National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

Reeves, Aaron; Steele, Sarah; Stuckler, David; McKee, Martin; Amato‐Gauci, Andrew J.; Semenza, Jan C.

doi:10.1016/s2352-3018(16)30217-x

Cited by 48 publications

(27 citation statements)

References 26 publications

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“…Notably, these qualitative studies provided important insights on how brothel closure had led to unintended negative public health outcomes such as unsafe work environments, sexual risk behaviours and increased HIV/STI risk among the sex workers. These findings were consistent with a recent study on the ecological analysis of criminalisation of sex work in European countries which found its association with higher HIV prevalence [ 25 ].…”

Section: Introductionsupporting

confidence: 93%

Trends in unprotected intercourse among heterosexual men before and after brothel ban in Siem Reap, Cambodia: a serial cross-sectional study (2003–2012)

et al. 2018

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BackgroundFollowing Cambodia’s implementation of the 100% condom use program with enforcement of condom use and STI treatment services for sex workers in 2001, sexually transmitted infection and HIV declined markedly. In 2008, Cambodia implemented a law to ban brothel-based sex work. We reported trends in unprotected vaginal intercourse with sex workers among heterosexual men buying sex before (2003–2008) and after (2009–2012) the brothel ban in Cambodia. We also determined the association of brothel ban with these men’s reports of unprotected intercourse with sex workers.MethodsIn this serial cross-sectional study, we collected yearly behavioural data on random cross-sectional samples of heterosexual men buying sex who attended the only government health centre in Siem Reap for voluntary confidential counselling and testing (VCCT) between 2003 and 2012. We used multivariable Poisson regression analysis on the 10-year data of 976 men to obtain the adjusted prevalence ratio (aPR) of unprotected intercourse in the last 6 months by brothel closure.ResultsMen buying sex from non-brothel-based sex workers increased almost 3-fold from 17% in 2007–2008 before brothel closure to 55% in 2011–2012 after brothel closure (p < 0.001). Unprotected intercourse with sex workers in the last week increased significantly from 37% (2003–2004) before brothel closure to 65% (2011–2012) after brothel closure. This increase corresponded closely with the increase in self-reported unprotected intercourse from 35% to 61% by the sex workers (n = 1805) attending the same clinic for VCCT. Brothel closure was associated with an increased risk (aPR: 1.65; 95% CI: 1.40–1.94) of unprotected intercourse with sex workers. HIV prevalence in the heterosexual men declined significantly from 26% in 2003–2004 to 4.8% in 2007–2008 and 0 case in 2009–2010 before increasing to 5.6% in 2011–2012.ConclusionOur findings suggest that the brothel ban had led to an increase in unprotected intercourse with all sex workers for men buying sex. This effect could be attributed to reduced condom access, a consequence of the lack of feasibility to implement the 100% condom use program following the brothel ban. The ban on brothels in Cambodia should be reviewed.

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Section: Introductionsupporting

confidence: 93%

Trends in unprotected intercourse among heterosexual men before and after brothel ban in Siem Reap, Cambodia: a serial cross-sectional study (2003–2012)

et al. 2018

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“…For instance, only about half of the countries in Europe and Central Asia offer HIV treatment to undocumented migrants . Other populations that are also likely to suffer differential provision of HIV health care services are sex workers and people who inject drugs . Consequently, our results are likely to be conservative estimates of the association between ART initiation policies and population‐level access to ART.…”

Section: Discussionmentioning

confidence: 99%

Population uptake and effectiveness of test‐and‐treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross‐national analysis

Mendez‐Lopez

Stuckler

Granich³

et al. 2019

HIV Medicine

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Objectives Although the benefits of adopting test‐and‐treat antiretroviral therapy (ART) guidelines that recommend initiation of ART regardless of CD4 cell counts have been demonstrated at the individual level, there is uncertainty about how this translates to the population level. Here, we explored whether adopting ART guidelines recommending earlier treatment initiation improves population ART access and viral suppression and reduces overall disease transmission. Methods Data on ART initiation guidelines and treatment coverage, viral suppression, and HIV incidence from 37 European and Central Asian countries were collected from the European Centre for Disease Prevention and Control and the Global HIV Policy Watch and HIV 90‐90‐90 Watch databases. We used multivariate linear regression models to quantify the association of ART initiation guidelines with population ART access, viral suppression, and HIV incidence, adjusting for potential confounding factors. Results Test‐and‐treat policies were associated with 15.2 percentage points (pp) [95% confidence interval (CI) 0.8–29.6 pp; P = 0.039] greater treatment coverage (proportion of HIV‐positive people on ART) compared with countries with ART initiation at CD4 cell counts ≤ 350 cells/μL. The presence of test‐and‐treat policies was associated with 15.8 pp (95% CI 2.4–29.1 pp; P = 0.023) higher viral suppression rates (people on ART virally suppressed) compared with countries with treatment initiation at CD4 counts ≤ 350 cells/μL. ART initiation at CD4 counts ≤ 500 cells/μL did not significantly improve ART coverage compared to initiation at CD4 counts ≤ 350 cells/μL but achieved similar degrees of viral suppression as test‐and‐treat. Conclusions Test‐and‐treat was found to be associated with substantial improvements in population‐level access to ART and viral suppression, further strengthening evidence that rapid initiation of treatment will help curb the spread of HIV.

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“…This is particularly important in countries where sex work is a criminal offense or legally prohibited (even if there is no criminal penalty). 42 Only when sex workers are able to communicate with police services about (the threat of) violence without incriminating themselves will they be spared the risk of physical abuse and HIV exposure. Both structural drivers and individual agency impact on condom use and HIV risk, and thus future HIV intervention programmes must assume a more holistic view in order to meet the needs of those engaged in sex work.…”

mentioning

confidence: 99%

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries

Reeves¹,

Steele²,

Stuckler³

et al. 2018

Preprint

Self Cite

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ObjectivesPersons engaged in the sex industry are at greater risk of HIV and other sexually transmitted infections than the general population. One major factor is exposure to higher levels of risky sexual activity. Expanding condom use is a critical prevention strategy, but this requires negotiation with those buying sex, which takes place in the context of cultural and economic constraints. Impoverished individuals who fear violence are more likely to forego condoms.MethodsHere we tested the hypotheses that poverty and fear of violence are two structural drivers of HIV infection risk in the sex industry. Using data from the European Centre for Disease Prevention and Control and the World Bank for 30 countries, we evaluated poverty, measured using the average income per day per person in the bottom 40% of the income distribution, and gender violence, measured using homicide rates in women and the proportion of women exposed to violence in the last 12 months and/or since age 16 years.ResultsWe found that HIV prevalence among those in the sex industry was higher in countries where there were greater female homicide rates (β = 0.86; P = 0.018) and there was some evidence that self‐reported exposure to violence was also associated with higher HIV prevalence (β = 1.37; P = 0.043). Conversely, HIV prevalence was lower in countries where average incomes among the poorest were greater (β = −1.05; P = 0.046).ConclusionsOur results are consistent with the theory that reducing poverty and exposure to violence may help reduce HIV infection risk among persons engaged in the sex industry.

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National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

Cited by 48 publications

References 26 publications

Trends in unprotected intercourse among heterosexual men before and after brothel ban in Siem Reap, Cambodia: a serial cross-sectional study (2003–2012)

Trends in unprotected intercourse among heterosexual men before and after brothel ban in Siem Reap, Cambodia: a serial cross-sectional study (2003–2012)

Population uptake and effectiveness of test‐and‐treat antiretroviral therapy guidelines for preventing the global spread of HIV: an ecological cross‐national analysis

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries

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