Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis

Abstract

Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10 years. The pooled estimate of HIV prevalence was 17.3 % (95 % CI 13.5–21.9 %); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32 %) and statistical heterogeneity was substantial (I2 = 0.89, Q = 123; p < 0.001). Although the variance across the 14 studies was high, prevalence was generally high (10 % or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.

Exchange Sex and HIV Infection Among Women Who Inject Drugs—20 US Cities, 2009

“…Although HIV prevalence among women who exchanged sex in our study is lower than that reported in a systematic review of US studies among female sex workers (17.3%), 23 most studies in that review were conducted in the 1990s. Furthermore, our findings may not be directly comparable as all women in our sample injected drugs and 60% only exchanged sex with a single partner.…”

“…A recent systematic review documented only 14 studies in the United States that reported HIV prevalence among sex workers, with estimates ranging from 0.3% to 30% and an average prevalence of 17.3% [95% confidence interval (CI): 13.5% to 21.9%]. 23 Most are decades old, only 3 present data beyond a single city or state, and the majority used convenience sampling. Findings regarding HIV prevalence specifically among women who inject drugs are inconsistent: A longitudinal case–control study among PWID in San Francisco found that women who traded sex for money in the past year were 5.1 times more likely to become HIV infected, 8 whereas other studies among PWID have found that exchange sex was not associated with being HIV positive, 24 or that this association was only seen for women with large numbers of partners.…”

Remaining Gap in HIV Testing Uptake Among Female Sex Workers in Iran

“…In comparison with other women in low- and middle-income countries (LMIC), FSW were found to be 13.5 times more likely to be living with HIV infection [5]. The overall HIV prevalence among FSW was found to be 11.8% in LMIC and 17.3% in the US as a high-income country [8]. …”

Sexually Transmitted Infections among Female Sex Workers in Some Selected Region of Bayelsa State

“…Paz-Bailey et al [17] reported HIV prevalence of 17.3% among adult female sex workers in US. Magnani et al [18] reported prevalence of among direct and indirect FSW in Indonesia as 10.5% and 4.9% respectively (HIV), 35.6% and 28.7% respectively (chlamydia), 31.8% and 14.3% respectively (gonorrhea) and 7.3% and 3.5% respectively (active syphilis).…”