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

Jones, Harriet S; Anderson, Rebecca L; Cust, Henry; McClelland, R. Scott; Richardson, Barbra A.; Thirumurthy, Harsha; Malama, Kalonde; Hensen, Bernadette; Platt, Lucy; Rice, Brian; Cowan, Frances M; Imai-Eaton, Jeffrey W.; Hargreaves, James R; Stevens, Oliver

doi:10.1101/2023.10.17.23297108

Cited by 3 publications

(5 citation statements)

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“…For all three models (KPSE, prevalence, ART coverage) in sensitivity analysis we used ages 15-29 years as the matched total population denominator for MSM and TGW regression analyses, and 15-39 years for FSW, reflecting the younger median age of survey respondents. 36,–3736–38…”

Section: Methodsmentioning

confidence: 99%

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Stevens

Sabin

Garcia

et al. 2022

Preprint

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Background: HIV programmes in sub-Saharan Africa (SSA) require information about HIV among key populations to ensure equitable and equal access to HIV prevention and treatment. Surveillance has been conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender populations, but is not systematically included in national HIV estimates. We consolidated existing KP surveys to create national-level estimates of key population size, HIV prevalence, and ART coverage for mainland SSA. Methods: Key population size estimates (KPSE), HIV prevalence, and ART coverage data from 38 countries from 2010-2021 were collated from existing databases, deduplicated, and verified against primary sources. We used Bayesian mixed-effects regression to spatially smooth KPSE, and regressed subnational key population HIV prevalence and ART coverage against age/sex/year/province-matched total population estimates. Findings: We extracted 1449 unique KPSE datapoints, 1181 HIV prevalence datapoints, and 242 ART coverage datapoints. Countries had data for a median of five of the twelve population/outcome stratifications. Across countries, a median of 1.44% of urban women were FSW (interquartile range [IQR] 0.83-1.89%); 0.60% of urban men were MSM; and 0.16% of urban adults injected drugs (IQR 0.14-0.24%). HIV prevalence in all key populations was higher than matched total population prevalence. ART coverage was correlated with, but lower than, total population ART coverage. Across SSA, key populations were estimated as 1.1% (95%CI 0.7-1.9%) of the population but 5.1% (95%CI 3.2-10.3%) of all PLHIV aged 15-49 years. Interpretation: Key populations in sub-Saharan experience disproportionate HIV burden and somewhat lower ART coverage, underscoring need for focused prevention and treatment services. However, large heterogeneity and incomplete data availability limit precise estimates for programming and monitoring trends. Future efforts should focus on integrating and strengthening key population surveys and routine data within national HIV strategic information systems.

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Section: Methodsmentioning

confidence: 99%

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Stevens

Sabin

Garcia

et al. 2022

Preprint

Self Cite

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“…Unlike for SW and MSM in SSA, for whom our infection estimates were supported by empirical meta-analyses, 3,31 for PWID, data about incidence and its trends are scarce. A meta-analysis of data published in 2000–2022 found a 1.7 per 100 person-years global incidence, 35 more than our 1.3 per 100 and 0.85 per 100 for 2010 and 2022, with most of this difference from MENA region.…”

Section: Discussionmentioning

confidence: 73%

“…This partially reflects that our IRRs were expressed relative to men and women combined (with, in SSA, a higher overall incidence rate than men alone). Also, incidence studies in this meta-analysis may have oversampled higher-risk MSM;Meta-analyses of FSW cohorts in SSA found declining incidence rates and stable IRRs over 2010–2020, 31 and prevalence ratios of 1.5–1.85 32,33 for clients of FSW relative to all men. Both are consistent with our results;For FSWs and their partners in MENA, a 12-country modeling study estimated that FSW, their clients, and spouses of clients comprised 28% of adult infections in 2020, 34 similar to our 23% and 19% for SW, FSW clients, and partners of FSW clients in 2010 and 2022, respectively;Unlike for SW and MSM in SSA, for whom our infection estimates were supported by empirical meta-analyses, 3,31 for PWID, data about incidence and its trends are scarce.…”

Section: Discussionmentioning

confidence: 96%

“…Also, incidence studies in this meta-analysis may have oversampled higher-risk MSM;Meta-analyses of FSW cohorts in SSA found declining incidence rates and stable IRRs over 2010–2020, 31 and prevalence ratios of 1.5–1.85 32,33 for clients of FSW relative to all men. Both are consistent with our results;For FSWs and their partners in MENA, a 12-country modeling study estimated that FSW, their clients, and spouses of clients comprised 28% of adult infections in 2020, 34 similar to our 23% and 19% for SW, FSW clients, and partners of FSW clients in 2010 and 2022, respectively;Unlike for SW and MSM in SSA, for whom our infection estimates were supported by empirical meta-analyses, 3,31 for PWID, data about incidence and its trends are scarce. A meta-analysis of data published in 2000–2022 found a 1.7 per 100 person-years global incidence, 35 more than our 1.3 per 100 and 0.85 per 100 for 2010 and 2022, with most of this difference from MENA region.…”

Section: Discussionmentioning

confidence: 96%

“…Meta-analyses of FSW cohorts in SSA found declining incidence rates and stable IRRs over 2010–2020, 31 and prevalence ratios of 1.5–1.85 32,33 for clients of FSW relative to all men. Both are consistent with our results;…”

Section: Discussionmentioning

confidence: 99%

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New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation

Korenromp,

Sabin,

Stover

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Previously, The Joint United Nations Programme on HIV/AIDS estimated proportions of adult new HIV infections among key populations (KPs) in the last calendar year, globally and in 8 regions. We refined and updated these, for 2010 and 2022, using country-level trend models informed by national data. Methods: Infections among 15–49 year olds were estimated for sex workers (SWs), male clients of female SW, men who have sex with men (MSM), people who inject drugs (PWID), transgender women (TGW), and non-KP sex partners of these groups. Transmission models used were Goals (71 countries), AIDS Epidemic Model (13 Asian countries), Optima (9 European and Central Asian countries), and Thembisa (South Africa). Statistical Estimation and Projection Package fits were used for 15 countries. For 40 countries, new infections in 1 or more KPs were approximated from first-time diagnoses by the mode of transmission. Infection proportions among nonclient partners came from Goals, Optima, AIDS Epidemic Model, and Thembisa. For remaining countries and groups not represented in models, median proportions by KP were extrapolated from countries modeled within the same region. Results: Across 172 countries, estimated proportions of new adult infections in 2010 and 2022 were both 7.7% for SW, 11% and 20% for MSM, 0.72% and 1.1% for TGW, 6.8% and 8.0% for PWID, 12% and 10% for clients, and 5.3% and 8.2% for nonclient partners. In sub-Saharan Africa, proportions of new HIV infections decreased among SW, clients, and non-KP partners but increased for PWID; elsewhere these groups' 2010-to-2022 differences were opposite. For MSM and TGW, the proportions increased across all regions. Conclusions: KPs continue to have disproportionately high HIV incidence.

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Characteristics and HIV-related Engagement of Male Sexual Partners of Female Sex Workers in Sub-Saharan Africa (SSA): a Scoping Review

Maringwa,

Matambanadzo,

Hargreaves

et al. 2024

Preprint

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Introduction Understanding the characteristics and behaviors of male sexual partners of female sex workers (FSWs) is crucial for comprehending the dynamics of HIV transmission. We aimed to explore and quantify the existing literature on male sexual partners of FSWs in SSA, where HIV prevalence is high and the dynamics of sex work are poorly understood. We focused on the proportions of men reporting sex with FSWs, along with their characteristics, HIV prevalence, and engagement with HIV services among the general population and specific subgroups. Methods We searched the literature in the EBSCOhost databases (Medline Complete, Global Health, and CINAHL). We included quantitative epidemiological peer-reviewed articles published in English between January 2010 and December 2023, following PRISMA guidelines for scoping reviews. The last search was performed on 09 October 2024. Eligible studies focused on men from the general population and subgroups of men who reported having sex with FSWs. The results were synthesized narratively to identify patterns and gaps in the literature. Results We identified 2,067 articles and reviewed 15, including one meta-analysis. The general population meta-analysis and the articles among subgroups revealed variations in reporting sex with FSWs, differences in HIV prevalence, suboptimal HIV testing uptake, and inconsistent condom use. The proportion of general population men in SSA who had ever paid for sex was 8.5%, with a pooled HIV prevalence of 3.6% and 67.5% reported condom use at last paid sex. High-risk subgroups of men reported different rates of sex with FSWs, ranging from 6.6% to 74%. HIV prevalence also varied significantly, from 7.5% to 26%. Across these high-risk groups, suboptimal HIV testing uptake and inconsistent condom use were common, with no comparative data for men who did not have sex with FSWs. Discussion Men who have sex with FSWs cannot be identified by specific characteristics. High-risk subgroups reported greater engagement with FSWs. Sex with an FSW was associated with higher HIV prevalence among men in the general population, with no data on subgroups. These findings highlight the need for tailored, occupation-specific interventions that address the unique needs of mobile and high-risk men.

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

Cited by 3 publications

References 90 publications

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation

Characteristics and HIV-related Engagement of Male Sexual Partners of Female Sex Workers in Sub-Saharan Africa (SSA): a Scoping Review

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