Combination HIV prevention for female sex workers: what is the evidence?

Bekker, Linda‐Gail; Johnson, Leigh F.; Cowan, Frances M; Overs, Cheryl; Besada, Donela; Hillier, Sharon L.; Cates, Willard

doi:10.1016/s0140-6736(14)60974-0

Cited by 184 publications

(180 citation statements)

References 133 publications

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“…The well-known stigmatization associated with a positive HIV status [6,19] was not reflected among the FSWs in our sample, of which we speculate the majority to be HIV positive, as demonstrated by the finding that they all take their ART in front of each other. This marginalized group has fostered an environment of open dialogue on issues of HIV.…”

Section: Discussionmentioning

confidence: 62%

“…[7,22,36–38] The prospect of receiving more money and avoiding violence creates pressure that incentivizes FSWs engagement in risky sex. [11,19,21,36,38,39] A study by Malta et al [40], conducted in Brazil showed that in moments of pressure and uncertainty, FSWs relied on physical assessments to determine HIV serostatus, despite high levels of HIV knowledge. Similarly the FSWs in our sample described similar behaviour as seen among their peers despite the knowledge of risks associated.…”

Section: Discussionmentioning

confidence: 99%

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Sexual transactions between long distance truck drivers and female sex workers in South Africa

Makhakhe

Lane

McIntyre

et al. 2017

Global Health Action

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Background: Female sex workers (FSWs) and long distance truck drivers (LDTDs) are considered key populations at high risk for HIV transmission due to high prevalence. The intersection of these mobile populations presents unique challenges in the fight against HIV and the movement towards reducing new infections. Objective: The purpose of this study was to explore the nature of sex trade along a particular transport route. Sexual transactions and the vulnerabilities that exist between these two groups with regards to HIV/AIDS are described, with the purpose of furthering the agenda for targeted interventions. Methods: Qualitative in-depth interviews were conducted with 14 participants, seven FSWs and seven LDTDs. We recruited FSWs through snowballing, and LDTDs through intercepts at truck stops. Semi-structured interview guides were used for data collection, and thematic analysis was conducted. Results: The sex trade in this study is characterized by competition, fuelled by money-driven and age-disparate rivalry. Despite widespread HIV knowledge, FSWs contend with persistent challenges regarding condom use negotiation, induced by more money in the exchange for unsafe sex. Despite the placement of wellness centres in truck stops along the highway, LDTDs face stigma related challenges with regards to testing for HIV and personal acknowledgement of their involvement in the sex trade. Conclusion: The nature of the sex trade along the highway continues to be risky despite the availability of HIV testing and antiretroviral treatment (ART). The sex trade is perceived to be increasing along trucking routes, in spite of measures instituted to limit access to FSWs. FSWs struggle to cope with the pressure of unprotected sex because of the need to generate more income, as well as avoid incidents of violence and threats. Interventions along transport routes need to be inclusive of FSWs who could play a vital role in stigma reduction amongst LDTDs through peer education.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Sexual transactions between long distance truck drivers and female sex workers in South Africa

Makhakhe

Lane

McIntyre

et al. 2017

Global Health Action

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“…In Johannesburg, 20% of FSWs reported experiencing sexual violence, while 54% reported any physical violence in the past year [1,6]. Globally, violence is associated with inconsistent condom usage, sexually transmitted infection (STI) and HIV acquisition, undermining economic capital, and it has a widespread social impact [7–11]. The resulting mental health complications, including post-traumatic stress disorder (PTSD) and depression, often undermine individuals’ effective functioning [11,12].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and patterns of victimization and polyvictimization among female sex workers in Soweto, a South African township: a cross-sectional, respondent-driven sampling study

Coetzee

Gray

Jewkes

2017

Global Health Action

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Background: Female sex workers (FSWs) are disproportionately affected by violence from multiple partner categories. This increases their vulnerability to HIV. Objectives: To describe patterns of violence and polyvictimization among female SWs in Soweto. Methods: A respondent-driven sampling (RDS) recruitment methodology was used to enrol 508 Soweto-based FSWs using a survey instrument. Raw and RDS adjusted data were descriptively analysed, Spearman’s correlation and chi2 test of association were used to show associations. Polyvictimization patterns are shown within a modified Venn diagram. Results: The median age of FSWs in Soweto was 31 years, and most had an incomplete education (74.2%). The prevalence of exposure to physical/sexual intimate partner violence (IPV) in the past year was 53.8%, 46.8% by clients, and 18.5% by police. Past year prevalence of sexual/physical violence by any perpetrator category was 70.8% and lifetime exposure was 76.0%. Childhood sexual violence was reported by 44.3%. Lifetime non-partner rape was 55.5% and all rape exposure was 62.4%. As a result of engaging in sex work in the past year, 65.2% women had been discriminated against. Client, police, IPV, and childhood trauma were all significantly associated with one another, with IPV being the most common co-occurrence. Polyvictimization was seen in almost two-thirds of FSWs, and increased with exposure to discrimination. Conclusion: In Soweto, FSWs are exposed to high rates of violence in multiple forms across their lifetime. Our findings show that violence continues unabated into adulthood at levels far higher than in the general population and overall at higher levels than previously recorded among SWs in South Africa. We argue that violence against FSWs is rooted in discrimination. The disparate burden of violence on FSWs requires urgent interventions to proactively address and reframe the normalisation of violence against all women.

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“…Their needs cannot be assumed to be congruent with the needs of those who trade sex for money or other commodities but do not selfidentify as sex workers. Peer-based, sex worker-friendly health care facilities are one example of an approach with proven effectiveness 18,24 that will not be prioritized for public funding until sex workers are recognized by federal and state health departments as a distinct key population in need of its own targeted services.…”

Section: What Next?mentioning

confidence: 99%

“…That single policy change resulted in "improved working conditions, reduction in police brutality, and empowerment of FSWs [female sex workers]". 18 Although marginalization, which increases vulnerability to HIV, is interwoven with cultural and economic factors, policy changes can help countries transition from a legal and cultural environment guided by punishment to one informed by public health imperatives.…”

Section: Introductionmentioning

confidence: 99%

Speaking of sex workers: How suppression of research has distorted the United States' domestic HIV response

Forbes¹

2015

Reproductive Health Matters

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Sex workers remain a vulnerable population at risk for HIV acquisition and transmission. Research suggests that interventions at the individual level, such as condom distribution, are less effective in preventing HIV among sex workers than structural changes such as allowing safer work settings and reducing the harassment and abuse of sex workers by clients and police. In the US, HIV incidence has not declined in the last decade. This may be due in part to its policy of wilful ignorance about sex work, but the data to resolve the question simply do not exist. Political actions such as PEPFAR's prostitution pledge and a congressional campaign against "waste, fraud and abuse" in research are products of an ideological environment that suppresses research on HIV prevention and treatment needs of sex workers. Even basic prevalence data are missing because there is no "sex worker" category in the US National HIV Behavior Surveillance System. However, international efforts are taking a public health approach and are calling for decriminalization of sex work, as the most effective public health strategy for reducing HIV incidence among sex workers. Although such an approach is not yet politically feasible in the US, some urgent practical policy changes can be implemented to improve data collection and generation of evidence to support HIV prevention and treatment programs targeting sex workers.

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Combination HIV prevention for female sex workers: what is the evidence?

Cited by 184 publications

References 133 publications

Sexual transactions between long distance truck drivers and female sex workers in South Africa

Sexual transactions between long distance truck drivers and female sex workers in South Africa

Prevalence and patterns of victimization and polyvictimization among female sex workers in Soweto, a South African township: a cross-sectional, respondent-driven sampling study

Speaking of sex workers: How suppression of research has distorted the United States' domestic HIV response

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