Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Khezri, Mehrdad; Tavakoli, Fatemeh; Bazrafshan, Azam; Sharifi, Hamid; Shokoohi, Mostafa

doi:10.1097/jnc.0000000000000305

Cited by 6 publications

(3 citation statements)

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“…Although women typically alcohol use less than men, the prevalence of alcohol use among FSWs in Iran is indeed higher than that of the general female population (Khezri et al., 2022 ). In Iran, sex work is illegal and criminalized, and sensitivities around FSWs in Iran are mainly rooted in the sociocultural, religious, and political context of Iran as a Muslim majority setting (Karamouzian et al., 2016 ; Karamouzian et al., 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Lifetime and past‐month alcohol use and related factors among female sex workers in Iran

Rasouli,

Zareie,

Gouya

et al. 2023

Brain and Behavior

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ObjectiveAlcohol use is more common among female sex workers (FSWs). This study assessed the prevalence of lifetime and past‐month alcohol use and related factors among FSWs in Iran.MethodsWe conducted a cross‐sectional survey among 1464 women from 8 major cities in Iran. Behavioral data were collected by trained interviewers and conducted face‐to‐face in a private room. Weighted analysis was used to determine the lifetime and past‐month alcohol use prevalence. Univariate and multivariate logistic regression was used to investigate the association between alcohol use and independent variables.ResultsThe most alcohol used in lifetime and past‐month (weekly, less than once a week, and daily) in FSWs was 52.7% (12.25%, 12.94%, and 1.83%), respectively. In the final model, factors that were independently associated with alcohol use included the 31–40 years (AOR = 2.41, 95% CI: 1.13–5.15), education level of diploma (AOR = 2.43, 95% CI: 1.31–4.51), history of lifetime drug use (AOR = 2.79, 95% CI: 2.01–3.89), history of lifetime group sex (AOR = 2.07, 95% CI: 1.41–3.03), history of intentional abortion (AOR = 1.42, 95% CI: 1.06–1.92), six or more sexual clients in the last month (AOR = 3.25, 95% CI: 1.80–5.87), history of lifetime anal sex (AOR = 2.47, 95% CI: 1.82‐3.35), and FSWs the married, temporarily married, and living with partner were positively associated with lifetime alcohol use.ConclusionAlcohol use is prevalent among FSWs in Iran. Further prevention programs are needed to address and reduce harms associated with alcohol use among this vulnerable population in Iran. Designing intervention programs, it is suggested to consider other variables affecting alcohol use in FSWs.

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Section: Introductionmentioning

confidence: 99%

Lifetime and past‐month alcohol use and related factors among female sex workers in Iran

Rasouli,

Zareie,

Gouya

et al. 2023

Brain and Behavior

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“…Syphilis infection was estimated at 1.7% among FSWs in China, which was 6.8 times higher than among general population women in 2017 ( 7 ). FSWs contribute significantly to STIs transmission networks through their engagement in frequent unprotected sexual activities, multiple commercial sex partners ( 8 – 10 ), and limited asymptomatic STIs awareness ( 11 ). An Ecuador study reported that 25.5% of FSWs had unprotected sexual activities at least once in the previous 3 months ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of syphilis and chlamydia trachomatis infection among female sex workers in Jiangsu, China: Results from a multicenter cross-sectional and venue-based study

Shi

Luo²,

Chen³

et al. 2022

Front. Public Health

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BackgroundFemale sex workers (FSWs) are considered highly vulnerable to sexually transmitted infections (STIs), but available data on the prevalence of STIs among FSWs in China is limited at a provincial level. This study aimed to evaluate the prevalence of STIs and risk factors among FSWs in Jiangsu, China.MethodsWe conducted a multicenter cross-sectional study in seven cities of Jiangsu to investigate the prevalence and risk factors associated with HIV and other STIs. Blood and urine were collected to test for HIV, syphilis, Hepatitis C (HCV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.ResultsWe enrolled 3,580 FSWs. The overall prevalence of bacterial STIs was 6.2% (5.4%−7.0%). The prevalence of HIV, syphilis infection, HCV, NG and CT were 0.1% (95%CI, 0.0–0.2), 1.8% (95%CI, 1.4–2.3), 0.3% (95%CI, 0.1–0.5), 0.3% (95%CI, 0.2–0.5) and 4.3% (95%CI, 3.6–5.0), respectively. Most FSWs (85.6%) reported consistent condom use with clients in the past month. Only 10.6% of FSWs reported group sex, and 68.3% self–reported HIV testing in the previous year. According to the multivariable model, having group sex in the past year (aOR, 2.521, 95%CI: 1.366–4.651) and HIV infection (aOR, 26.260, 95%CI: 2.432–283.563) were associated with a higher risk of syphilis infection. Migrants (aOR, 1.669, 95%CI: 1.163–2.395), having a history of STIs in the past year (aOR, 4.601, 95%CI: 1.003–21.118), and NG infection (aOR, 38.549, 95%CI: 11.214–132.514) were associated with a higher risk of CT infection. On the contrary, FSWs aged older than 25 were associated with lower risk of syphilis infection (25–34: aOR, 0.339, 95%CI: 0.151–0.763) and CT infection (25–34: aOR, 0.503, 95%CI: 0.316–0.802; ≥35: aOR, 0.578, 95%CI: 0.362–0.925).ConclusionThis study's prevalence rates of syphilis and CT infections show the need to promote comprehensive STIs control and prevention strategies, including behavioral intervention and STIs screening, especially in younger high–risk populations. With the increasing coverage of HIV testing, integrating other STIs screening with HIV testing may be a reasonable way to implement comprehensive STIs control and prevention.

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“…Societal views on sex work further restrict their access to legal aid and support, isolating them and complicating their efforts to promote safer sex. Moreover, the criminalization of sex work in various places prevents them from seeking justice for abuses and accessing health services freely, perpetuating their risk and marginalization (7)(8)(9).…”

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confidence: 99%

Patterns of Inconsistent Condom Use and Risky Sexual Behaviors among Female Sex Workers in Mozambique

Muleia,

Banze,

Damião

et al. 2024

Preprint

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Background Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, due to inconsistent condom use and engagement in risky sexual behaviors. Understanding the determinants of these practices is crucial for developing targeted interventions. Methods This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019–2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Logistic regression models were used to assess the association of various socio-demographic, economic, and behavioral factors with the outcomes, providing adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 2,570 FSWs reporting inconsistent condom use, the majority were younger (15–24 years old, 69.5%), single (68.2%), with secondary or higher education (69.9%), nationals (66.6%), and residents of Quelimane City (77.2%). Initiating sex work < 18 years (73.3%), having 5 + clients in the last month (61.8%), binge drinking (61.7%), and experiencing physical violence (82.9%) were significantly associated with this behavior. From the 2,514 FSWs reporting risky sexual behaviors, the majority aged 15–24 (83.0%) had secondary or higher education (84.2%), were nationals (82.5%), and resided in Quelimane (87.3%). Early sexual debut (< 15 years, 87.4%) and starting sex work < 18 years (86.4%) were linked to increased risks, as was drug use (86.8%). FSWs older > 25 years (aOR = 1.4, 95% CI: 1.0–2.0, p = 0.034), from Tete (aOR = 5.8, 95% CI: 3.6–9.3, p < 0.001), with 5 + clients in the last month (aOR = 2.3, 95% CI: 1.3–4.7, p = 0.003), were more likely to report inconsistent condom use. Additionally, FSWs aged 15–24 years (aOR = 1.4, 95% CI: 1.1–1.9, p = 0.011) with early sexual debut (aOR = 1.4, 95% CI: 1.1-2.0, p = 0.002). Conclusion The study highlights the complex interplay factors as individual characteristics, geographic location, client volume, early sexual debut, and substance use that influence sexual risks behaviour among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and substance use are imperative for mitigating these risks.

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Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 50 publications

Lifetime and past‐month alcohol use and related factors among female sex workers in Iran

Lifetime and past‐month alcohol use and related factors among female sex workers in Iran

Prevalence of syphilis and chlamydia trachomatis infection among female sex workers in Jiangsu, China: Results from a multicenter cross-sectional and venue-based study

Patterns of Inconsistent Condom Use and Risky Sexual Behaviors among Female Sex Workers in Mozambique

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