TY - JOUR
T1 - HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.
AU - Jones, Harriet S.
AU - Anderson, Rebecca L.
AU - Cust, Henry
AU - McClelland, R. Scott
AU - Richardson, Barbra A.
AU - Thirumurthy, Harsha
AU - Malama, Kalonde
AU - Hensen, Bernadette
AU - Platt, Lucy
AU - Rice, Brian
AU - Cowan, Frances
AU - Imai-Eaton, Jeffrey W.
AU - Hargreaves, James R.
AU - Stevens, Oliver
PY - 2024/8/1
Y1 - 2024/8/1
N2 - BackgroundWomen who engage in sex work (WESW) in sub-Saharan Africa (SSA) experience high risk of acquiring HIV infection. HIV incidence has declined among all women in SSA, but trends among WESW are poorly characterised. We synthesised data on HIV incidence among WESW in SSA and compared these to the female population to understand relative incidence levels and time trends.MethodsWe searched Medline, Embase, Global Health, and Google Scholar from January 1990 to February 2024, and grey literature for studies that reported empirical estimates of HIV incidence among WESW in any SSA country. We calculated incidence rate ratios (IRR) compared to age-district-year matched total female population incidence estimates, and conducted a meta-analysis of IRRs and used a continuous mixed-effects model to estimate changes in IRR over time.ResultsFrom 32 studies conducted between 1985 and 2020, 2,194 new HIV infections were observed among WESW over 51,490 person-years (py). Median HIV incidence was 4·3/100py (interquartile range: 2·8- 7·0/100py). Incidence among WESW was eight times higher than matched total population women (IRR 7·8, 95%CI: 5·1-11·8), with larger relative difference in Western and Central Africa (IRR 19·9, 95%CI: 9·6-41·0) than in Eastern and Southern Africa (IRR 4·9, 95%CI: 3·4–7·1). There was no evidence that IRRs changed over time (IRR per 5 years: 0·9, 95% CI: 0·6,1·3%).ConclusionsAcross sub-Saharan Africa, HIV incidence among WESW remains disproportionately high compared to the total female population. However, constant relative incidence over time indicates HIV incidence among WESW has declined at a similar rate. Location-specific data for WESW incidence are sparse, which improved surveillance and standardisation of incidence measurement approaches could fill. Sustained and enhanced HIV prevention for WESW is critical to address continuing inequalities and ensure declines in new HIV infections.
AB - BackgroundWomen who engage in sex work (WESW) in sub-Saharan Africa (SSA) experience high risk of acquiring HIV infection. HIV incidence has declined among all women in SSA, but trends among WESW are poorly characterised. We synthesised data on HIV incidence among WESW in SSA and compared these to the female population to understand relative incidence levels and time trends.MethodsWe searched Medline, Embase, Global Health, and Google Scholar from January 1990 to February 2024, and grey literature for studies that reported empirical estimates of HIV incidence among WESW in any SSA country. We calculated incidence rate ratios (IRR) compared to age-district-year matched total female population incidence estimates, and conducted a meta-analysis of IRRs and used a continuous mixed-effects model to estimate changes in IRR over time.ResultsFrom 32 studies conducted between 1985 and 2020, 2,194 new HIV infections were observed among WESW over 51,490 person-years (py). Median HIV incidence was 4·3/100py (interquartile range: 2·8- 7·0/100py). Incidence among WESW was eight times higher than matched total population women (IRR 7·8, 95%CI: 5·1-11·8), with larger relative difference in Western and Central Africa (IRR 19·9, 95%CI: 9·6-41·0) than in Eastern and Southern Africa (IRR 4·9, 95%CI: 3·4–7·1). There was no evidence that IRRs changed over time (IRR per 5 years: 0·9, 95% CI: 0·6,1·3%).ConclusionsAcross sub-Saharan Africa, HIV incidence among WESW remains disproportionately high compared to the total female population. However, constant relative incidence over time indicates HIV incidence among WESW has declined at a similar rate. Location-specific data for WESW incidence are sparse, which improved surveillance and standardisation of incidence measurement approaches could fill. Sustained and enhanced HIV prevention for WESW is critical to address continuing inequalities and ensure declines in new HIV infections.
U2 - 10.1016/s2214-109x(24)00227-4
DO - 10.1016/s2214-109x(24)00227-4
M3 - Article
SN - 2572-116X
VL - 12
SP - e1244-e1260
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 8
ER -
