Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis

Tavakoli, Fatemeh; Khezri, Mehrdad; Tam, Michelle W.; Bazrafshan, Azam; Sharifi, Hamid; Shokoohi, Mostafa

doi:10.1016/j.drugalcdep.2021.108655

Cited by 18 publications

(8 citation statements)

References 39 publications

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“…FSWs in Iran are considered the second most affected population by HIV after people who inject drugs (PWID) ( Mirzazadeh et al, 2020 ). Around 228,700 FSWs are estimated to live and work in urban settings in Iran ( Sharifi et al, 2017 ) with a pooled HIV prevalence of 2.23% (95% confidence interval [CI] = [0.82, 3.64]) ( Karamouzian, Nasirian, et al, 2019 ), and lifetime non-injection and injection drug use prevalence of 76.1% and 10.7%, respectively ( Tavakoli et al, 2021 ). Sexual transmission of HIV, particularly among women and FSWs is on the rise in Iran ( Shahesmaeili et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey

Hosseini‐Hooshyar

Mirzazadeh

Karamouzian

et al. 2021

Violence Against Women

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Sexual violence increases the risk of adverse health outcomes among female sex workers (FSWs). Using data from the 2015 national bio-behavioral survey, we explored the experience of sexual violence and its associated factors among Iranian FSWs. Lifetime and recent sexual violence were reported by 40.1% and 16.9%, respectively. History of substance use, ever engaging in anal sex, engaging in group sex within the last year, a high number of clients, recent unstable housing, and incarceration increased the likelihood of experiencing recent sexual violence. These findings underscore the need for community-empowerment and policy-level interventions to address violence among FSWs in Iran.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey

Hosseini‐Hooshyar

Mirzazadeh

Karamouzian

et al. 2021

Violence Against Women

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“…In a nationwide study of FSWs in Iran, more than 70% of FSWs had ever used drugs and about 15% had ever injected drugs [29]. A recent systematic review estimated the pooled prevalence of recent non-injecting and injecting drug use at 56.9% and 5.6%, respectively [36]. In studies of drug use by FSWs in Iran, estimates of drug use range from over 60% [37] to 70% [10], whereas estimates of injecting drug use range from 1.1% [38] to 18% [32].…”

Section: Discussionmentioning

confidence: 99%

HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020

et al. 2022

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Despite the overall decline in human immunodeficiency virus (HIV) prevalence, it remains unacceptably high in key populations. This study aimed to estimate prevalence of HIV infection and high-risk behaviors among female sex workers (FSWs). This study was a cross-sectional survey of FSWs conducted between December 2019 and August 2020 in eight geographically diverse cities in Iran. After providing informed consent, participants completed a bio-behavioral questionnaire and after completion of the interview, rapid diagnostic tests (RDT) and dried blood spots (DBS) were collected to determine HIV and syphilis status as per national guidelines, if the women consented. All analyzes were based on RDS adjustment. Weighting was done according to Giles’SS estimator. Among the 1515 FSWs, the overall prevalence of HIV and syphilis were 1.6% (95% CI: 0.8–2.3) and zero, respectively. The highest HIV prevalence was observed in Shiraz (5.1%) and Khorramabad city (1.6%). In addition, HIV-positive FSWs had a higher mean age at first sexual contact than HIV-negative FSWs (21.4 ± 5.6 vs. 17.2 ± 4.2 years). Injection drug use and a history of arrest or incarceration were associated with an increased odds of HIV infection (OR = 6.25; 95% CI: 1.90-20.55 and OR = 4.57; 95% CI: 1.64–12.72, respectively). Based on the results, strategies to improve early HIV diagnosis, harm reduction, and use of testing and treatment strategies are needed to reduce and control HIV infections.

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“…Additionally, Item 10 was not included in the quality assessment because it focuses on the identification of subpopulations, which was not applicable as our study pooled the data in the total population of FSWs. This tool provides a numeric score ranging from 0 to 10, with scores ≤5 indicating “low/moderate quality” and >5 indicating “fair quality” (Karamouzian et al, 2020; Tavakoli et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

“…Female sex workers are considered to be an understudied subpopulation in Iran, and most efforts have been made to understand HIV prevalence and drug use practices among these women (Karamouzian et al, 2020; Tavakoli et al, 2021). Here, we conducted a systematic review and meta-analysis to summarize the existing body of evidence about the prevalence of condomless sex among FSWs in Iran.…”

mentioning

confidence: 99%

Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Khezri¹,

Tavakoli²,

Bazrafshan³

et al. 2022

J Assoc Nurses AIDS Care

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Condomless sex is the most proximal risk for HIV acquisition among female sex workers (FSWs). We performed a systematic review and meta-analysis to summarize the evidence for the prevalence of condomless sex among FSWs in Iran. A random-effect metaanalysis model was used to pool the prevalence estimates and their 95% confidence intervals (CIs). The pooled prevalence of condomless sex at last sex with a paying client and a nonpaying partner was 34.23% (95% CI: 27.83-40.93) and 48.34 (95% CI: 38.43-58.32), respectively. Last-month inconsistent condom use was 49.01% (95% CI: 21.64-76.71) with paying clients and 60.21% (95% CI: 31.27-85.73) with nonpaying partners. The pooled prevalence of lifetime condom nonuse with any partners/clients was 15.26% (95% CI: 10.68-20.49). These findings indicate that a substantial proportion of FSWs engage in high-risk sexual practices. Community-led programs should be stimulated to improve consistent condom use among FSWs.

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Injection and non-injection drug use among female sex workers in Iran: A systematic review and meta-analysis

Cited by 18 publications

References 39 publications

Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey

Prevalence and Correlates of Sexual Violence Experienced by Female Sex Workers in Iran: Results from a National HIV Bio-Behavioral Surveillance Survey

HIV prevalence and associated factors among female sex workers in Iran: a bio-behavioral survey in 2020

Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

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