What proportion of female sex workers practise anal intercourse and how frequently? A systematic review and meta-analysis
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Supporting information
Published version
Author(s)
Type
Journal Article
Abstract
HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers’ (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2–19.3%, N = 30, I 2 = 99%; past month: 16.2% 95%CI 10.8–21.6%, N = 18, I 2 = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7–36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1–83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
Date Issued
2020-03-01
Date Acceptance
2019-04-01
Citation
AIDS and Behavior, 2020, 24, pp.697-713
ISSN
1090-7165
Start Page
697
End Page
713
Journal / Book Title
AIDS and Behavior
Volume
24
Copyright Statement
© 2019 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Sponsor
National Institutes of Health
Medical Research Council (MRC)
Grant Number
5R01AI057020 Sub#201224310-05
MR/R015600/1
Subjects
Science & Technology
Social Sciences
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Social Sciences, Biomedical
Biomedical Social Sciences
Anal intercourse
Female sex workers
Sexual behaviour
HIV
SEXUALLY-TRANSMITTED INFECTIONS
HUMAN-IMMUNODEFICIENCY-VIRUS
HIV RISK BEHAVIOR
COMMERCIAL SEX
HEPATITIS-B
CONDOM USE
CHLAMYDIA-TRACHOMATIS
DRUG-USE
NEISSERIA-GONORRHOEAE
TRANSACTIONAL SEX
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
Anal intercourse
Female sex workers
HIV
Sexual behaviour
Public Health
1117 Public Health and Health Services
1607 Social Work
Publication Status
Published
Date Publish Online
2019-04-05