Combination HIV Prevention For Female Sex Workers: What Is The Evidence?

March 2015 - Combination Prevention

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Bekker, L-G., Johnson, L., Cowan, F., et al. The Lancet (January 2015), Vol. 385, Number 9962, pp. 72 – 87.

The authors conducted a review of observational studies, randomized controlled trials, and consensus papers or program reports from implementing organizations, and a targeted web-based search of reports from the World Health Organization and the Joint UN Programme on HIV/AIDS, to identify new policy guidelines on female sex workers (FSWs) and the latest evidence on HIV prevention for this group. Behavioral and structural prevention strategies and sexual and reproductive health services for FSWs include condom distribution programs, counselling, testing, and supportive linkages to care. They found that programs for FSWs have reported more significant success in uptake and adoption of condoms than programs for any other affected population. The authors also noted that community-based programs, such as India's Sonagachi and Empower Thailand, are associated with both increased condom use and decreased HIV prevalence, not only among FSWs but also among bridge populations. Community-based programs are feasible to implement and take to scale; they are safe and are highly acceptable to FSWs. The authors stressed that new biomedical interventions, including topical and oral antiretroviral-based pre-exposure prophylaxis and earlier antiretroviral treatment as prevention, must be added to more established structural interventions such as law reform and protective policing. In addition, high levels of coverage and quality, and sustainability of services, are critical for maximizing the effect of structural interventions.

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