Cowan, F.M., Mtetwa, S., Davey, C., et al. PLOS One (October 213), Vol. 8 No. 10, p e77080.
As part of a national program for female sex workers (FSWs) established in 2009, the authors conducted a survey to estimate FSWs' HIV prevalence and use of HIV prevention, treatment, and care services at three sites in Zimbabwe. They found exceptionally high HIV prevalence and inadequate HIV service uptake among Zimbabwean FSWs. The study confirmed that FSWs are at an increased risk of HIV compared to the general population, and also revealed that they experience high rates of intimate partner violence, police harassment, and discrimination. Using respondent-driving sampling, the authors recruited 370, 237, and 229 FSWs in Mutare, Hwange, and Victoria Falls, respectively. The majority of FSWs (50 to 70 percent) were HIV-positive. Of most concern were FSWs with laboratory-confirmed HIV (finger prick blood samples were collected and tested as part of the study) but unaware of their status, either because they had never previously been tested or collected HIV test results before the study. In all three sites, these FSWs accounted for half of all HIV-positive participants. Further, the majority (62 to 74 percent) with confirmed HIV were not on antiretroviral therapy. Most HIV-negative FSWs were also unaware of their status. FSWs were more likely to report consistent condom use with commercial partners than with permanent partners. Interventions to increase Zimbabwean FSWs’ engagement with HIV services are critical to protect both FSWs and general public health.