interpersonal (eg, sexual abuse), and structural (eg, housing) risk factors and questioned on their sex work risk environment. Women were tested for HIV/sexually transmitted infections. We used logistic regression to identify key risk factors for prevalent HIV in each population. We recruited 262 CFSW and 62 TFSW between 2016 and 2017. Compared with TFSW, CFSW were more likely to be white (66% vs. 0%), recently homeless (62% vs. 23%, P < 0.001), regularly gone to sleep hungry (54% vs. 16%, P < 0.001), and to inject drugs (71% vs. 4%, P < 0.001). HIV prevalence was 8 times greater in TFSW than in CFSW (40% vs. 5%, P < 0.001). All participants reported high rates of lifetime physical and sexual violence. Cocaine injection [adjusted odds ratio (aOR) = 3.65, 95% confidence interval (CI): 1.12 to 11.88], food insecurity (aOR = 1.92, 95% CI: 1.22 to 3.04), and >5 years in sex work (aOR = 5.40, 95% CI: 2.10 to 13.90) were independently associated with HIV among CFSW. Childhood sexual abuse (aOR = 4.56, 95% CI: 1.20 to 17.32), being in sex work due to lack of opportunities (aOR = 4.81, 95% CI: 1.29 to 17.90), and >5 years in sex work (aOR = 5.62, 95% CI: 1.44 to 21.85) were independently associated with HIV among TFSW. Although distinct, both populations share a history of extensive childhood abuse and later life structural vulnerability, which drive their engagement in street-based sex work and their HIV risk profiles.

Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda.

BackgroundKey populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers.ObjectiveThe aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda.MethodsWe utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis.ResultsWe estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono.ConclusionsThe CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.

Novel Approaches for Estimating Female Sex Worker Population Size in Conflict-Affected South Sudan.

BackgroundLimited data exist describing the population size of female sex workers (FSW) in South Sudan. A population size estimation exercise among FSW was undertaken in Juba and Nimule during the Eagle Survey.ObjectiveThe study aimed to estimate the number of FSW in Juba and Nimule to inform resource allocation and service provision for FSW.MethodsWe utilized service and unique object multipliers, and 3-source capture-recapture methods in conjunction with a respondent-driven sampling (RDS) survey to estimate the number of FSW in Juba and Nimule. For service multiplier, the number of FSW testing for HIV in 2015 (Juba) and 2016 (Nimule) was obtained from the LINKAGES program targeting FSW. Survey participants were asked whether they had been tested for HIV by LINKAGES during the relevant period. A total of 2 separate unique object distributions were conducted in Juba and Nimule. In Nimule, these were combined to produce a 3-source capture-recapture estimate. The exercise involved distribution of key chains and bangles to FSW, documentation of the number of those who received unique objects, and questions during RDS survey to assess whether participants received unique objects.ResultsIn Juba, the service multiplier method yielded an estimate of 5800 (95% CI 4927-6673) FSW. The unique object estimate (key chain and RDS participation) yielded 5306 (95% CI 4673-5939). Another estimate using RDS participation and receipt of a bangle yielded a much lower estimate of 1863 (95% CI 1776-1951), as did a 2-source estimate of key chain and bangle (2120, 95% CI 2028-2211). A 3-source capture-recapture estimate could not be produced because aggregate rather than individual level data were collected during the third capture. The multiplier estimate using key chain and RDS participation was taken as the final population estimate for FSW in Juba, which constitutes more than 6% of the female population aged 15 to 64 years.In Nimule, the service multiplier method yielded an estimate of 9384 (95% CI 8511-10,257). The 2-source estimates for key chain and RDS yielded 6973 (95% CI 4759-9186); bangles and RDS yielded a higher estimate of 13,104 (95% CI 7101-19,106); key chains and bangles yielded a lower estimate of 1322 (95% CI 1223-1420). The 3-source capture-recapture method using Bayesian nonparametric latent-class model-based estimate yielded a population of 2694 (95% CI 1689-6945), and this was selected as the final estimate for Nimule, which constitutes nearly 40% of female population aged 15 to 64 years.ConclusionsThe service and unique object multiplier, and 3-source capture-recapture methods were successfully used to estimate the number of FSW in Nimule, whereas service and unique object multiplier methods were successfully used in Juba. These methods yielded higher than previously estimated FSW population sizes. These estimates will inform resource allocation and advocacy efforts to support services for FSW.

Mapping and size estimates of female sex workers in Cameroon: Toward informed policy for design and implementation in the national HIV program

BackgroundDue to high HIV prevalence among Female Sex Workers (FSWs) in Cameroon (36.5%), this population is especially vulnerable to HIV acquisition and transmission nationwide. Though being prioritized in the national HIV response, it would be relevant to generate statistics on the number of FSWs in order to guide HIV interventions among FSWs. Our objective was to estimate the size of FSWs within hotspots of Cameroon.MethodsA cross-sectional study was conducted from September-November 2015 in selected cities in Cameroon: Bafoussam, Bamenda, Bertoua, Buea, Douala, Kribi, Limbé, and Yaoundé. A programmatic mapping was used, consisting of interviews with secondary key informants (KI) to identify hotspots of FSWs and their respective estimated numbers. Validation of size estimates was done by interviews with FSW at each hotspot. Size estimations in the councils mapped were extended to others not mapped using a Poisson regression model.ResultsA total of 2,194 hotspots were identified: Douala (760), Yaoundé (622), Bamenda (263), Bafoussam (194), Kribi (154), Bertoua (140), Limbé (35), and Buea (26). The estimated total number (range) of FSWs was 21,124 (16,079–26,170), distributed per city as follows: Douala 7,557 (5,550–9,364), Yaoundé 6,596 (4,712–8,480), Bafoussam 2,458 (1,994–2,923), Bamenda 1,975 (1,605–2,345), Kribi 1,121 (832–1,408), Bertoua 1,044 (891–1,198), Buea 225 (185–266), and Limbé 148 (110–148). The variability of estimates among cities was also observed within the councils of each city. The national predicted estimate of FSW population was 112,580 (103,436–121,723), covering all councils of Cameroon. An estimate of 1.91% (112,580/5,881,526; 0.47%-3.36%) adult female population in Cameroon could be sex workers.ConclusionThere are considerable numbers of FSW in major cities in Cameroon. There is a need to prioritize interventions for HIV prevention toward this population in order to limit the burden of HIV sexual transmission nationwide.

Female sex workers in HIV/AIDS prevention: A social network analysis perspective

Female Sex Workers (FSWs) are a high-risk group that not only are susceptible to, but also may contribute to the spread of, HIV/AIDS. How to effectively intervene the FSW population for HIV/AIDS prevention has been a public concern. In this paper, relied on a set of interview data of FSWs collected from a city in Yunnan Province, China, we first construct a social network based on if FSWs have been acquaint. We find that the network has the characteristics of “small world” with a small average shortest path and a big clustering coefficient. The network also shows a “small community” phenomenon with a low average density. In other words, individuals are close to each other in community, and their external connection is sparse. The degree of the FSW social network obeys an exponential distribution, indicating that few numbers of nodes have a large centrality (i.e. the important individuals). In addition, those nodes that is more passive in HIV/AIDS prevention have a higher level of clustering, but a lower similarity with their neighbors. Finally, we use individuals’ responses to the AIDS KAP questionnaire to predict one’s position (or status) in the social network, as the social network structure is invisible, observable individual responses to the questionnaire is easier to obtain. We then propose an efficient method to choose the nodes based on individuals’ responses to AIDS KAP questionnaire for intervention and network clogging. We found that, compared with a random node selection method, our method is more effective.

Condom use attitude and self-efficacy, and STIs risk perception among Iranian female sex workers: A psychometric study

In this cross-sectional study, we aimed to investigate psychometric properties of the Persian versions of condom use self-efficacy (CUSES), attitude toward condom use (ATCUS), and sexually transmitted infection risk perception (STIsRP) scales among Iranian female sex workers (FSWs). We translated original versions of the scales into Persian, and through census, recruited and interviewed 140 FSWs. Appropriate validity, reliability, functionality and simplicity were demonstrated for the scales. We found the measurement model with a good fit to the data (χ2 [104] = 89.537, p < .01, CFI = 0.978, NFI = 0.931, TLI = 0.981, RMSEA = 0.055 [0.023–0.081]). Our findings supported the applicability of the Persian CUSES, ATCUS, and STIsRP in the Iranian and other Persian-speaking FSW populations.

Estimating the Population Size of Female Sex Workers in Three South African Cities: Results and Recommendations From the 2013-2014 South Africa Health Monitoring Survey and Stakeholder Consensus.

BackgroundRobust population size estimates of female sex workers and other key populations in South Africa face multiple methodological limitations, including inconsistencies in surveillance and programmatic indicators. This has, consequently, challenged the appropriate allocation of resources and benchmark-setting necessary to an effective HIV response. A 2013-2014 integrated biological and behavioral surveillance (IBBS) survey from South Africa showed alarmingly high HIV prevalence among female sex workers in South Africa’s three largest cities of Johannesburg (71.8%), Cape Town (39.7%), and eThekwini (53.5%). The survey also included several multiplier-based population size estimation methods.ObjectiveThe objective of our study was to present the selected population size estimation methods used in an IBBS survey and the subsequent participatory process used to estimate the number of female sex workers in three South African cities.MethodsIn 2013-2014, we used respondent-driven sampling to recruit independent samples of female sex workers for IBBS surveys in Johannesburg, Cape Town, and eThekwini. We embedded multiple multiplier-based population size estimation methods into the survey, from which investigators calculated weighted estimates and ranges of population size estimates for each city’s female sex worker population. Following data analysis, investigators consulted civil society stakeholders to present survey results and size estimates and facilitated stakeholder vetting of individual estimates to arrive at consensus point estimates with upper and lower plausibility bounds.ResultsIn total, 764, 650, and 766 female sex workers participated in the survey in Johannesburg, Cape Town, and eThekwini, respectively. For size estimation, investigators calculated preliminary point estimates as the median of the multiple estimation methods embedded in the IBBS survey and presented these to a civil society-convened stakeholder group. Stakeholders vetted all estimates in light of other data points, including programmatic experience, ensuring inclusion only of plausible point estimates in median calculation. After vetting, stakeholders adopted three consensus point estimates with plausible ranges: Johannesburg 7697 (5000-10,895); Cape Town 6500 (4579-9000); eThekwini 9323 (4000-10,000).ConclusionsUsing several population size estimates methods embedded in an IBBS survey and a participatory stakeholder consensus process, the South Africa Health Monitoring Survey produced female sex worker size estimates representing approximately 0.48%, 0.49%, and 0.77% of the adult female population in Johannesburg, Cape Town, and eThekwini, respectively. In data-sparse environments, stakeholder engagement and consensus is critical to vetting of multiple empirically based size estimates procedures to ensure adoption and utilization of data-informed size estimates for coordinated national and subnational benchmarking. It also has the potential to increase coherence in national and key population-specific HIV responses and to decrease the likelihood of duplicative and wasteful resource allocation. We recommend building cooperative and productive academic-civil society partnerships around estimates and other strategic information dissemination and sharing to facilitate the incorporation of additional data as it becomes available, as these additional data points may minimize the impact of the known and unknown biases inherent in any single, investigator-calculated method.

Combining the randomized response technique and the network scale-up method to estimate the female sex worker population size: an exploratory study.

Recall bias, barrier effects, transmission error, and response bias affecting the network scale-up method (NSUM) led the Joint United Nations Programme on HIV/AIDS and the World Health Organization to designate NSUM as a developing method for estimating the size of high-risk populations in 2010. The method has subsequently been adjusted for three of these biases. The present study, therefore, aimed to explore the combination of the randomized response technique (RRT) and NSUM to adjust the last remaining bias. RRT was used in an NSUM survey to estimate the population proportion of female sex workers (FSWs) in Taiyuan, China, in 2012. Multiplier method estimates and national-level estimates of the population proportion of FSWs were used as criteria to assess the aforementioned results. Successful interviews were completed with 96.4% of the respondents selected for the NSUM survey. The NSUM estimate fell within the range of the national-level estimates of the population proportion of FSWs in Asia and was close to the estimate yielded by the multiplier method. In the present study, the combination of RRT and NSUM obtained a high response rate and produced a reliable estimate of the size of a high-risk population.

The influence of mobility among high-risk populations on HIV transmission in Western Kenya.

Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An agent-based network model of HIV transmission, geographically stratified at the county level, was fit to the HIV epidemic, scale-up of interventions, and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients. In the first, all clients were assumed to be resident in the same geographies as their interactions with FSW. In the second, some clients were considered non-resident and engaged only in interactions with FSW, but not in longer-term non-FSW partnerships in these geographies. Under both assumptions, the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence. Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties, with 30.0% of local HIV transmissions attributable to current and former FSW and clients, compared to 21.9% when mobility of clients was included. Nonetheless, the overall epidemic drivers remained similar, with risky behavior in the general population dominating transmission in high-prevalence counties. Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV, but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population.

Estimating the Population of Female Sex Workers in Hamadan, Western Iran, 2014

Background: Estimating the population of female sex workers (FSWs) is necessary to monitor HIV epidemic, behavioral risk factors and implement preventive. Objectives: The current study aimed to evaluate the population of FSWs in Hamadan, west of Iran. Patients and Methods: Minimum required data was extracted from 3 registry centers of (a) woman volunteer counseling and Testing Centers (WVCTCs); (b) welfare office drop in Centers (DICw); and (c) health deputy drop in centers (DICh) in Hamadan. The current study estimated the number of FSWs not identified by any of the 3 centers by log-linear model, and hence, the total FSWs population (N). The Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC) were used as model selection and goodness of fit criteria. Results: There might be 493 (95% confidence interval (CI): 351 - 693) FSWs not identified by any of the centers. Therefore, the real number of FSWs is expected to be 842 (95%CI: 700 - 1042). These results showed that only 41.4% of FSWs were registered by the 3 sources. Conclusions: According to the underestimation of FSWs population by registry data sources in Hamadan, it was concluded that the policy makers should provide health care services and preventive activities according to actual size of FSWs population.

Cross-sectional study of female sex workers in Soweto, South Africa: Factors associated with HIV infection.

IntroductionIn South Africa, the rate of HIV in the sex worker (SW) population is exceedingly high, but critical gaps exist in our understanding of SWs and the factors that make them vulnerable to HIV. This study aimed to estimate HIV prevalence among female sex workers (FSWs) in Soweto, South Africa, and to describe their sexual behavior and other factors associated with HIV infection.MethodsA cross-sectional, respondent-driven sampling (RDS) recruitment methodology was used to enroll 508 FSWs based in Soweto. Data were collected using a survey instrument, followed by two HIV rapid tests. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multivariate logistic regression to show factors associated with HIV infection.FindingsHIV prevalence among FSWs was 53.6% (95% CI 47.5–59.9). FSWs were almost exclusively based in taverns (85.6%) and hostels (52.0%). Less than a quarter (24.4%) were under 25 years of age. Non-partner violence was reported by 55.5%, 59.6% of whom were HIV-infected. Advancing age, incomplete secondary schooling, migrancy and multiple clients increased the likelihood of HIV acquisition: >30 years of age was associated with a 4.9 times (95% CI 2.6–9.3) increased likelihood of HIV; incomplete secondary schooling almost tripled the likelihood (AOR 2.8, 95% CI 1.6–5.0); being born outside of the Gauteng province increased the likelihood of HIV 2.3 times (95% CI 1.3–4.0); and having more than five clients per day almost doubled the likelihood (AOR 1.9, 95% CI 1.1–3.2).ConclusionOur findings highlight the extreme vulnerability of FSWs to HIV. Advancing age, limited education and multiple clients were risk factors associated with HIV, strongly driven by a combination of structural, biological and behavioral determinants. Evidence suggests that interventions need to be carefully tailored to the varying profiles of SW populations across South Africa. Soweto could be considered a microcosm of South Africa in terms of the epidemic of violence and HIV experienced by the SW population, which is influenced by factors often beyond an individual level of control. While describing a hitherto largely undocumented population of FSWs, our findings confirm the urgent need to scale up innovative HIV prevention and treatment programs for this population.

Estimating the number of female sex workers in Côte d'Ivoire: results and lessons learned.

To report on the results of three size estimations of the populations of female sex workers (FSW) in five cities in Côte d'Ivoire and on operational lessons learned, which may be relevant for key population programmes in other parts of the world. We applied three methods: mapping and census, capture-recapture and service multiplier. All were applied between 2008 and 2009 in Abidjan, San Pedro, Bouaké, Yamoussoukro and Abengourou. Abidjan was the city with the highest number of FSW by far, with estimations between 7880 (census) and 13 714 (service multiplier). The estimations in San Pedro, Bouaké and Yamoussoukro were very similar, with figures ranging from 1160 (Yamoussoukro, census) to 1916 (San Pedro, capture-recapture). Important operational lessons were learned, including strategies for mapping, the importance of involving peer sex workers for implementing the capture-recapture and the identification of the right question for the multiplier method. Successful application of three methods to estimate the population size of FSW in five cities in Côte d'Ivoire enabled us to make recommendations for size estimations of key population in low-income countries.

Estimating the Population Size of Female Sex Worker Population in Tehran, Iran: Application of Direct Capture-Recapture Method.

There is no reliable estimate of the size of female sex workers (FSWs). This study aimed to estimate the size of FSWs in south of Tehran, Iran in 2016 using direct capture-recapture method. In the capture phase, the hangouts of FSWs were mapped as their meeting places. FSWs who agreed to participate in the study tagged with a T-shirt. The recapture phase was implemented at the same places tagging FSWs with a blue bracelet. The total estimated size of FSWs was 690 (95% CI 633, 747). About 89.43% of FSWs experienced sexual intercourse prior to age 20. The prevalence of human immunodeficiency virus infection among FSWs was 4.60%. The estimated population size of FSWs was much more than our expectation. This issue must be the focus of special attention for planning prevention strategies. However, alternative estimates require to estimating the number FSWs, reliably.

Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda

BackgroundWhile female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in...

Humans Papillomavirus (Hpv) Infections in Female Sex Workers in Cote D’ivoire

Background: Human Papillomaviruses (HPV) are small virus non-enveloped double-stranded circular DNA. They infect epithelial cells (mucous membranes and skin). Many studies have indicated that having multiple sexual partners may lead to higher HPV transmission. Thus female sex workers (FSWs) may be at greater risk of infection compared to the general population. In female sex workers (FSWs), the risk of HPV infection and cervical cancer is especially high. The aim of this work is to determine the prevalence and the genotypes of Humans Papillomavirus (HPV) that circulate in female sex workers populations in Cote d’Ivoire. Methods: From December 2015 to May 2016, cervical samples from 350 female sex workers were tested for some HR-HPV. HPV DNA was amplified using PGMY09 /11 primers which generated 450 base pairs at the L1 region. The samples harboring HPV DNA were genotyped using the multiplex PCR with HPV 16, 18, 31, 33, 35, 45 and 51 primers. Results: The mean age of this population was 32.5 years. On 350 female sex workers HPV DNA was obtained in 51.5% of the population. A total of 168 (94.38%) specimens harboring HPV DNA were genotypes using multiplex PCR versus 5.61 %, which were not genotyped using HPV 16,18, 31, 33, 35, 45 and 51 by multiplex PCR. These 168 strains permit us to identify 204 strains of HPV on whom we have 88.69 % with single infection while 11.30 % with a multiple infection. Among the multiple infection 36.84 % had respectively double and triple HPV infection and 26.31 % had four HPV infections. HPV genotypes prevalence was the followed: HPV 16 (22.47%), HPV 18 (26.97%), HPV 35 (11.23%), HPV 31 and HPV 33 (7.86%) respectively and HPV 45 (7.30%). Any case of HPV genotype 51 was founded. Conclusion: The prevalence of HPV infection in female sex workers is high. The most genotypes which circulate in female sex workers are type 16 and type 18 which are the best known in the world.

Associations Between Vaginal Infections and Potential High-risk and High-risk Human Papillomavirus Genotypes in Female Sex Workers in Western Kenya

PurposeInfection with and persistence of high-risk human papillomavirus (HR HPV) are the strongest risk factors for cervical cancer. Little is known about the prevalence and role of concurrent sexually transmitted infections (STIs) found in HPV-infected female sex workers (FSW) in Africa. This study purports to test our a priori hypotheses that STIs are associated with genotypes pertaining to the α-group species 9. The objectives were to determine the prevalence of bacterial vaginosis (BV), Trichomonas vaginalis, and Candida spp in FSW, the association between these STIs and the prevalence of any potential HR and HR HPV genotypes in FSWs. MethodsA cross-sectional study design of 616 FSW from Western Kenya aged between 18 and 61 years during 2009–2015 using a peer recruitment sampling strategy. Inclusion criteria for the study entailed female sex and >18 years of age and having engaged in transactional sex in exchange for money, goods, services, or drugs in the last 3 months. Women were excluded if they were pregnant, <18 years of age, had a history of cervical dysplasia or cancer, had current abnormal bleeding, or had a hysterectomy. FindingsOf the FSW, 33.3% had HIV and 57.7% harbored a potential HR and HR HPV genotype. The 2 most prevalent potential HR and HR genotypes were HPV 16 (16.10%) and HPV 59 (12.20%). BV was the most common infection (48.3%), followed by Trichomonas vaginalis (31.4%) and Candida spp (19.9%). A multivariate regression revealed significant associations with both α-group 9 and 6; BV and HPV 58 (adjusted odds ratio [aOR] = 2.3; 95% CI, 1.0–5.2; P = 0.05), Trichomonas vaginalis and HPV 31 and HPV 35 (aOR = 2.0; 95% CI, 1.0–3.8; P = 0.04 and aOR = 1.8; 95% CI, 1.0–3.3, P = 0.05 respectively); and between Candida spp and HPV 53 (aOR = 2.0; 95% CI, 1.1–4.0; P = 0.03) and 16 (aOR = 1.9; 95% CI, 1.1–3.3; P = 0.03). ImplicationsSnowball sampling may have inadvertently excluded FSW less likely to benefit from a social network. Significant associations between BV and HPV 58 and between Candida spp and HPV 16 and 53 suggest the need for sexually transmitted disease management within a cervical cancer prevention program. The probable synergistic effects of the vaginal microbiota should be elucidated, especially within this vulnerable population. Given the potential for FSW to transmit STIs, robust epidemiologic sampling methods are urgently required that account for the heterogeneity of the FSW population.

Correlates of HIV infection among street-based and venue-based sex workers in Vietnam.

Commercial sex work is one of the driving forces of the HIV epidemic across the world. In Vietnam, although female sex workers (FSWs) carry a disproportionate burden of HIV, little is known about the risk profile and associated factors for HIV infection among this population. There is a need for large-scale research to obtain reliable and representative estimates of the measures of association. This study involved secondary data analysis of the 'HIV/STI Integrated Biological and Behavioral Surveillance' study in Vietnam in 2009-2010 to examine the correlates of HIV among FSWs. Data collected from 5298 FSWs, including 2530 street-based sex workers and 2768 venue-based sex workers from 10 provinces in Vietnam, were analyzed using descriptive statistics and bivariate and multivariate logistic regression analyses. HIV prevalence among the overall FSW population was 8.6% (n = 453). However, when stratified by FSW subpopulations, HIV prevalence was 10.6% (n = 267) for street-based sex workers and 6.7% (n = 186) for venue-based sex workers. Factors independently associated with HIV infection in the multivariate analysis, regardless of sex work types, were injecting drug use, high self-perceived HIV risk, and age ≥ 25 years. Additional factors independently associated with HIV risk within each FSW subpopulation included having ever been married among street-based sex workers and inconsistent condom use with clients and having sex partners who injected drugs among venue-based sex workers. Apart from strategies addressing modifiable risk behaviours among all FSWs, targeted strategies to address specific risk behaviours within each FSW subpopulation should be adopted.

Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis.

BackgroundThe 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.MethodFour electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.ResultThree hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.ConclusionPrevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.

O18.6 A method to estimate the national prevalence of hiv-infection among female sex workers in zimbabwe by pooling data from multiplie respondent driven sampling surveys and programme consultations

Introduction Respondent driven sampling (RDS) surveys are often used to estimate site-specific HIV-prevalence among female sex workers (FSW). Methods to combine data from multiple sites to estimate national or provincial HIV-prevalence are rarely described. Methodology Using data from the Zimbabwean national FSW HIV prevention programme, working in 36 priority sites across all provinces, we estimated the average number of visits made by FSW to outreach sexual/reproductive health clinics each month at each site between January 2014–Dec 2014. We treated this variable as a proxy for the relative size of the FSW population at each site. We conducted RDS surveys with HIV testing among 200 FSW in 14 of the 36 sites, purposively selected. We used the RDS-2 analysis approach to estimate HIV prevalence in each of the 14 sites. We then combined data from the 14 sites, weighting each site by the proxy for FSW population size to provide an estimate of the national prevalence of HIV among FSW in Zimbabwe. Results The HIV prevalence across sites ranged from 43 to 79%. The unweighted mean of the site-specific prevalences was 57.5% (95% CI 51.9–62.8%). The mean number of women visiting each site per month over 2014 ranged from 16 to 87. The weighted women visiting each site per month in 2014 mean of the site-specific HIV prevalences was 58.1% (95% CI 53.8.4–62.2%). Conclusions HIV prevalence among FSW in Zimbabwe is very high but variable by site. We describe an approach to estimating national HIV prevalence from multiple site-specific surveys. Here, weighting made little difference to a mean approach though this may not always be the case. Several future refinements to the method proposed are possible and will be discussed. Disclosure of interest statement The SAPPH-IRe trial is using Truvada donated by Gilead. We have no other relationships with commercial entities to disclose.

Antiretroviral treatment coverage for men who have sex with men and female sex workers living with HIV in Cameroon.

Men who have sex with men (MSM) and female sex workers (FSW) are more likely to be living with HIV and experience difficulty accessing HIV health services due to stigma and discrimination. Antiretroviral treatment and sustained viral suppression among individuals living with HIV is the last step in the continuum of HIV care, which has been shown to improve health outcomes and decrease the risk of onward transmission of HIV. To calculate the numerator and denominator for antiretroviral therapy (ART) coverage estimates among MSM and FSW living with HIV, the Priority Locations for AIDS Control Efforts methods were modified to include individual quantitative interviews, health service assessment and mapping, and size estimation in 7 cities in Cameroon. MSM and FSW were recruited using peer referral and venue-based sampling. The numerator was calculated from interviews with MSM and FSW. Population size estimation of MSM and FSW was used to determine the denominator. Antiretroviral coverage varied by site from 0% to 25% among HIV infected MSM and FSW. ART provision to the general population was reported at a significantly greater proportion of HIV health centers (56.5%) than ART provision to MSM and FSW populations (13.2%). The majority of MSM and FSW living with HIV and eligible for treatment in Cameroon are not connected to ART care. Additionally, ART provision for MSM and FSW at HIV health centers is insufficient. Characterizing effective strategies to reach optimal levels of engagement in the continuum of HIV care among MSM and FSW is essential for an AIDS-free generation for Cameroon.