GLOBAL EPIDEMIOLOGY OF HIV AMONG FEMALE SEX WORKERS: INFLUENCE OF STRUCTURAL DETERMINANTS
Identifieur interne : 001B50 ( Pmc/Curation ); précédent : 001B49; suivant : 001B51GLOBAL EPIDEMIOLOGY OF HIV AMONG FEMALE SEX WORKERS: INFLUENCE OF STRUCTURAL DETERMINANTS
Auteurs : K. Shannon [Canada] ; Sa Strathdee [États-Unis] ; Sm Goldenberg [Canada] ; P. Duff [Canada] ; P. Mwangi ; M. Rusakova [Kenya] ; S. Reza-Paul [Russie] ; J. Lau [Inde] ; K. Deering [Canada] ; M. Pickles [République populaire de Chine] ; M-C Boily [République populaire de Chine]Source :
- Lancet [ 0140-6736 ] ; 2014.
Abstract
Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.
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DOI: 10.1016/S0140-6736(14)60931-4
PubMed: 25059947
PubMed Central: 4297548
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<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea> Chinese University of Hong Kong</wicri:regionArea>
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<author><name sortKey="Boily, M C" sort="Boily, M C" uniqKey="Boily M" first="M-C" last="Boily">M-C Boily</name>
<affiliation wicri:level="1"><nlm:aff id="A7"> Chinese University of Hong Kong, China</nlm:aff>
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<front><div type="abstract" xml:lang="en"><title>SUMMARY</title>
<p id="P3">Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">2985213R</journal-id>
<journal-id journal-id-type="pubmed-jr-id">5470</journal-id>
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<journal-id journal-id-type="iso-abbrev">Lancet</journal-id>
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<article-id pub-id-type="manuscript">NIHMS646703</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>GLOBAL EPIDEMIOLOGY OF HIV AMONG FEMALE SEX WORKERS: INFLUENCE OF STRUCTURAL DETERMINANTS</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Shannon</surname>
<given-names>K</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Strathdee</surname>
<given-names>SA</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Goldenberg</surname>
<given-names>SM</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duff</surname>
<given-names>P</given-names>
</name>
<degrees>MSc</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mwangi</surname>
<given-names>P</given-names>
</name>
<degrees>MA</degrees>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rusakova</surname>
<given-names>M</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Reza-Paul</surname>
<given-names>S</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lau</surname>
<given-names>J</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Deering</surname>
<given-names>K</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pickles</surname>
<given-names>M</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Boily</surname>
<given-names>M-C</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada</aff>
<aff id="A2"><label>2</label>
University of California San Diego School of Medicine, California, United States</aff>
<aff id="A3"><label>3</label>
Bar Hostesses Empowerment and Support Program; African Sex Workers</aff>
<aff id="A4"><label>4</label>
Alliance, Nairobi, Kenya</aff>
<aff id="A5"><label>5</label>
Stellit NGO, St Petersburg, Russia</aff>
<aff id="A6"><label>6</label>
Ashodaya Samathi Collective, Mysore, India</aff>
<aff id="A7"><label>7</label>
Chinese University of Hong Kong, China</aff>
<aff id="A8"><label>8</label>
Imperial College, London, United Kingdom</aff>
<author-notes><corresp id="CR1"><bold>Corresponding Author:</bold>
Kate Shannon, PhD, Associate Professor of Medicine University of British Columbia, Director, Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC, V5N 1P7, Canada, Tel: 1(604) 806---9459, <email>kshannon@cfenet.ubc.ca</email>
</corresp>
<fn id="FN1"><p id="P1"><bold>Contributors</bold>
</p>
<p id="P2">KS conceptualised the report, was lead author, and oversaw all stages. M-CB devised and oversaw the modelling process, and M-CB and MRP did the modelling analysis and wrote corresponding methods, results, and interpretations, with support from KD in the early stages. SMG, PD, SAS, and KS devised the review stages. SMG and PD carried out the review process with all co-authors and SMG drafted the review methods. SMG, PD, PM, SR-P, MR, JL, SAS, and KS extracted and categorised the data for the systematic review with a standard data extraction form. PM and SR-P provided local context input and grey literature to inform the modelling. All authors provided input on interpretation of results and report writing.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>5</day>
<month>12</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>22</day>
<month>7</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><day>3</day>
<month>1</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>03</day>
<month>1</month>
<year>2016</year>
</pub-date>
<volume>385</volume>
<issue>9962</issue>
<fpage>55</fpage>
<lpage>71</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/S0140-6736(14)60931-4</pmc-comment>
<abstract><title>SUMMARY</title>
<p id="P3">Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.</p>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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