Beyrer, C., Crago, A-L., Bekker, L-G., et al. The Lancet (January 2015), Vol. 385, Number 9964, pp. 287 – 301.
The authors conducted a global analysis of studies on female sex workers (FSWs) and HIV among FSWs in low-, middle-, and high-income countries. They found that over half of HIV prevalence in sex workers was in sub-Saharan Africa. Data were limited for male sex workers; of 51 countries that provided the data for this issue, six reported HIV prevalence of more than 25 percent. Global data on the burden of HIV in transgender sex workers were also limited. However, the authors cited a meta-analysis of data from 14 countries which reported that transgender FSWs had a higher burden of HIV (27 percent) than other transgender women (15 percent) and male (15 percent) and female sex workers (5 percent). They called for action through structural measures, such as decriminalizing sex work and addressing stigma; behavioral and biomedical prevention interventions, such as condoms distribution, access to pre-exposure prophylaxis (PrEP), and interventions based on antiretroviral therapy; and rights-based approaches. They also summarized promising prevention strategies such as microbicides and oral PrEP, adding that more data are needed on efficacy, acceptability, adherence, and risk compensation for these interventions for these populations. They concluded by calling for appropriately tailored implementation of promising HIV interventions for sex workers, and for recognition of the diversity of sex workers and their environments.