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Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis
  1. Lucy Platt1,
  2. Emma Jolley1,
  3. Tim Rhodes1,
  4. Vivian Hope1,2,
  5. Alisher Latypov3,4,
  6. Lucy Reynolds1,
  7. David Wilson5
  1. 1Centre for Research on Drugs and Health Behaviour, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
  3. 3The Central Asia Program, Institute for European, Russian, and Eurasian Studies, George Washington University, Washington DC, USA
  4. 4Global Health Research Centre of Central Asia, Columbia University, New York, USA
  5. 5Global HIV/AIDS Programme, World Bank, Washington DC, USA
  1. Correspondence to Dr Lucy Platt; lucy.platt{at}lshtm.ac.uk

Abstract

Objectives We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs.

Design A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. ‘Best’ estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models.

Studies reviewed Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs.

Results HIV in Europe remains low among FSWs who do not inject drugs (<1%), but STIs are high, particularly syphilis in the East and gonorrhoea. FSWs experience high levels of violence and structural risk factors associated with HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment.

Conclusions Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better systematically delineate how microenvironmental and macroenvironmental factors combine to increase or reduce HIV/STI risk.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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