HIV incidence estimation among female sex workers in South Africa: a multiple methods analysis of cross-sectional survey data

Kassanjee, Reshma; Welte, Alex; Otwombe, Kennedy; Jaffer, Maya; Milovanovic, Minja; Hlongwane, Khuthadzo; Puren, Adrian; Hill, Naomi; Mbowane, Venice; Dunkle, Kristin; Gray, Glenda; Abdullah, Fareed; Jewkes, Rachel; Coetzee, Jenny

doi:10.1016/s2352-3018(22)00201-6

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…Our analysis identified and reported several baseline predictors such as the age of the oldest sex partner, participant's age at enrollment, earning a salary or not, years with a stable partner, income source, whether the sex partner has other partners, and frequency of sex in the last 30 days as significantly associated with HIV incidence. These findings align with those of other research studies (47)(48)(49)(50)(51)(52)(53)(54)(55).…”

Section: Figuresupporting

confidence: 92%

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Section: Figuresupporting

confidence: 92%

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“…The application of methodological standards for directly measuring incidence in key populations would also be beneficial. Data gaps could be addressed by incorporating incidence measurements into survey and routine programmatic data analysis via serial cross-sectional prevalence data from biobehavioural surveys and recency testing, 12, 13, 17, 39 instead of resource-intensive cohort studies. This would increase the number of available estimates to enable country-specific estimation and support real-time data-driven programming.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…We adapted scoring to account for exclusion of reporting criteria and for studies calculating incidence from cross-sectional recent infection testing or serial HIV prevalence measures. 12,13 Data synthesis and meta-analysis HIV incidence observations among WESW were matched to HIV incidence in the total female population by district (subnational location where each study was conducted), age, and year. Estimates missing age information were matched to incidence in total population women aged 15-39, reflecting the age distribution observed in sex workers in studies reporting age data.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Additionally, mobility among WESW is high, 9 and repeated initiation and cessation of sex work common, thus programmes and cohort studies encounter challenges with loss to follow-up. 10, 11 To mitigate these challenges, there is growing focus on techniques leveraging cross-sectional data to estimate incidence, 12, 13 whilst recruitment approaches such as respondent-driven sampling (RDS) and time-location sampling (TLS) are increasingly used to capture more representative samples of WESW.…”

Section: Introductionmentioning

confidence: 99%

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HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis

Jones,

Anderson,

Cust

et al. 2023

Preprint

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Introduction: HIV incidence among women in sub-Saharan Africa (SSA) has declined steadily, but it is unknown whether new infections among women who engage in sex work (WESW) have declined at a similar rate. We synthesised estimates of HIV incidence among WESW in SSA and compared these to the wider female population to understand levels and trends in incidence over time. Methods: We searched Medline, Embase, Global Health, Popline, Web of Science, and Google Scholar from January 1990 to October 2022, and grey literature for estimates of HIV incidence among WESW in SSA. We included studies reporting empirical estimates in any SSA country. We calculated incidence rate ratios (IRR) compared to age-district-year matched total female population incidence estimates. We conducted a meta-analysis of IRRs and used a continuous mixed-effects model to estimate changes in IRR over time. Results: From 32 studies between 1985 and 2020, 2,194 new HIV infections were observed in WESW over 51,000 person-years (py). Median HIV incidence was 4.3/100py (IQR 2.8-7.0/100py), declining from a median of 5.96/100py between 1985 and 1995 to a median of 3.2/100py between 2010 and 2020. Incidence among WESW was nine times higher than in matched total population women (RR 8.6, 95%CI: 5.7-12.9), and greater in Western and Central Africa (RR 22.4, 95%CI: 11.3-44.3) than in Eastern and Southern Africa (RR 5.3, 95%CI: 3.7-7.6). Annual changes in log IRRs were minimal (-0.1% 95%CI: -6.9 to +6.8%). Conclusions: Across SSA, HIV incidence among WESW remains disproportionately high compared to the total female population but showed similar rates of decline between 1990 and 2020. Improved surveillance and standardisation of approaches to obtain empirical estimates of sex worker incidence would enable a clearer understanding of whether we are on track to meet global targets for this population and better support data-driven HIV prevention programming.

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Sex Work in Africa

Yingwana

2024

The Palgrave Encyclopedia of Sexuality Education

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HIV incidence estimation among female sex workers in South Africa: a multiple methods analysis of cross-sectional survey data

Cited by 18 publications

References 27 publications

Data_Sheet_1.PDF

Data_Sheet_1.PDF

HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis

Sex Work in Africa

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