Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions
File(s)
Accepted version
Accepted version
Author(s)
Type
Journal Article
Abstract
In the context of generalized human immunodeficiency virus (HIV) epidemics, there has been limited recent investment in HIV surveillance and prevention programming for key populations including female sex workers. Often implicit in the decision to limit investment in these epidemic settings are assumptions including that commercial sex is not significant to the sustained transmission of HIV, and HIV interventions designed to reach "all segments of society" will reach female sex workers and clients. Emerging empiric and model-based evidence is challenging these assumptions. This article highlights the frameworks and estimates used to characterize the role of sex work in HIV epidemics as well as the relevant empiric data landscape on sex work in generalized HIV epidemics and their strengths and limitations. Traditional approaches to estimate the contribution of sex work to HIV epidemics do not capture the potential for upstream and downstream sexual and vertical HIV transmission. Emerging approaches such as the transmission population attributable fraction from dynamic mathematical models can address this gap. To move forward, the HIV scientific community must begin by replacing assumptions about the epidemiology of generalized HIV epidemics with data and more appropriate methods of estimating the contribution of unprotected sex in the context of sex work.
Date Issued
2016-06-15
Date Acceptance
2016-06-03
Citation
Annals of Epidemiology, 2016, 26 (8), pp.557-569
ISSN
1873-2585
Publisher
Elsevier
Start Page
557
End Page
569
Journal / Book Title
Annals of Epidemiology
Volume
26
Issue
8
Copyright Statement
© 2016 Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
HIV
Generalized HIV epidemics
Sex work
Sub-Saharan Africa
Mathematical models
Population attributable fraction
Transactional sex
Key populations
West-Africa
Transmission model
Different regions
Potential impact
Epidemiology
Medical And Health Sciences
Publication Status
Published