1
|
Bose DL, Hundal A, Singh S, Singh S, Seth K, Hadi SU, Saran A, Joseph J, Goyal K, Salve S. Evidence and gap map report: Social and Behavior Change Communication (SBCC) interventions for strengthening HIV prevention and research among adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1297. [PMID: 36911864 PMCID: PMC9831290 DOI: 10.1002/cl2.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Adolescent girls and young women (AGYW), aged 15-24 years, are disproportionately affected by HIV and other sexual and reproductive health (SRH) risks due to varying social, cultural, and economic factors that affect their choices and shape their knowledge, understanding, and practices with regard to their health. Socio-Behavioral Change Communication (SBCC) interventions targeted at strengthening the capabilities of individuals and their networks have supported the demand and uptake of prevention services and participation in biomedical research. However, despite growing global recognition of the domain, high-quality evidence on the effectiveness of SBCC remains scattered. This evidence and gap map (EGM) report characterizes the evidence base on SBCC interventions for strengthening HIV Prevention and Research among AGYW in low- and middle-income countries (LMICs), identifying evidence gaps and outlining the scope of future research and program design. Objectives The objectives of the proposed EGM are to: (a) identify and map existing EGMs in the use of diverse SBCC strategies to strengthen the adoption of HIV prevention measures and participation in research among AGYW in LMICs and (b) identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research. Methods This EGM is based on a comprehensive search of systematic reviews and impact evaluations corresponding to a range of interventions and outcomes-aimed at engaging AGYW in HIV prevention and research - that were published in LMICs from January 2000 to April 2021. Based on guidance for producing a Campbell Collaboration EGM, the intervention and outcome framework was designed in consultation with a group of experts. These interventions were categorized across four broad intervention themes: mass-media, community-based, interpersonal, and Information Communication and Technology (ICT)/Digital Media-based interventions. They were further sub-categorized into 15 intervention categories. Included studies looked at 23 unique behavioral and health outcomes such as knowledge attitude and skills, relationship dynamics, household dynamics, health care services, and health outcomes and research engagement. The EGM is presented as a matrix in which the rows are intervention categories/sub-categories, and the columns are outcome domains/subdomains. Each cell is mapped to an intervention targeted at outcomes. Additional filters like region, country, study design, age group, funding agency, influencers, population group, publication status, study confidence, setting, and year of publication have been added. Selection Criteria To be eligible, studies must have tested the effectiveness of SBCC interventions at engaging AGYW in LMICs in HIV prevention and research. The study sample must have consisted of AGYW between the ages of 15-24, as defined by UNAIDS. Both experimental (random assignment) and quasi-experimental studies that included a comparison group were eligible. Relevant outcomes included those at the individual, influencer, and institutional levels, along with those targeting research engagement and prevention-related outcomes. Results This EGM comprises 415 impact evaluations and 43 systematic reviews. Interventions like peer-led interactions, counseling, and community dialogues were the most dominant intervention sub-types. Despite increased digital penetration use of media and technology-driven interventions are relatively less studied. Most of the interventions were delivered by peers, health care providers, and educators, largely in school-based settings, and in many cases are part of sex-education curricula. Evidence across geographies was mostly concentrated in Sub-Saharan Africa (70%). Most measured outcomes focused on disease-related knowledge dissemination and enhancing awareness of available prevention options/strategies. These included messaging around consistent condom use, limiting sexual partners, routine testing, and awareness. Very few studies were able to include psychographic, social, and contextual factors influencing AGYW health behaviors and decisions, especially those measuring the impact of social and gender norms, relationship dynamics, and household dynamics-related outcomes. Outcomes related to engagement in the research were least studied. Conclusion This EGM highlights that evidence is heavily concentrated within the awareness-intent spectrum of behavior change and gets lean for outcomes situated within the intent-action and the action-habit formation spectrum of the behavior change continuum. Most of the evidence was concentrated on increasing awareness, knowledge, and building risk perception around SRH domains, however, fewer studies focused on strengthening the agency and self-efficacy of individuals. Similarly, evidence on extrinsic factors-such as strengthening social and community norms, relationships, and household dynamics-that determine individual thought and action such as negotiation and life skills were also found to be less populated. Few studies explore the effectiveness of these interventions across diverse AGYW identities, like pregnant women and new mothers, sex workers, and people living with HIV, leading to limited understanding of the use of these interventions across multiple user segments including key influencers such as young men, partners, families, religious leaders, and community elders was relatively low. There is a need for better quality evidence that accounts for the diversity of experiences within these populations to understand what interventions work, for whom, and toward what outcome. Further, the evidence for use of digital and mass-media tools remains poorly populated. Given the increasing penetration of these tools and growing media literacy on one end, with widening gender-based gaps on the other, it is imperative to gather more high-quality evidence on their effectiveness. Timely evidence generation can help leverage these platforms appropriately and enable intervention designs that are responsive to changing communication ecologies of AGYW. SBCC can play a critical role in helping researchers meaningfully engage and collaborate with communities as equal stakeholders, however, this remains poorly evidenced and calls for investigation and investment. A full list of abbreviations and acronyms are available in Supporting Information: Appendix F.
Collapse
|
2
|
Seroprevalence of ToRCH Pathogens in Southeast Asia. Microorganisms 2021; 9:microorganisms9030574. [PMID: 33799699 PMCID: PMC7999562 DOI: 10.3390/microorganisms9030574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
ToRCH is the acronym for several pathogens associated with pregnancy complications and sequelae in the unborn or newborn child. Particularly primary infections during pregnancy are associated with increased risk. Seroprevalence data of ToRCH infections are important, especially in countries with weak disease surveillance systems, to estimate immunity and vaccination levels, as well as exposure rates and thus the risk of infection during pregnancy. A systematic literature search spanning a 30-year time period was conducted to identify serosurveys on ToRCH pathogens in Southeast Asia. The 96 identified studies showed that some pathogens were well studied, while only limited data were available for others. Studies from the better-developed countries of the region were more abundant. Moreover, seroprevalence data were often limited to a certain geographical region within the country or to certain cohorts, there was an evident lack of recent serosurveys, and the study quality was often not adequate. Well-designed and area-wide serosurveys of ToRCH pathogens are clearly warranted. If combined with risk factor analysis, these studies may guide the development and implementation of effective measures for infection prevention, especially during pregnancy. In addition, educational programs for health care workers and for pregnant women during antenatal care are urgently needed.
Collapse
|
3
|
Abstract
One of the four national HIV prevention goals is to incorporate combinations of effective, evidence-based approaches to prevent HIV infection. In fields of public health, techniques that alter environment and affect choice options are effective. Structural approaches may be effective in preventing HIV infection. Existing frameworks for structural interventions were lacking in breadth and/or depth. We conducted a systematic review and searched CDC's HIV/AIDS Prevention Research Synthesis Project's database for relevant interventions during 1988-2013. We used an iterative process to develop the taxonomy. We identified 213 structural interventions: Access (65%), Policy/Procedure (32%), Mass Media (29%), Physical Structure (27%), Capacity Building (24%), Community Mobilization (9%), and Social Determinants of Health (8%). Forty percent targeted high-risk populations (e.g., people who inject drugs [12%]). This paper describes a comprehensive, well-defined taxonomy of structural interventions with 7 categories and 20 subcategories. The taxonomy accommodated all interventions identified.
Collapse
|
4
|
Zhu J, Yuan R, Hu D, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China. Int J STD AIDS 2017; 29:424-434. [PMID: 28901213 DOI: 10.1177/0956462417730258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female sex workers (FSWs) and their male clients are vulnerable to HIV infection and serve as a bridge in HIV transmission from the high-risk population to the general, low-risk population. To examine the factors of FSWs and male clients that correlate with the prevalence of HIV infection in the Chinese-Vietnamese border region, a cross-sectional survey was conducted in 2014 in the Hekou county of the Yunnan province of China. We performed a questionnaire survey to collect data on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections and drug use. We found that the prevalence of HIV infection among FSWs was 2.74%, and 15 male clients (2.62%) were HIV-positive. Multivariate logistic regression analysis revealed that herpes simplex virus type 2 infection was a risk factor for HIV infection in FSWs and male clients, suggesting the increased role of sexual transmission in the HIV epidemic in the Chinese-Vietnamese border region. Positive urinalysis result for amphetamine-type stimulants was observed in FSWs with HIV infection. History of drug use was correlated with HIV infection, which increased the HIV infection risk of male clients, confirming that drug use is an important target in future interventions for HIV prevention.
Collapse
Affiliation(s)
- Jing Zhu
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Rui Yuan
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Dan Hu
- 2 Department of Health Policy and Management, 12461 Nanjing Medical University , Nanjing City, China
| | - Zhibin Zhu
- 3 Hekou Center for Disease Control and Prevention, Hekou, China
| | - Ning Wang
- 4 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing City, China
| | - Bei Wang
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| |
Collapse
|
5
|
Van Tam V, Cuong DD, Alfven T, Phuc HD, Chuc NTK, Hoa NP, Diwan V, Larsson M. HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam. AIDS Res Ther 2016; 13:39. [PMID: 27891160 PMCID: PMC5109648 DOI: 10.1186/s12981-016-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time. Methods All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients’ records, and a structured questionnaire was used to collect social, demographic and economic data. Results Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education. Conclusion The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples. Trial registration NCT01433601
Collapse
|
6
|
Firestone R, Rowe CJ, Modi SN, Sievers D. The effectiveness of social marketing in global health: a systematic review. Health Policy Plan 2016; 32:110-124. [DOI: 10.1093/heapol/czw088] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/30/2022] Open
|
7
|
Tran LTH, Bui TC, Markham CM, Swartz MD, Tran QM, Nyitray AG, Huynh TTT, Hwang LY. Women's communication self-efficacy and expectations of primary male partners' cooperation in sexually transmitted infection treatment in Ho Chi Minh City, Vietnam: a cross-sectional study. BMC Public Health 2016; 16:28. [PMID: 26758034 PMCID: PMC4710979 DOI: 10.1186/s12889-016-2690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 01/05/2016] [Indexed: 12/01/2022] Open
Abstract
Background Effective control of sexually transmitted infections (STIs) depends on affected patients notifying their sexual partners, and partners following through with screening and treatment. Our study assessed high-risk-STI women’s confidence in STI-diagnosis-related communications with their primary male partners in Ho Chi Minh City, Vietnam, and determined associated characteristics of the women and their partners. Methods We employed convenience and snowball sampling in a clinic-based setting to recruit 126 women from August to October 2013. All data were obtained from women’s self-report. Results The proportions of participants who were “slightly confident” or “very confident” that they could disclose their STI positivity to partners, ask partners to have an STI examination or treatment, and give partners bacterial-STI medications were 70.3 %, 62.1 %, and 69.0 %, respectively. The proportions who perceived that their partners would be “very likely” to have an STI examination and to take STI medications were 16.2 % and 38.8 %, respectively. Significantly lower self-efficacy was observed in women who had a lower education level, who had ever traded sex, or whose primary partners were not husbands or fiancés. Conclusions Our results suggest potential for piloting STI-partner-targeted interventions. To be effective, these programs should improve women’s self-efficacy and primary partners’ cooperation with screening and treatment.
Collapse
Affiliation(s)
- Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Thanh Cong Bui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael D Swartz
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Quan Minh Tran
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Alan G Nyitray
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Lu-Yu Hwang
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
8
|
Liu J, Calzavara L, Mendelsohn JB, O'Leary A, Kang L, Pan Q, Myers T, Ren J, Cha Y, Shi G, Liu X, Tian X, Fan H, Ni Y, Remis RS. Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China. BMC Public Health 2015; 15:147. [PMID: 25880416 PMCID: PMC4377073 DOI: 10.1186/s12889-015-1439-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. Methods From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. Results The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type. Conclusion Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners). Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1439-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Joshua B Mendelsohn
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Ann O'Leary
- US Centres for Disease Control, Atlanta, GA, USA.
| | - Laiyi Kang
- Shanghai Centre for Disease Control and Prevention, Shanghai, China.
| | - Qichao Pan
- Shanghai Centre for Disease Control and Prevention, Shanghai, China.
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Jinma Ren
- Shanghai Centre for Disease Control and Prevention, Shanghai, China. .,Centre for Outcomes Research, University of Illinois, College of Medicine, Peoria, IL, USA.
| | - Yanfeng Cha
- Songjiang District Centre for Disease Control and Prevention, Shanghai, China.
| | - Guozheng Shi
- Jiading District Centre for Disease Control and Prevention, Shanghai, China.
| | - Xiaofeng Liu
- Baoshan District Centre for Disease Control and Prevention, Shanghai, China.
| | - Xiuhong Tian
- Minhang District Centre for Disease Control and Prevention, Shanghai, China.
| | - Huili Fan
- Luwan District Centre for Disease Control and Prevention, Shanghai, China.
| | - Yinqing Ni
- Changning District Centre for Disease Control and Prevention, Shanghai, China.
| | - Robert S Remis
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| |
Collapse
|
9
|
Lessons learned from a review of interventions for adolescent and young key populations in Asia Pacific and opportunities for programming. J Acquir Immune Defic Syndr 2014; 66 Suppl 2:S186-92. [PMID: 24918594 DOI: 10.1097/qai.0000000000000185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over a third of new HIV infections globally are among 15-24 year-olds and over 20% among adolescents aged 10-19 years in Asia Pacific. The review was initiated to identify interventions in the region with demonstrated or potential impact for adolescent and young key populations (YKP) looking at the role of individual and structural factors in accessibility and delivery. The review is a component of a more comprehensive review undertaken by UNICEF and partners in the region. METHODS This was a desk review of over 1000 articles, and 37 were selected. Journal articles in PubMed, Cochrane Library, Cochrane DARE, EMBASE, PsycINFO, CINAHL, and Web of Science databases were searched for HIV intervention-related information for adolescent and YKP. RESULTS AND DISCUSSION Findings showed that except for low levels of risk perception, most individual decisions regarding safe behavior and testing uptake were mediated by structural factors. Critical enablers such as design and delivery of services, peer education, and condom policies were associated with the uptake of high-impact interventions. Synergistic development interventions such as sexuality education, rights-based enforcement of antitrafficking laws, and addressing violence and abuse could increase safer behaviors. CONCLUSIONS Although structural factors play a key role in access and uptake of HIV prevention services for adolescent and YKP, further qualitative research is needed to understand and mitigate the drivers of vulnerability and constructed perceptions of risk.
Collapse
|
10
|
Sakha MA, Kazerooni PA, Lari MA, Sayadi M, Azar FEF, Motazedian N. Effect of an educational intervention on knowledge, attitudes and preventive behaviours related to HIV and sexually transmitted infections in female sex workers in southern Iran: a quasi-experimental study. Int J STD AIDS 2013; 24:727-35. [DOI: 10.1177/0956462413482424] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This quasi-experimental, before–after study was designed to assess the effect of an educational intervention on knowledge and attitudes about sexually transmitted infections, HIV and preventive behaviours among female sex workers in Shiraz, Iran. A single-group pre–post test design was used and the study was done between August and December 2009. The participants were 80 female sex workers recruited from three drop-in centers in Shiraz, with stratified random sampling. Pre-intervention knowledge was assessed by interview with a standard questionnaire. The educational intervention consisted of a lecture, face-to-face education, printed information, an educational movie, role playing and a contest. After 2 months, the effect of the intervention was evaluated (post-test). The average age of the participants was 32.6 ± 9.1 years. After the intervention, the mean score for general knowledge about HIV and sexually transmitted infections increased from 13.7 ± 0.95 (pre-test) to 19.47 ± 11.62 (post-test, p < 0.001). There were significant improvements in attitude and the number of participants who self-reported preventive behaviours such as using a condom consistently (from 45 to 63) ( p < 0.001). The results show that the educational programme was successful in increasing the participants’ HIV- and AIDS-related knowledge and attitudes, and in decreasing their risk behaviours.
Collapse
Affiliation(s)
- Minoo Alipour Sakha
- School of Health Management and Information Sciences, Tehran University of Medical Science, Tehran, Iran
| | | | - Mahmood Amini Lari
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Vice-chancellor for health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nasrin Motazedian
- Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
11
|
Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, Sherman SG, Kerrigan D. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2012; 12:538-49. [PMID: 22424777 DOI: 10.1016/s1473-3099(12)70066-x] [Citation(s) in RCA: 861] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. METHODS We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. FINDINGS Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99,878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6-12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0-18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2-31·3; 8627 of 28,075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1-14·8). INTERPRETATION Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. FUNDING The World Bank, UN Population Fund.
Collapse
Affiliation(s)
- Stefan Baral
- Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Wong WCW, Yim YL, Lynn H. Sexually transmitted infections among female sex workers in Hong Kong: the role of migration status. J Travel Med 2011; 18:1-7. [PMID: 21199136 DOI: 10.1111/j.1708-8305.2010.00453.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Female sex workers (FSW) have been considered reservoirs and vectors of sexually transmitted infections (STI) in the community. This study estimated the prevalence of STI/human immunodeficiency virus (HIV) among FSW of various migration and residential status in Hong Kong and identified possible risk factors. METHODS An outreach "Well-women" clinic was set up at Ziteng, a non-governmental organization working with FSW. Details of their lifestyle and health risk behavior were gathered before screening tests were performed, and the data were analyzed according to their place of origin. RESULTS A total of 503 FSW were screened for STI/HIV between 2005 and 2007. Syphilis, gonorrhea, chlamydia, and HIV accounted for 1.8, 1.8, 4.6, and 0.2%, respectively. After adjusting for confounders, having ≥ 2 sexual partners (odds ratio [OR] 8.33, 95%CI: 2.17-33.46), residence status (OR 0.38, 95%CI: 0.17-0.89), and daily frequency of douching (OR 3.02, 95%CI: 1.23-7.35) were identified as significant predictors. CONCLUSIONS This study provides important insights on the screening and associated risk factors of STI among FSW working in Hong Kong. The contextual factors identified reflect the social and geographical context in which these women are operating and how they protect their health using their own means. These findings encourage policymakers and health professionals to redirect their focus and resources to a more holistic approach to sexual health when planning and implementing effective STI/HIV prevention programs.
Collapse
Affiliation(s)
- William C W Wong
- Family Medicine Unit, Department of Medicine, The University of Hong Kong, 161 Main Street, Ap Lei Chau Clinic, Hong Kong, China.
| | | | | |
Collapse
|
13
|
Pascom ARP, Szwarcwald CL, Júnior AB. Sampling studies to estimate the HIV prevalence rate in female commercial sex workers. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70081-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|