HIV In Sex Workers Research Articles

Flesh Trade: Research Summary of Human Rights Abuses Against Sex Workers

Sex labourers keep on confronting criminalization, savagery, segregation and different types of human rights infringement, which increment their danger of procuring HIV. Sex labourers—female, male and transgender grown-ups who have consensual sex in return for cash or merchandise, either consistently or every so often—are among the populace that are by and large deserted in the HIV reaction. HIV pervasiveness among sex labourers is multiple times higher than among everyone, and sex labourers are inadequately served by HIV administrations. A significant number of the human rights difficulties, vulnerabilities and hindrances sex labourers face in getting to HIV administrations are because of criminalization and the prohibitive laws, guidelines and practices they face. Selling and additionally purchasing sex is in part or completely condemned in any event 39 nations. In a lot more nations some part of sex work is condemned, and in different nations general criminal law is applied to condemn sex work (for instance, laws against dallying and vagrancy). The danger of detainment, just as laws that take into account the utilization of condoms as proof of sex work, are not kidding hindrances to the accessibility and take-up of HIV anticipation projects and administrations. At the point when the police as proof of sex work utilize ownership of condoms, this significantly builds the danger of HIV among this key populace. Indeed, even where sex work isn't condemned, sex labourers are seldom insured under the law. Moreover, considers have indicated that female sex labourers are exposed to elevated levels of brutality—in Haiti, for instance, 36.6% of female sex labourers report physical savagery and 27.1% report sexual viciousness. Notwithstanding, sex specialist associations are driving endeavors to propel their human rights and access to HIV administrations in numerous nations. In South Africa, sex specialist drove associations worked intimately with the Ministry of Health to build up the South African National Sex Worker HIV Plan 2016–2019, which requires an empowering domain for the insurance of, and access to HIV administrations for, sex labourers. The across the country program enrolled peer sparks to aid the dispersion of condoms and oil, data on explicitly transmitted diseases and HIV avoidance, paralegal administrations and wellbeing administration referrals. Network strengthening administrations that intend to diminish viciousness, disgrace and segregation included refinement preparing and a help line for sex labourers.

HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project.

BackgroundOperational research is required to design delivery of pre-exposure prophylaxis (PrEP) and early antiretroviral treatment (ART). This paper presents the primary analysis of programmatic data, as well as demographic, behavioural, and clinical data, from the TAPS Demonstration Project, which offered both interventions to female sex workers (FSWs) at 2 urban clinic sites in South Africa.Methods and findingsThe TAPS study was conducted between 30 March 2015 and 30 June 2017, with the enrolment period ending on 31 July 2016. TAPS was a prospective observational cohort study with 2 groups receiving interventions delivered in existing service settings: (1) PrEP as part of combination prevention for HIV-negative FSWs and (2) early ART for HIV-positive FSWs. The main outcome was programme retention at 12 months of follow-up. Of the 947 FSWs initially seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after HIV testing and clinical screening, 93% of the women who were HIV-negative were confirmed as clinically eligible for PrEP (n = 224/241), and 41% (n = 110/270) of the women who were HIV-positive had CD4 counts within National Department of Health ART initiation guidelines at assessment. Of the remaining women who were HIV-positive, 93% were eligible for early ART (n = 148/160). From those eligible, 98% (n = 219/224) and 94% (n = 139/148) took up PrEP and early ART, respectively. At baseline, a substantial fraction of women had a steady partner, worked in brothels, and were born in Zimbabwe. Of those enrolled, 22% on PrEP (n = 49/219) and 60% on early ART (n = 83/139) were seen at 12 months; we observed high rates of loss to follow-up: 71% (n = 156/219) and 30% (n = 42/139) in the PrEP and early ART groups, respectively. Little change over time was reported in consistent condom use or the number of sexual partners in the last 7 days, with high levels of consistent condom use with clients and low use with steady partners in both study groups. There were no seroconversions on PrEP and 7 virological failures on early ART among women remaining in the study. Reported adherence to PrEP varied over time between 70% and 85%, whereas over 90% of participants reported taking pills daily while on early ART. Data on provider-side costs were also collected and analysed. The total cost of service delivery was approximately US$126 for PrEP and US$406 for early ART per person-year. The main limitations of this study include the lack of a control group, which was not included due to ethical considerations; clinical study requirements imposed when PrEP was not approved through the regulatory system, which could have affected uptake; and the timing of the implementation of a national sex worker HIV programme, which could have also affected uptake and retention.ConclusionsPrEP and early ART services can be implemented within FSW routine services in high prevalence, urban settings. We observed good uptake for both PrEP and early ART; however, retention rates for PrEP were low. Retention rates for early ART were similar to retention rates for the current standard of care. While the cost of the interventions was higher than previously published, there is potential for cost reduction at scale. The TAPS Demonstration Project results provided the basis for the first government PrEP and early ART guidelines and the rollout of the national sex worker HIV programme in South Africa.

Systematic review of sex work interventions in sub-Saharan Africa: examining combination prevention approaches.

The incidence of HIV and sexually transmitted infections is disproportionately high among sex workers (SW). We aimed to update the evidence on the effectiveness of SW interventions in sub-Saharan Africa and to provide more insights into combination prevention. The Systematic review followed PRISMA guidelines in a search of PUBMED and POPLINE for peer-reviewed literature published between 1 January 2000 and 22 July 2016 (registration number on PROSPERO: CRD42016042529). We considered cohort interventions, randomised controlled trials and cross-sectional surveys of SW programmes. A framework was used in the description and mapping of intervention to desired outcomes. Twenty-six papers(reporting on 25 studies) were included. A strategy that empowered peer educator leaders to steer community activities showed a twofold increase in coverage of behaviour change communication and utilisation of health facility among SW. Brief alcohol harm reduction effort demonstrated a significant effect on sexual violence and engagement in sex trading. A risk reduction counselling intervention among drug-injecting SW showed an effect on alcohol, substance use and engagement in sex work. No study on a promising intervention like PrEP among SWs was found. We observed that interventions that combined some structural components, biomedical and behavioural strategies tend to accumulate more desired outcomes. The evidence base that can be considered in intervention designs to prevent HIV in SW in SSA is vast. The health sector should consider interventions to reduce binge alcohol intake and intravenous drug use among sex workers. Programmes should staunchly consider multicomponent approaches that explore community-based structural approaches.

Community-Led Economic Initiatives with Sex Workers: Establishing a Conceptual Framework for a Multidimensional Structural Intervention

Commercial sex workers are at significant risk of contracting HIV. Scholars have identified economic insecurity and the exploitation resulting from it as structural vectors of HIV risk for this community. While community-led structural interventions have successfully reduced HIV risk with sex workers, economic structural interventions remain under-utilized and under-studied in this population. The few existing economic interventions described in the literature are limited to individual interventions and do not adopt a community-led structural intervention approach. We conduct a literature review to examine the connections between economic insecurity and sex worker HIV risk, the limitations of existing economic interventions with sex workers, and the evidence in support of HIV structural interventions with sex workers. We then develop a conceptual framework for a community-led structural economic intervention model that would enable sex workers to negotiate the socio-political and economic barriers that increase their HIV vulnerability. Specifically, we articulate an economic structural intervention model which stands on three pillars: (1) a meaningful community ownership, (2) a multilevel (individual, community, socio-political) intervention approach, and (3) a commitment to empowering sex workers as workers, rather than an orientation that seeks to rescue them from sex work through alternative income generation.

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Objective: HIV prevention programs such as Jamaica AIDS Support for Life (JASL) work to lower the rate of HIV among marginalized groups. Thus the objective of this study was to evaluate condom use and HIV status in JASLs Sex Worker (SW) population with the intent to identify behavioral differences between this self-selected group and the general SW population in Jamaica. We hypothesized that JASLs SW population would demonstrate higher condom use and a lower prevalence of HIV potentially attributable to their prevention and education endeavours. Methods: This cross-sectional study (n=459) uses 2011-2014 data from three cities: Kingston Montego Bay and Ocho Rios. Data was obtained through voluntary counseling and testing (VCT) forms. Primary outcomes were HIV status and condom use. Frequencies and bivariate analyses were employed. Results: SW HIV prevalence was 1.3% as compared to the Jamaican SW rate of 4.6%. Most participants reported always using a condom with an outside partner while only 22% reported always using a condom with their regular partner. Conclusion: Emphasis on condom use within long-term relationships should be considered when planning HIV prevention programs for SWs. This requires addressing gender roles within noncommercial relationships and more discussions surrounding sexual behavior outside paid sex work. Although causality may not be inferred through cross-sectional data the lower HIV prevalence in JASLs SWs is promising and highlights opportunities for further analysis specifically around the impact of JASLs work.

Problematics of empowerment: sex worker HIV prevention in the Pacific.

A recent overview of HIV/STI prevention programmes for sex workers in the Pacific region indicates that, despite a regional policy shift from universal to targeted interventions, Pacific Island countries currently lack core HIV/STI prevention services for sex workers. Across the region, condom distribution, peer outreach and support services for sex workers have ceased even in countries where such programmes had previously existed. This article cautions that the endorsement of empowerment projects does not negate the important role of condom access in HIV and STI prevention efforts for Pacific sex workers. While community empowerment underpins, and is essential to the sustainability of, effective interventions, it does not constitute an adequate form of HIV and STI prevention in and of itself. We contend that in the context of the Pacific Islands, timely and effective HIV prevention measures must specifically attend to the implementation of, and sustained support for, behavioural interventions such as sex-worker-specific peer education, condom and lubricant distribution, and access to appropriate sexual health services. Further, the responsibility for delivery of these should not be borne solely by fledgling sex worker organizations and communities. The evolution of targeted interventions in the Pacific and the current lack of funded condom distribution programmes highlight a more generalizable imperative within HIV prevention to ensure that behaviour change efforts are not considered to be extraneous to, or rendered redundant by, empowerment-based interventions.

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Tendencias de la prevalencia del VIH y de las conductas de riesgo asociadas en mujeres trabajadoras del sexo en Cataluña

ObjectivesTo describe trends in HIV prevalence, sexual risk behaviors and other sexual health indicators in female sex workers (SW) from 2005 to 2011. MethodsCross-sectional studies were conducted biennially among SW recruited in Catalonia (Spain) in the street, flats and clubs (n = 400). In addition to an anonymous questionnaire, oral fluid samples were collected to estimate HIV prevalence. Linear trends in proportions were assessed by the Mantel test. ResultsThe percentage of SW who used condoms inconsistently with clients (past 6 months) increased from 5.1% in 2005 to 9.9% in 2011 (p = 0.005); this percentage also increased with steady partners (86.2% in 2005 to 94.4% in 2011, p = 0.002). The prevalence of self-reported sexually transmitted infections (STI) increased from 14% in 2005 to 20.6% in 2011 (p = 0.001). The prevalence of HIV held constant over the years (about 2%), being higher in Spanish women (14.7% in 2011). DiscussionThe prevalence of HIV in SW remained stable over the years, being higher in Spanish SW. The increase in unprotected sex and in the prevalence of self-reported STI among SW from 2005 to 2011 highlights a possible relaxation in preventive behaviors in this group. Interventions to reduce the transmission of these infections, as well as unwanted pregnancies, should continue in Catalonia in SW.

Being pimped out - How South Africa's AIDS response fails sex workers

abstract Sex work is highly stigmatised in South Africa. All aspects of sex work are currently a criminal offence. Sex workers’ stigmatised position in society, and the nature of their work-multiple, concurrent sexual partnerships, working within dangerous and violent spaces, and lack of services and legal protection-render them particularly vulnerable to HIV and other Sexually Transmitted Infections (STIs). No recent data on sex worker HIV prevalence in South Africa exists, but it ranged from 45%–69% in 1998. Sex work often occupies a much maligned – and often sensationalised or lurid – space in contemporary thinking and social change activism on feminism, health matters, policy-formation and human rights in Africa. Few individuals or institutions treat sex work or sex workers with seriousness or respect. Indeed, in areas of policy-formation, programme design or law reform, sex workers are often either overlooked, paid lip-service to, or they are let down during power-broking. South Africa's AIDS response has been no exception. This Briefing explores South Africa's 2007 and 2012 AIDS Plans and the South African National AIDS Council (SANAC) processes during 2007–2011 as a case study of sex work marginalisation at a critical time where their interests and demands should have been heeded: not only as it would recognise sex worker health, human rights and dignity, but as it would have significant public health effects.

The Need to Focus on Sex Workers in Generalized HIV Epidemic Settings

The Need to Focus on Sex Workers in Generalized HIV Epidemic Settings

What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work

Increasing emphasis is being placed on the need for ‘structural interventions’ (SIs) in HIV prevention internationally. There is great variation in how the concept of SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. In this paper, we clarify and elucidate what constitutes a SI with particular reference to the structured distribution of power and to the role of communities. We summarise the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy, and present ethnographic case-study material from a sex worker's HIV project in Kolkata, India, to illustrate the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of (1) attending to local complexities in the micro and macro-level structures that produce vulnerability; and (2) clarifying the meaning and role of communities within SIs.

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings. Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomized-controlled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies. Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV. Rigorous evaluation of HIV/STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and/or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.