National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

BackgroundSex workers are disproportionately affected by HIV compared with the general population. Most studies of HIV risk among sex workers have focused on individual-level risk factors, with few studies assessing potential structural determinants of HIV risk. In this Article, we examine whether criminal laws around sex work are associated with HIV prevalence among female sex workers.MethodWe estimate cross-sectional, ecological regression models with data from 27 European countries on HIV prevalence among sex workers from the European Centre for Disease Control; sex-work legislation from the US State Department's Country Reports on Human Rights Practices and country-specific legal documents; the rule of law and gross-domestic product per capita, adjusted for purchasing power, from the World Bank; and the prevalence of injecting drug use among sex workers. Although data from two countries include male sex workers, the numbers are so small that the findings here essentially pertain to prevalence in female sex workers.FindingsCountries that have legalised some aspects of sex work (n=17) have significantly lower HIV prevalence among sex workers than countries that criminalise all aspects of sex work (n=10; β=–2·09, 95% CI −0·80 to −3·37; p=0·003), even after controlling for the level of economic development (β=–1·86; p=0·038) and the proportion of sex workers who are injecting drug users (−1·93; p=0·026). We found that the relation between sex work policy and HIV among sex workers might be partly moderated by the effectiveness and fairness of enforcement, suggesting legalisation of some aspects of sex work could reduce HIV among sex workers to the greatest extent in countries where enforcement is fair and effective.InterpretationOur findings suggest that the legalisation of some aspects of sex work might help reduce HIV prevalence in this high-risk group, particularly in countries where the judiciary is effective and fair.

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National sex work policy and HIV prevalence among sex workers: an ecological regression analysis of 27 European countries

The Lancet HIV ◽

10.1016/s2352-3018(16)30217-x ◽

2017 ◽

Vol 4 (3) ◽

pp. e134-e140 ◽

Cited By ~ 14

Author(s):

Aaron Reeves ◽

Sarah Steele ◽

David Stuckler ◽

Martin McKee ◽

Andrew Amato-Gauci ◽

...

Keyword(s):

Regression Analysis ◽

Sex Work ◽

Sex Workers ◽

Hiv Prevalence ◽

European Countries ◽

Ecological Regression ◽

Sex Work Policy

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MOTIVATIONS FOR ENTRY INTO SEX WORK AND HIV RISK AMONG MOBILE FEMALE SEX WORKERS IN INDIA

Journal of Biosocial Science ◽

10.1017/s0021932011000277 ◽

2011 ◽

Vol 43 (5) ◽

pp. 535-554 ◽

Cited By ~ 14

Author(s):

NIRANJAN SAGGURTI ◽

RAVI K. VERMA ◽

SHIVA S. HALLI ◽

SUVAKANTA N. SWAIN ◽

RAJENDRA SINGH ◽

...

Keyword(s):

Sex Work ◽

Hiv Risk ◽

Sex Workers ◽

Female Sex Workers ◽

Economic Conditions ◽

Cross Sectional Survey ◽

Inconsistent Condom ◽

Cross Sectional ◽

Female Sex ◽

Family Tradition

SummaryThis paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007–2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.

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From Violence to Sex Work: Agency, Escaping Violence, and HIV Risk Among Establishment-Based Female Sex Workers in Tijuana, Mexico

Global Perspectives on Women's Sexual and Reproductive Health Across the Lifecourse ◽

10.1007/978-3-319-60417-6_12 ◽

2017 ◽

pp. 191-212

Author(s):

Shonali M. Choudhury ◽

Debbie Anglade ◽

Kyuwon Park

Keyword(s):

Sex Work ◽

Hiv Risk ◽

Sex Workers ◽

Female Sex Workers ◽

Female Sex

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Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: a cross-sectional analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052549 ◽

2016 ◽

Vol 92 (8) ◽

pp. 593-598 ◽

Cited By ~ 9

Author(s):

Angela M Parcesepe ◽

Kelly L L'Engle ◽

Sandra L Martin ◽

Sherri Green ◽

Chirayath Suchindran ◽

...

Keyword(s):

Condom Use ◽

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Cross Sectional ◽

Female Sex ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

International Journal of STD & AIDS ◽

10.1177/0956462418799018 ◽

2018 ◽

Vol 30 (2) ◽

pp. 120-130 ◽

Cited By ~ 1

Author(s):

Gunjika Misra ◽

Damodar Sahu ◽

Umenthala S Reddy ◽

Saritha Nair

Keyword(s):

Sex Work ◽

Sex Workers ◽

Female Sex Workers ◽

Uttar Pradesh ◽

Hiv Prevalence ◽

Indian States ◽

Factors Affecting ◽

East Indian ◽

Female Sex ◽

Behavioural Surveillance

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4–18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2–6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6–16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the ‘Sustainable Development Goals’ goal of ‘Ending the AIDS epidemic’ by 2030.

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HIV prevalence among female sex workers in Guigang City, Guangxi, China: an 8-year consecutive cross-sectional study

BMC Public Health ◽

10.1186/s12889-018-5380-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Jingzhen Lai ◽

Chunwei Qin ◽

Eric J. Nehl ◽

Junjun Jiang ◽

Yunxuan Huang ◽

...

Keyword(s):

Sex Workers ◽

Female Sex Workers ◽

Cross Sectional Study ◽

Hiv Prevalence ◽

Sectional Study ◽

Cross Sectional ◽

Female Sex

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HIV testing behaviour and HIV prevalence among female sex workers in Ukraine: findings from an Integrated Bio-Behavioural Survey, 2013–2014

Sexually Transmitted Infections ◽

10.1136/sextrans-2018-053684 ◽

2019 ◽

Vol 95 (3) ◽

pp. 193-200 ◽

Cited By ~ 1

Author(s):

Anna Tokar ◽

Iana Sazonova ◽

Sharmistha Mishra ◽

Pavlo Smyrnov ◽

Tetiana Saliuk ◽

...

Keyword(s):

Hiv Testing ◽

Sex Work ◽

Sex Workers ◽

Sexual Partner ◽

Female Sex Workers ◽

Hiv Prevalence ◽

Factors Associated ◽

Female Sex ◽

Living With Hiv ◽

Test Result

ObjectivesUkraine has one of the largest HIV epidemics in Europe, with high prevalence among female sex workers (FSWs). We aimed to identify factors associated with HIV testing and receipt of the test result in the last 12 months, HIV prevalence and self-reported positive status among FSWs in Ukraine.MethodsWe used data from an Integrated Bio-Behavioural Survey among FSWs conducted in 2013–2014. The survey methodology combined three sampling strategies: time and location sampling, respondent-driven sampling and key informant recruitment. We used multivariable regression to identify factors associated with self-reported HIV testing in the last 12 months, HIV prevalence and self-reported positive status among FSWs living with HIV. Explored factors included: age, age at first sex, age at entry into sex work, education, marital status, employment status beside sex work, condom use with last paying or non-paying sexual partner, drug or alcohol consumption and sex work venue.ResultsRecent HIV testing was low overall with only 63.2% of FSWs reported having tested and received their test result in the last 12 months prior to the survey. HIV prevalence was 7.1% overall, but only 45.0% of FSWs living with HIV were aware of their HIV status. Testing in the last 12 months with receipt of test result was less common among FSWs who used drugs ever in life (adjusted OR (AOR) 0.7, 95% CI 0.6 to 0.9), women soliciting clients indoors (AOR 0.8, 95% CI 0.7 to 0.9) and those not using a condom with last paying sexual partner (AOR 0.3, 95% CI 0.2 to 0.5). HIV positivity was associated with history of ever using drugs (AOR 2.3, 95% CI 1.4 to 3.6) and soliciting clients outdoors (AOR 1.5, 95% CI 1.1 to 2.0). Women working indoors were less aware of their positive status (AOR 0.1, 95% CI 0.1 to 0.9).ConclusionHIV prevalence is high among FSWs in Ukraine, and testing and knowledge of one’s status remain insufficient. HIV testing programmes need to expand with strategies to reach specific subgroups of FSWs.

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Unprotected Sex with Injecting Drug Users among Iranian Female Sex Workers: Unhide HIV Risk Study

AIDS Research and Treatment ◽

10.1155/2012/651070 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Khodabakhsh Ahmadi ◽

Majid Rezazade ◽

Mohammad Nafarie ◽

Babak Moazen ◽

Mosaieb Yarmohmmadi Vasel ◽

...

Keyword(s):

Hiv Risk ◽

Sex Workers ◽

Drug Users ◽

Female Sex Workers ◽

Injecting Drug Users ◽

Unprotected Sex ◽

Perceived Behavioral Control ◽

Hiv Knowledge ◽

Cross Sectional ◽

Female Sex

Purpose. To assess the prevalence and associated factors of unprotected sex with injecting drug users (IDUs) among a sample of female sex workers (FSWs) in Iran.Methods. This cross-sectional study included 144 FSWs who were interviewed as a part of Unhide HIV Risk Study, a national behavioral survey focusing on various high-risk populations, including IDUs, FSWs, and Men who have Sex with Men (MSMs) in 2009. The survey was conducted in eight provinces in Iran using respondent-driven sampling. Participants’ sociodemographic status, HIV knowledge, and HIV attitude were analyzed via logistic regression to determine the predictors of unprotected sex with IDU(s) during the past month.Results. Nineteen percent of FSWs reported at least one occasion of unprotected sex with IDU(s) in the month preceding the study. Higher educational level (OR=−0.653, 95%CI=-1.192to −0.115), perceived HIV risk (OR=−1.047, 95%CI=-2.076to −0.019), and perceived family intimacy during childhood (OR=−1.104, 95%CI=-1.957to −0.251) were all independently associated with lower odds of having unprotected sex with IDU(s) in the month preceding the study. Age, marital status, living condition, HIV knowledge, and perceived behavioral control did not affect the odds of FSWs having sex with IDUs.Conclusion. Perceived HIV risk, which is a modifiable factor, seems to be a promising target for harm reduction interventions amongst Iranian female sex workers. Data presented here may aid in reducing or eliminating the role of sex workers as a bridge for HIV transmission from IDUs to the general population in Iran.

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Depression and HIV Risk Behaviors among Female Sex Workers in Guangdong, China: A Multicenter Cross-Sectional Study

BioMed Research International ◽

10.1155/2016/6986173 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Hongcheng Shen ◽

Huachun Zou ◽

Shujie Huang ◽

Fengying Liu ◽

Peizhen Zhao ◽

...

Keyword(s):

Risk Behaviors ◽

Hiv Risk ◽

Sexual Behaviors ◽

Sex Workers ◽

Female Sex Workers ◽

General Health Questionnaire ◽

Hiv Risk Behaviors ◽

Cross Sectional ◽

Female Sex ◽

Sex Partner

Background. Our study aimed to assess the burden of depression and evaluate factors associated with depression and status of HIV risk behaviors among female sex workers (FSWs) in Guangdong, China. Method. We recruited FSWs from massage parlors, saunas, restaurants, hotels, hair salons, and streets in Guangdong, China, in 2014. Information on demographic characteristics, HIV testing history, and sexual behaviors was collected using a questionnaire. A blood sample was collected to test for HIV, syphilis, and HCV. A participant was defined as being depressed if she obtained 6 points or above using the 12-item General Health Questionnaire. Results. Among the 653 participants, 41.7% were 21–30 years old and 43.6% married. Overall, 52.4% were found to be depressed. FSWs who had correct syphilis related knowledge [aOR = 1.45; 95% CI: 1.04–2.03] and had primary sex partner (1.63, 1.14–2.33) were more likely to be depressed. FSWs who did not use a condom during their last sex with the primary sex partner were less likely to be depressed (0.47, 0.31–0.71). Conclusion. Our study observed high level of depression and HIV risk behaviors among Chinese FSWs. Future interventions should integrate mental health services in comprehensive interventions to prevent depression among Chinese FSWs.

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