Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

Abstract

Summaryobjective To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings.method Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomizedcontrolled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies.results Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV.conclusion Rigorous evaluation of HIV ⁄ STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and ⁄ or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.

The Peer and Non-peer: the potential of risk management for HIV prevention in contexts of prostitution

“…5 In a systematic review of the literature on HIV prevalence among vulnerable populations in Brazil, Malta et al 6 found that sex workers were three times more likely to use condoms with clients than with steady partners (67.3 versus 19.2%) 6 . This difference between condom use with clients and partners is consistent with the results of other studies conducted in Brazil [7][8][9] , and is a major trend in international research [10][11][12] . Only one survey specifically about the use of female condoms was found.…”

“…REV BRAS EPIDEMIOL SEP 2015; 18 SUPPL 1: [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] prostitution has aspects that remain in Brazil's Penal Code. Although the inclusion of "sex workers" in the Brazilian Classification of Occupations by the Ministry of Labor ensures the right to social security and other labor benefits, commercial activities related to prostitution (such as brothels) are illegal, which creates an extremely difficult context for sex workers to work safely.…”

Confronting structural violence in sex work: lessons from a community-led HIV prevention project in Mysore, India

“…Empowerment of sex workers, starting with building awareness and recognition, is the key to establish longterm, sustainable changes to their health and wellbeing (Chattopadhyay & McKaig, 2004). Evidence suggests that intervention strategies that empower sex workers result in more success in both acceptability of the intervention as well as prevention of HIV transmission (Shahmanesh et al, 2008). However, the ramifications of these intervention strategies that target sex workers is unknown, such as the potential to impact stigma, violence, or drive sex work underground.…”

Syphilis and Herpes Simplex Virus Type 2 Sero-Prevalence Among Female Sex Workers and Men Who Have Sex with Men in Ecuador and Andhra Pradesh (India)

“…Without such information, the size of the population being affected by STI may stay largely unknown as well as their health needs (Shahmanesh et al, 2008). An understanding of STI levels and its distribution across a geographical region would allow the planning of effective prevention efforts that correctly address the needs of most vulnerable groups (Dhawan & Khandpur, 2009;Jain et al, 2008).…”