The Global HIV Epidemics Among Sex Workers

Since the beginning of the epidemic sex workers have experienced a heightened burden of HIV. Unfortunately, sex workers' HIV and health-related risks and rights have often gone unattended and global resource allocation related to HIV prevention, treatment and care has not been based on rigorous analysis of the evidence related to sex work and HIV. The following questions were addressed in this analysis, focusing largely on female sex workers from lower and middle income countries: What is the global burden of HIV among sex workers? How does the policy and social context shape sex workers' HIV risk across geographic settings? To what extent can comprehensive HIV prevention at-scale among sex workers modify HIV transmission dynamics among sex workers and the general population? What are the most cost-effective HIV prevention, treatment, and care interventions in the context of sex work? What combinations of services are most cost-effective? Key findings include: HIV prevalence is significantly higher (5 times greater on average) across geographic settings among female sex workers than among women in the general adult population. However service coverage levels for HIV prevention services among sex workers are low (generally <50%). HIV transmission dynamics can be significantly reduced among sex workers and the general population across settings by scaling up community empowerment-based, comprehensive HIV prevention services and earlier initiation of ART. Where sex worker rights organizations have partnered effectively with government the response to HIV among sex workers has been particularly effective and sustainable. Empowerment-based, comprehensive HIV prevention among sex workers is cost-effective, particularly in higher prevalence settings where it becomes cost-saving. Violence, stigma and discrimination against sex workers are extremely prevalent. There is a clear justification based on the analyses presented herein to more equitably allocate HIV prevention funding to interventions focused on sex workers. Addressing violence, stigma and discrimination against sex workers is also human rights imperative.