Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

Matthew F Chersich, Stanley Luchters, Innocent Ntaganira, Antonio Gerbase, Ying-Ru Lo, Fiona Scorgie and Richard Steen

Introduction:

Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery.

Methods:

We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. 

Results:

We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. 

Conclusions:

There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services including peer interventions, condom promotion and STI screening would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.

March 16, 2016
Year of publication
2013
Resource types
Journal and research articles, Literature review, Reports and Fact sheets
Tags
sex work, sex workers, female sex workers (FSWs), FSWs, HIV, HIV prevention, treatment, ART, antiretroviral treatment, sexually transmitted infections (STIs), STI, key populations, HIV prevention services, peer interventions, condom promotion

Similar Resources

Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide.

This supplement to Acta Paediatrica presents a series of meta-analyses and systematic literature reviews examining a variety of health effects potentially related to breastfeeding.

Objective(S)

To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare.

Design

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on vulnerable populations, including TB in prisons and intimate partner violence in the context of HIV.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on key populations.

Hepatitis C virus (HCV) is present in the semen of a third of co-infected HIV-positive men who have sex with men (MSM), investigators from the United States report in Open Forum Infectious Diseases. Levels of HCV in semen were plausibly high enough to transmit the infection.

The heightened risk of HIV infection among female sex workers (FSWs) has been clearly established across settings. In sub-Saharan Africa (SSA), FSWs have an estimated HIV prevalence of 36.9% as compared to 7.4% in the general adult female population. In the Iringa region of Tanzania, a…

Adolescents living with HIV are an underserved population, with poor retention in HIV health care services and high mortality, who are in need of targeted effective interventions.

In all countries where there is an HIV epidemic, certain subgroups of the population are at greater risk of HIV than others. These “key” populations include female sex workers (FSWs), men who have sex with men (MSM), transgender people, and people who inject drugs.

Remarkable progress is being made on HIV treatment. Ahead of World AIDS Day, UNAIDS has launched a new report showing that access to treatment has risen significantly. In 2000, just 685 000 people living with HIV had access to antiretroviral therapy.