HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed

Purpose of reviewThis article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors. Recent findingsOur review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work. SummaryFuture research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.

[1]  Sm Goldenberg,et al.  "Right Here is the Gateway": Mobility, Sex Work Entry and HIV Risk Along the Mexico-U.S. Border. , 2014, International migration.

[2]  T. Patterson,et al.  Can't Buy My Love: A Typology of Female Sex Workers' Commercial Relationships in the Mexico–U.S. Border Region , 2014, Journal of sex research.

[3]  S. Baral,et al.  A cross-sectional evaluation of the prevalence and associations of HIV among female sex workers in the Gambia , 2014, International journal of STD & AIDS.

[4]  C. Beyrer,et al.  Female Sex Workers in Three Cities in Russia: HIV Prevalence, Risk Factors and Experience with Targeted HIV Prevention , 2014, AIDS and Behavior.

[5]  G. Henderson,et al.  The Organization of Sex Work in Low- and High-Priced Venues with a Focus on the Experiences of Ethnic Minority Women Working in These Venues , 2014, AIDS and Behavior.

[6]  Julio S. G. Montaner,et al.  Early Sex Work Initiation Independently Elevates Odds of HIV Infection and Police Arrest Among Adult Sex Workers in a Canadian Setting , 2014, Journal of acquired immune deficiency syndromes.

[7]  Xiaoming Li,et al.  Perceived peer engagement in HIV-related sexual risk behaviors and self-reported risk-taking among female sex workers in Guangxi, China , 2013, AIDS care.

[8]  H. Bradley,et al.  Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia , 2013, BMC Public Health.

[9]  S. Moses,et al.  Degree and correlates of sexual mixing in female sex workers in Karnataka, India. , 2013, Sexual health.

[10]  J. Silverman,et al.  Individual, Interpersonal, and Social-Structural Correlates of Involuntary Sex Exchange Among Female Sex Workers in Two Mexico–U.S. Border Cities , 2013, Journal of acquired immune deficiency syndromes.

[11]  S. Bharat,et al.  Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India , 2013, PloS one.

[12]  Kimberly C. Brouwer,et al.  The longitudinal association of venue stability with consistent condom use among female sex workers in two Mexico–USA border cities , 2013, International journal of STD & AIDS.

[13]  Naeem Akhtar,et al.  The organisation, operational dynamics and structure of female sex work in Pakistan , 2013, Sexually Transmitted Infections.

[14]  T. Patterson,et al.  Reductions in HIV/STI Incidence and Sharing of Injection Equipment among Female Sex Workers Who Inject Drugs: Results from a Randomized Controlled Trial , 2013, PloS one.

[15]  L. Palinkas,et al.  "Eyes that don't see, heart that doesn't feel": coping with sex work in intimate relationships and its implications for HIV/STI prevention. , 2013, Social science & medicine.

[16]  R. Hayes,et al.  Condom use among female sex workers in Uganda , 2013, AIDS care.

[17]  T. Johnson,et al.  Sex work venue and condom use among female sex workers in Senggigi, Indonesia , 2013, Culture, health & sexuality.

[18]  M. Boily,et al.  Decline in the Prevalence of HIV and Sexually Transmitted Infections Among Female Sex Workers in Benin Over 15 Years of Targeted Interventions , 2013, Journal of acquired immune deficiency syndromes.

[19]  L. Palinkas,et al.  ‘Where sex ends and emotions begin’: love and HIV risk among female sex workers and their intimate, non-commercial partners along the Mexico-US border , 2013, Culture, health & sexuality.

[20]  T. Patterson,et al.  Venue-level correlates of female sex worker registration status: A multilevel analysis of bars in Tijuana, Mexico , 2013, Global public health.

[21]  C. Kennedy,et al.  Community Empowerment Among Female Sex Workers is an Effective HIV Prevention Intervention: A Systematic Review of the Peer-Reviewed Evidence from Low- and Middle-Income Countries , 2013, AIDS and Behavior.

[22]  S. Moses,et al.  Community mobilization, empowerment and HIV prevention among female sex workers in south India , 2013, BMC Public Health.

[23]  B. Stanton,et al.  Unprotected sex with their clients among low-paying female sex workers in southwest China , 2013, AIDS care.

[24]  J. Silverman,et al.  Situating HIV risk in the lives of formerly trafficked female sex workers on the Mexico–US border , 2013, AIDS care.

[25]  S. Moses,et al.  Violence and HIV Risk Among Female Sex Workers in Southern India , 2013, Sexually transmitted diseases.

[26]  J. Silverman,et al.  How does sex trafficking increase the risk of HIV Infection? An observational study from Southern India. , 2013, American journal of epidemiology.

[27]  R. DiClemente,et al.  Gender Based Violence as a Risk Factor for HIV-Associated Risk Behaviors Among Female Sex Workers in Armenia , 2013, AIDS and Behavior.

[28]  J. Silverman,et al.  Motherhood and HIV Risk Among Female Sex Workers in Andhra Pradesh, India: The Need to Consider Women’s Life Contexts , 2013, AIDS and Behavior.

[29]  S. Strathdee,et al.  Social and Structural Factors Associated with Consistent Condom Use Among Female Entertainment Workers Trading Sex in the Philippines , 2013, AIDS and Behavior.

[30]  T. Kochel,et al.  Violence as a Barrier for HIV Prevention among Female Sex Workers in Argentina , 2013, PloS one.

[31]  Xiaoming Li,et al.  Alcohol Use and Sexual Risks: Use of the Alcohol Use Disorders Identification Test (AUDIT) Among Female Sex Workers in China , 2013, Health care for women international.

[32]  C. Wachihi,et al.  Mucosal Serpin A1 and A3 Levels in HIV Highly Exposed Sero‐Negative Women are Affected by the Menstrual Cycle and Hormonal Contraceptives but are Independent of Epidemiological Confounders , 2013, American journal of reproductive immunology.

[33]  S. Loue,et al.  Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk , 2013, Women & health.

[34]  E. Coast,et al.  Transactional Sex Risk across a Typology of Rural and Urban Female Sex Workers in Indonesia: A Mixed Methods Study , 2012, PloS one.

[35]  B. Sartorius,et al.  Migration Status, Work Conditions and Health Utilization of Female Sex Workers in Three South African Cities , 2012, Journal of Immigrant and Minority Health.

[36]  M. Roger,et al.  Natural Immunity to HIV: A Delicate Balance between Strength and Control , 2012, Clinical & developmental immunology.

[37]  S. Strathdee,et al.  Sexual Risk Behaviors and HIV Among Female Sex Workers in Nigeria , 2012, Journal of acquired immune deficiency syndromes.

[38]  T. Patterson,et al.  Concurrent sexual partnerships among female sex workers and their non-commercial male partners in Tijuana and Ciudad Juárez, Mexico , 2012, Sexually Transmitted Infections.

[39]  Xiangsheng Chen,et al.  HIV prevalence varies between female sex workers from different types of venues in southern China. , 2012, Sexually transmitted diseases.

[40]  Adam Fletcher,et al.  Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers , 2012, Sexually Transmitted Infections.

[41]  J. Lau,et al.  Prevalence and associated factors of condom use during commercial sex by female sex workers who were or were not injecting drug users in China. , 2012, Sexual health.

[42]  S. Ramesh,et al.  Relationship between mobility, violence and HIV/STI among female sex workers in Andhra Pradesh, India , 2012, BMC Public Health.

[43]  J. H. van de Wijgert,et al.  Risk Factor Detection as a Metric of STARHS Performance for HIV Incidence Surveillance Among Female Sex Workers in Kigali, Rwanda , 2012, The open AIDS journal.

[44]  Tiantian Zheng,et al.  Occupational safety and HIV risk among female sex workers in China: A mixed-methods analysis of sex-work harms and mommies , 2012, Global public health.

[45]  T. Patterson,et al.  Mujer Mas Segura (Safer Women): a combination prevention intervention to reduce sexual and injection risks among female sex workers who inject drugs , 2012, BMC Public Health.

[46]  M. Shang,et al.  Social, psychological, and environmental-structural factors determine consistent condom use among rural-to-urban migrant female sex workers in Shanghai China , 2012, BMC Public Health.

[47]  A. Baschieri,et al.  Risk reduction and perceived collective efficacy and community support among female sex workers in Tamil Nadu and Maharashtra, India: the importance of context , 2012, Journal of Epidemiology & Community Health.

[48]  C. Beyrer,et al.  Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. , 2012, The Lancet. Infectious diseases.

[49]  J. Abbott,et al.  Negotiating safety and sexual risk reduction with clients in unsanctioned safer indoor sex work environments: a qualitative study. , 2012, American journal of public health.

[50]  Minxing Chen,et al.  HIV risk among female sex workers in Miami: The impact of violent victimization and untreated mental illness , 2012, AIDS care.

[51]  O. Levina,et al.  Clients of street-based female sex workers and potential bridging of HIV/STI in Russia: Results of a pilot study , 2012, AIDS care.

[52]  Xiaoming Li,et al.  Partner Violence and HIV Risk Among Female Sex Workers in China , 2012, AIDS and Behavior.

[53]  T. Patterson,et al.  Exploring the Impact of Underage Sex Work Among Female Sex Workers in Two Mexico–US Border Cities , 2012, AIDS and Behavior.

[54]  K. Blankenship,et al.  Trends in condom use among female sex workers in Andhra Pradesh, India: the impact of a community mobilisation intervention , 2012, Journal of Epidemiology & Community Health.

[55]  K. Blankenship,et al.  Migration/mobility and risk factors for HIV among female sex workers in Andhra Pradesh, India: implications for HIV prevention , 2012, International journal of STD & AIDS.

[56]  N. Saggurti,et al.  The Extent and Nature of Fluidity in Typologies of Female Sex Work in Southern India: Implications for HIV Prevention Programs , 2012, Journal of HIV/AIDS & social services.

[57]  J. Silverman,et al.  Condom Negotiations among Female Sex Workers in the Philippines: Environmental Influences , 2012, PloS one.

[58]  B. Moazen,et al.  Unprotected Sex with Injecting Drug Users among Iranian Female Sex Workers: Unhide HIV Risk Study , 2012, AIDS research and treatment.

[59]  Z. Bi,et al.  Condom use, intervention service utilization and HIV knowledge among female sex workers in China: results of three consecutive cross-sectional surveys in Shandong Province with historically low HIV prevalence , 2012, International journal of STD & AIDS.

[60]  T. Patterson,et al.  Study protocol for the recruitment of female sex workers and their non-commercial partners into couple-based HIV research , 2012, BMC Public Health.

[61]  S. Moses,et al.  Why do condoms break? A study of female sex workers in Bangalore, south India , 2012, Sexually Transmitted Infections.

[62]  C. Beyrer,et al.  Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers , 2012, Sexually Transmitted Infections.

[63]  R. Detels,et al.  Difference in Risk Behaviors and STD Prevalence Between Street-Based and Establishment-Based FSWs in Guangdong Province, China , 2012, AIDS and Behavior.

[64]  E. Roth,et al.  Partners and clients of female sex workers in an informal urban settlement in Nairobi, Kenya , 2012, Culture, health & sexuality.

[65]  S. Moses,et al.  Condom use within non-commercial partnerships of female sex workers in southern India , 2011, BMC public health.

[66]  T. Patterson,et al.  How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana, Mexico. , 2011, Health & place.

[67]  Rajendra Singh,et al.  Indicators of Mobility, Socio-Economic Vulnerabilities and HIV Risk Behaviours Among Mobile Female Sex Workers in India , 2011, AIDS and Behavior.

[68]  D. Morisky,et al.  A Multilevel Analysis of the Impact of Socio-Structural and Environmental Influences on Condom Use Among Female Sex Workers , 2011, AIDS and Behavior.

[69]  S. Aral,et al.  Overview: the role of emergent properties of complex systems in the epidemiology and prevention of sexually transmitted infections including HIV infection , 2010, Sexually Transmitted Infections.

[70]  S. Aral,et al.  Emergent properties and structural patterns in sexually transmitted infection and HIV research , 2010, Sexually Transmitted Infections.

[71]  S. Moses,et al.  Factors Associated With Numbers of Client Partners of Female Sex Workers Across Five Districts in South India , 2010, Sexually transmitted diseases.

[72]  Peter Vickerman,et al.  To what extent is the HIV epidemic in southern India driven by commercial sex? A modelling analysis , 2010, AIDS.

[73]  Dolores Albarracin,et al.  A Dynamic Social Systems Model for Considering Structural Factors in HIV Prevention and Detection , 2010, AIDS and Behavior.

[74]  Tara S. Beattie,et al.  Changes in risk behaviours and prevalence of sexually transmitted infections following HIV preventive interventions among female sex workers in five districts in Karnataka state, south India , 2010, Sexually Transmitted Infections.

[75]  Sandro Galea,et al.  Causal thinking and complex system approaches in epidemiology. , 2010, International journal of epidemiology.

[76]  N. Krieger.  Proximal, distal, and the politics of causation: what's level got to do with it? , 2008, American journal of public health.

[77]  S. Aral,et al.  Drivers of STD/HIV epidemiology and the timing and targets of STD/HIV prevention , 2007, Sexually Transmitted Infections.

[78]  Ana V Diez Roux,et al.  Multilevel analysis of infectious diseases. , 2005, The Journal of infectious diseases.

[79]  A. Ghani,et al.  Patterns of sex worker-client contacts and their implications for the persistence of sexually transmitted infections. , 2005, The Journal of infectious diseases.

[80]  T. Rhodes.  The ‘risk environment’: a framework for understanding and reducing drug-related harm , 2002 .

[81]  K. Blankenship,et al.  Structural interventions in public health , 2000, AIDS.

[82]  Myron S. Cohen,et al.  Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis , 1998, The Lancet.

[83]  W. Cao,et al.  Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China. , 2013, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[84]  M. Couture,et al.  Correlates of amphetamine-type stimulant use and associations with HIV-related risks among young women engaged in sex work in Phnom Penh, Cambodia. , 2012, Drug and alcohol dependence.

[85]  Xiaoming Li,et al.  HIV Testing Behaviors Among Female Sex Workers in Southwest China , 2011, AIDS and Behavior.

[86]  Raewyn Connell,et al.  Gender and Power: Society, the Person and Sexual Politics. , 1991 .