Early sex work initiation and its association with condomless sex and sexually transmitted infections among female sex workers in Iran

Khezri, Mehrdad; Shokoohi, Mostafa; Mirzazadeh, Ali; Karamouzian, Mohammad; Sharifi, Hamid; Haghdoost, Ali Akbar; Baral, Stefan

doi:10.1177/0956462420913431

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Overall HIV prevalence ranged from 5.2% in Iran [44] to 42.9% in Rwanda [48]. Studies were published between 1995 and 2020 with 13 studies published since 2010.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 18 studies were eligible for inclusion. These studies are summarized in Table 2, grouped by geographical region [17,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Most studies were in Asia (India N = 4, Nepal and Thailand N = 2), North America (Canada N = 2, the United States = 2 and Mexico), sub-Saharan Africa (Lesotho and Rwanda) or Latin America (Ecuador and Guatemala), with one study in Ukraine and one study in Iran (Table 2).…”

Section: Hiv Prevalence Reviewmentioning

confidence: 99%

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Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta‐analysis

et al. 2022

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Introduction:Young women who sell sex (YWSS) are at heightened risk of HIV acquisition and transmission and are among the least engaged in HIV services. There is insufficient epidemiologic evidence characterizing the burden of HIV among YWSS, particularly as compared to older WSS. These data are needed to design and tailor effective HIV prevention and treatment programmes for this population. Methods: We conducted two parallel systematic reviews and meta-analyses to define both the immediate and long-term HIV risks for YWSS, including among women engaged in sex work, survival sex and transactional sex. In the first review, we identified and synthesized published studies of HIV incidence comparing estimates for cisgender women ≤24 years of age versus >24. In the second review, we identified and synthesized studies of HIV prevalence, comparing estimates for cisgender women who initiated selling sex <18 versus ≥18 years. In both reviews, we completed a search of four databases for articles in any language and any geographic area published from 1 January 1980 until 12 February 2021. Included articles were assessed for quality and a random effects model was used to calculate pooled effect estimates for each review. Results and Discussion: We identified 12 studies for the HIV incidence review and 18 studies for the HIV prevalence review. In a meta-analysis, HIV incidence was elevated in younger (5.3 per 100 person-years [PY]; 95% confidence interval [CI]: 3.5, 7.1) compared to older women (2.8 per 100 PY; 95% CI: 1.7, 3.9), although CIs overlapped. HIV prevalence among those who initiated selling sex <18 years of age (28.8; 95% CI: 18.9, 38.7) was higher than those who initiated later (20.5; 95% CI: 12.4, 28.6). Conclusions: These companion reviews offer an important perspective on the relative HIV risk of engaging in selling sex at a younger age. Our findings highlight the unique and intersectional challenges YWSS face, and the importance of ensuring that health services are tailored to meet their specific needs. Research and programming should routinely stratify data into meaningful age bands to differentiate and intervene within this population.

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“…Overall HIV prevalence ranged from 5.2% in Iran [44] to 42.9% in Rwanda [48]. Studies were published between 1995 and 2020 with 13 studies published since 2010.…”

Section: Resultsmentioning

confidence: 99%

Section: Hiv Prevalence Reviewmentioning

confidence: 99%

Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta‐analysis

et al. 2022

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“…The most important risk factors of syphilis has been reported to be sexual relationship with casual partners in the last year, same-sex sexual relationships, more than 10 partners, and having sexual intercourse before 15 years of age (33). The initiation of sex before the age of 18 is associated with an increased chance of chlamydia infection, this relationship is not statistically significant for syphilis (25). Nevertheless, early start of sex work between FSW is a great risk factor for unsafe sexual practices which can increase the chance of infecting with either HIV or STI.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Syphilis Infections among the Iranian Population: A Systematic Review and Meta-Analysis

Esmaeilzadeh¹,

Mohammadi²,

Amjadipour³

et al. 2022

ijph

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Background: Syphilis is one of the most important sexually transmitted infections (STI) and a public health problem, but the literature describing the true burden of syphilis is limited. In Iran, there are no accurate results on the prevalence of syphilis. This study aimed to conduct a systematic review and meta-analysis of syphilis in Iran. Methods: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the prevalence of Syphilis in Iran. We systematically reviewed the literature to identify eligible studies as of Sep 13, 2020, in international and national databases. The results are presented in the form of forest plots and tables. Pooled prevalence and 95% confidence intervals were calculated using Der Simonian and Laird method. Perform subgroup analysis through population, gender, city, and diagnostic tests to assess the source of heterogeneity. Results: We reviewed 1,229 papers and reports, and extracted data from 15 eligible records. The prevalence of combined syphilis in Iran is 0.1% (95% confidence interval [95% CI] 0.1-0.1%). The prevalence of syphilis was 0.4% in men (95% confidence interval [95% CI] -0.3, 1%) and 0.6% in women (95% confidence interval [95% CI] (0.1, 1%)). The cumulative meta-analysis showed a decline in the prevalence of syphilis between the years 1999 and 2015. Conclusion: The prevalence of syphilis in Iran is low. In the past few decades, the prevalence of syphilis across the country has declined. Syphilis infection is a small burden that needs to be revised in the implementation of high-cost screening programs.

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“…Diverse studies from multiple regions globally show that between 20% and 40% of FSWs enter into sex work as minors 4–6. Women who initiate sex work while under the age of 18 years face greater risks of adverse sexual health outcomes,7–9 inconsistent condom use10 and barriers to condom negotiation 7 9–13. Other adverse health outcomes of underage initiation into sex work include harmful alcohol and substance use,13 14 increased prevalence of mental health problems15 and increased physical and sexual violence victimisation from different perpetrators 16–18.…”

Section: Introductionmentioning

confidence: 99%

“…These adverse outcomes are often accompanied by stigma and discrimination, violence from official authorities, and barriers to healthcare 19. While some studies report an increased prevalence of HIV in adolescent girls and young women (AGYW) who initiate sex work under the age of 18 years compared with those who initiate sex work as adults,12 20 21 others find no significant difference in HIV prevalence between the two groups 9 10 21…”

Section: Introductionmentioning

confidence: 99%

Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya

Shah,

Kabuti,

Beksinska

et al. 2023

BMJ Open

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ObjectiveTo explore factors associated with early age at entry into sex work, among a cohort of female sex workers (FSWs) in Nairobi, Kenya.BackgroundYounger age at sex work initiation increases the risk of HIV acquisition, condom non-use, violence victimisation and alcohol and/or substance use problems. This study aimed to understand factors in childhood and adolescence that shape the vulnerability to underage sex work initiation.DesignBuilding on previous qualitative research with this cohort, analysis of behavioural–biological cross-sectional data using hierarchical logistic regression.Participants and measuresFSWs aged 18–45 years were randomly selected from seven Sex Workers Outreach Programme clinics in Nairobi, and between June and December 2019, completed a baseline behavioural–biological survey. Measurement tools included WHO Adverse Childhood Experiences, Alcohol, Smoking and Substance Involvement Screening Test and questionnaires on sociodemographic information, sexual risk behaviours and gender-based violence. Descriptive statistics and logistic regression were conducted using hierarchical modelling.ResultsOf the 1003 FSWs who participated in the baseline survey (response rate 96%), 176 (17.5%) initiated sex work while underage (<18 years). In the multivariable analysis, factors associated with entering sex work while underage included incomplete secondary school education (aOR=2.82; 95% CI=1.69 to 4.73), experiencing homelessness as a child (aOR=2.20; 95% CI=1.39 to 3.48), experiencing childhood physical or sexual violence (aOR=1.85; 95% CI=1.09 to 3.15), young age of sexual debut (≤15 years) (aOR=5.03; 95% CI=1.83 to 13.79) and being childless at time of sex work initiation (aOR=9.80; 95% CI=3.60 to 26.66).ConclusionsLower education level and childhood homelessness, combined with sexual violence and sexual risk behaviours in childhood, create pathways to underage initiation into sex work. Interventions designed for girls and young women at these pivotal points in their lives could help prevent underage sex work initiation and their associated health, social and economic consequences.

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Early sex work initiation and its association with condomless sex and sexually transmitted infections among female sex workers in Iran

Cited by 9 publications

References 37 publications

Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta‐analysis

Differentiating the incidence and burden of HIV by age among women who sell sex: a systematic review and meta‐analysis

Prevalence of Syphilis Infections among the Iranian Population: A Systematic Review and Meta-Analysis

Childhood and adolescent factors shaping vulnerability to underage entry into sex work: a quantitative hierarchical analysis of female sex workers in Nairobi, Kenya

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