The role of sex work laws and stigmas in increasing HIV risks among sex workers

Lyons, Carrie; Schwartz, Sheree; Murray, Sarah M.; Shannon, Kate; Diouf, Daouda; Mothopeng, Tampose; Kouanda, Séni; Anato, Simplice; Kouamé, Abo; Mnisi, Zandile; Tamoufé, Ubald; Phaswana‐Mafuya, Nancy; Cham, Bai; Dramé, Fatou Maria; Djaló, Mamadú Aliu; Baral, Stefan

doi:10.1038/s41467-020-14593-6

Cited by 89 publications

(84 citation statements)

References 61 publications

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“…Punitive laws not only increase vulnerabilities among sex workers (e.g. unregulated work environments, increased economic insecurities), but also exacerbate sex work‐related stigma, which decreases engagement in HIV prevention and treatment services [38,45]. Expansion of HIV prevention and treatment services in Africa has led to substantial improvements in HIV‐related health outcomes among the general population, however, FSW have not equitably benefitted from efforts to increase HIV service coverage [46].…”

Section: Resultsmentioning

confidence: 99%

Overview of the epidemiological conditions of HIV among key populations in Africa

Jin¹,

Restar²,

Beyrer³

2021

J Int AIDS Soc

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Introduction Despite extraordinary progress in HIV treatment coverage and expanding access to HIV prevention services and that multiple African countries are on track in their efforts to reach 90‐90‐90 goals, the epidemic continues to persist, with prevalence and incidence rates too high in some parts of the continent to achieve epidemic control. While data sources are improving, and research studies on key populations in specific contexts have improved, work on understanding the HIV burdens and barriers to services for these populations remains sparse, uneven and absent altogether in multiple settings. More data have become available in the last several years, and data published in 2010 or more recently are reviewed here for each key population. This scoping review assesses the current epidemiology of HIV among key populations in Africa and the social and political environments that contribute to the epidemic, both of which suggest that without significant policy reform, these epidemics will likely continue. Results and discussion Across Africa, the HIV epidemic is most severe among key populations including women and men who sell or trade sex, men who have sex with men, people who inject drugs, transgender women who have sex with men and prisoners and detainees. These groups account for the majority of new infections in West and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those populations. The HIV literature in Africa emphasizes that despite significant health needs, key populations experience barriers to accessing services within the healthcare and legal justice systems. Current shortcomings of surveillance systems in enumerating key populations impact the way funding mechanisms and resources are allocated and distributed. Adapting more equitable and epidemiologically sound frameworks will be necessary for current and future HIV programming investments. Conclusions Through this review, the available literature on HIV epidemiology among key populations in Africa brings to light a number of surveillance, programmatic and research gaps. For many communities, interventions targeting the health and security conditions continue to be minimal. Compelling evidence suggests that sweeping policy and programmatic changes are needed to effectively tackle the persistent HIV epidemic in Africa.

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Section: Resultsmentioning

confidence: 99%

Overview of the epidemiological conditions of HIV among key populations in Africa

Jin¹,

Restar²,

Beyrer³

2021

J Int AIDS Soc

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“…Across sub-Saharan African countries, the odds of HIV among cisgender women sex workers in criminalised and non-protective settings was higher than in settings in which sex work is partially legalised. Furthermore, the effect of stigmas on HIV was higher in criminalised and non-protective settings compared to partially legalised settings [57]. However, partial legalisation policies in Sweden, Norway, and the UK, where clients of sex work and/or third-party managers are criminalised while the selling of sex is legal, have also been associated with many of the same HIV risks as full criminalisation, reinforcing the need for full decriminalisation to optimise health outcomes [58].…”

Section: Criminalisation Violence and Policingmentioning

confidence: 99%

The Epidemiology of HIV Among Sex Workers Around the World: Implications for Research, Programmes, and Policy

Viswasam

Rivera²,

Comins

et al. 2021

Sex Work, Health, and Human Rights

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Globally, sex workers of all genders and identities continue to face disproportionately high burdens of HIV, demonstrating the need for programmes better tailoring services to their unmet needs. The reasons for this high burden are complex, intersecting across behavioural, social, and structural realities experienced by sex workers. Here, we build on systematic reviews of HIV among sex workers and case studies rooted in sex workers’ lived experience to describe: (1) the global HIV burden among sex workers; (2) the factors and determinants that influence the HIV burden; (3) intervention coverage and gaps to reduce HIV-related inequities faced by sex workers, over the past decade.Sex workers living with HIV have not benefited enough from significant increases in HIV treatment among the general population. Engagement in this HIV treatment cascade is hindered by structural factors including stigma, migration, policing, criminalisation, and violence, as well as substance use, which present increasingly concurrent risks with HIV among sex workers.Emerging biomedical HIV prevention innovations exist to support the health and human rights of sex workers and reduce onward transmission risk, but persistent data gaps remain, and should be addressed via community-driven implementation research. Epidemiologic research engaging sex workers who are cismen and transgender persons is similarly crucial. Community empowerment approaches have reduced the odds of HIV infection, highlighting the case for greater investments in structural interventions. These investments, combined with filling data gaps and national action towards sex work decriminalisation alongside legal protections, are critical to achieving reductions in sex workers’ HIV burden.

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“…Evidence of the impact of legal reform on HIV outcomes remains limited. There is now substantial evidence pointing to the HIV-associated risks related to criminalised legal environments for sex work [10,47,48]. Modelling studies suggest that decriminalisation of sex work would have the biggest impact on reducing HIV incidence among sex workers, yet lack of policy changes limit the real-world evaluation of this intervention [7,23].…”

Section: Hiv and Stismentioning

confidence: 99%

Integrated Interventions to Address Sex Workers’ Needs and Realities: Academic and Community Insights on Incorporating Structural, Behavioural, and Biomedical Approaches

Schwartz

Viswasam

Abdalla³

2021

Sex Work, Health, and Human Rights

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Sex workers experience multi-factorial threats to their physical and mental health. Stigma, human rights violations and occupational exposures to violence, STIs, HIV, and unintended pregnancy create complex health inequities that may not be effectively addressed through programmes or services that focus on a single disease or issue. Meeting cisgender female, male, and transgender sex workers’ unmet needs and realities effectively requires more nuanced, multi-faceted public health approaches. Using a community-informed perspective, this chapter reviews layered multi-component and multi-level interventions that address a combination of structural, behavioural, and biomedical approaches. This chapter addresses (1) what are integrated interventions and why they are important; (2) what types of integrated interventions have been tested and what evidence is available on how integrated interventions have affected health outcomes; (3) what challenges and considerations are important when evaluating integrated interventions. Key findings include the dominance of biomedical and behavioural research among sex workers, which have produced mixed results at achieving impact. There is a need for further incorporation and evaluation of structural intervention components, particularly those identified as highest priority among sex workers, as well as the need for more opportunities for leadership from the sex work community in setting and implementing the research agenda.

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The role of sex work laws and stigmas in increasing HIV risks among sex workers

Cited by 89 publications

References 61 publications

Overview of the epidemiological conditions of HIV among key populations in Africa

Overview of the epidemiological conditions of HIV among key populations in Africa

The Epidemiology of HIV Among Sex Workers Around the World: Implications for Research, Programmes, and Policy

Integrated Interventions to Address Sex Workers’ Needs and Realities: Academic and Community Insights on Incorporating Structural, Behavioural, and Biomedical Approaches

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