Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Leclerc, P.; Garenne, Michel

doi:10.1258/ijsa.2008.008099

Cited by 20 publications

(17 citation statements)

References 34 publications

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“…Indeed, prevalence was even higher among FSW who reported not knowing their HIV status at the time of the survey (26%). Overall prevalence among FSW in our study is 3 times the 2005 DHS+ estimate of 8.0% HIV prevalence among women in Kigali [5], although it falls within the general range reported by other studies among sex workers in the sub-Saharan region [11], [24]–[30]. It is likely, however, that HIV prevalence among FSW was underestimated in our study because we excluded known HIV-positives.…”

Section: Discussionsupporting

confidence: 62%

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

Braunstein

Ingabire²,

Geubbels

et al. 2011

PLoS ONE

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ObjectivesTo estimate HIV prevalence and risk factors in population-based samples of female sex workers (FSW) and female voluntary counseling and testing (VCT) clients in Rwanda.MethodsWe conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women.ResultsPrevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0–27.0), 59.8% (56.4–63.2), and 7.6% (5.8–9.5) among FSW, and 12.8% (10.9–14.6), 43.2% (40.4–46.0), and 11.4% (9.7–13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible for ART based on CD4<350 cells/µl. Condom use at last sex was higher among FSW (74%) than VCT clients (12%). In age and district of residence-adjusted models, HIV-1 seropositivity was associated with HSV-2 co-infection; recent treatment for sexually transmitted infection (STI); genital symptoms; forced sex; imprisonment; widowhood; and alcohol consumption. Eleven percent of FSW and 12% of VCT clients had recently acquired HIV-1 per BED-CEIA and AI. HSV-2 infection and recent STI treatment were associated with recent HIV infection in both groups, and being married and vaginal cleansing were associated with recent infection before last sex among VCT clients.ConclusionsThis population-based survey reveals a high HIV prevalence and incidence among FSW and female VCT clients in Kigali, the scale of which is masked by the low general-population HIV prevalence in Rwanda. HIV/STI and family planning services should be strengthened.

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Section: Discussionsupporting

confidence: 62%

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

Braunstein

Ingabire²,

Geubbels

et al. 2011

PLoS ONE

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“…However, contrary to Talbott, we did not find an association between FSW population size estimates and HIV prevalence in the general population (in our study, HIV prevalence among pregnant women was used as proxy for general population prevalence). This study was however highly criticised for the vagueness of the country data on numbers of FSWs,16 even by the authors who published the data on FSW population size estimates,17 as well as for the positions taken by the non-governmental association chaired by the author on sex work and HIV,18 that could have influenced choices in his analyses, and the strength of his conclusions, given the limitations of ecological analyses 19…”

Section: Discussionmentioning

confidence: 99%

Ecological analysis of the association between high-risk population parameters and HIV prevalence among pregnant women enrolled in sentinel surveillance in four southern India states

Alary

Jayachandran²,

Lowndes³

et al. 2010

Sexually Transmitted Infections

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BackgroundThe HIV epidemic is very heterogeneous at the district level in the four Southern states of India most affected by the epidemic and where transmission is mainly heterosexual. The authors carried out an ecological study of the relationship between high-risk population parameters and HIV prevalence among pregnant women (ANC HIV prevalence).MethodsThe data used in this study included: ANC HIV prevalence available from the National AIDS Control Organization (dependent variable); data on prevalence of HIV and other sexually transmitted infections among female sex workers (FSWs), their clients and high-risk men who have sex with men (HR-MSM) from studies carried out in 24 districts under Avahan; data on clients' volume reported by FSWs and on the size estimates of FSWs and HR-MSM in each district; and census data. The latter two sets of data were used to estimate the percentage of female (male) adults who are FSWs (HR-MSM). The latter was also multiplied by HIV prevalence in FSWs (HR-MSM) to obtain the percentage of HIV-positive FSWs (HR-MSM) in the adult female (male) population. Linear regression was used for statistical analyses.ResultsIn univariate analyses, HIV (r=0.59, p=0.002) and HSV-2 (r=0.49, p=0.014) prevalence among FSWs and mean number of clients in the last week reported by FSWs (r=0.43, p=0.036) were significant predictors of ANC HIV prevalence. In multivariate analysis, only FSW HIV prevalence remained significant.ConclusionsThis ecological study suggests that there is a link between HIV prevalence among FSWs and the spread of HIV to the general population in Southern India. Such an observation supports the rationale of interventions targeted at the sex industry.

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“…The 4-city study conducted in the late 1990's concluded that commercial sex could not explain differential prevalence within the sites [30]. We showed from five case studies in the early 2000s that the role of female sex workers seems limited, and accounts for only 1.3 to 9.4% of infections in the general population, although Zambia was not included in this sample [56]. To a certain extent, results of our simulation H0 reflect this fact.…”

Section: Discussionmentioning

confidence: 70%

Fitting the HIV Epidemic in Zambia: A Two-Sex Micro-Simulation Model

2009

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BackgroundIn describing and understanding how the HIV epidemic spreads in African countries, previous studies have not taken into account the detailed periods at risk. This study is based on a micro-simulation model (individual-based) of the spread of the HIV epidemic in the population of Zambia, where women tend to marry early and where divorces are not frequent. The main target of the model was to fit the HIV seroprevalence profiles by age and sex observed at the Demographic and Health Survey conducted in 2001.Methods and FindingsA two-sex micro-simulation model of HIV transmission was developed. Particular attention was paid to precise age-specific estimates of exposure to risk through the modelling of the formation and dissolution of relationships: marriage (stable union), casual partnership, and commercial sex. HIV transmission was exclusively heterosexual for adults or vertical (mother-to-child) for children. Three stages of HIV infection were taken into account. All parameters were derived from empirical population-based data. Results show that basic parameters could not explain the dynamics of the HIV epidemic in Zambia. In order to fit the age and sex patterns, several assumptions were made: differential susceptibility of young women to HIV infection, differential susceptibility or larger number of encounters for male clients of commercial sex workers, and higher transmission rate. The model allowed to quantify the role of each type of relationship in HIV transmission, the proportion of infections occurring at each stage of disease progression, and the net reproduction rate of the epidemic (R 0 = 1.95).ConclusionsThe simulation model reproduced the dynamics of the HIV epidemic in Zambia, and fitted the age and sex pattern of HIV seroprevalence in 2001. The same model could be used to measure the effect of changing behaviour in the future.

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Commercial sex and HIV transmission in mature epidemics: a study of five African countries

Cited by 20 publications

References 34 publications

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda

Ecological analysis of the association between high-risk population parameters and HIV prevalence among pregnant women enrolled in sentinel surveillance in four southern India states

Fitting the HIV Epidemic in Zambia: A Two-Sex Micro-Simulation Model

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