SynthesisThe Lancet. Global health2024
HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.
Synthesis in The Lancet. Global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed.
- HIV Seroprevalence, Incidence, and Viral Suppression Among Ugandan Males with Bar or Sex Worker Partners: A Population-Based Study.AIDS and behavior · 2026Article
- HIV Seroprevalence, Incidence, and Viral Suppression Among Ugandan Female Bar Workers: A Population-Based Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Health inequities faced by sex workers.The Lancet. Public health · 2026Review
- Special Issue: New Horizons in HIV and Reproductive Health Research: HIV Acquisition and Reproductive Health in Key Populations.American journal of reproductive immunology (New York, N.Y. : 1989) · 2026Review
- Genital Immune Correlates of Seroprevalent and Seroincident Herpes Simplex Type 2 Infection Among Women Who Sell Sex in Nairobi, Kenya.American journal of reproductive immunology (New York, N.Y. : 1989) · 2026Article
- Associations Between Extreme Weather Events, Resource Insecurities, and HIV Vulnerabilities Among Adolescent Girls and Young Women in Kenya: Latent Profile Analysis Findings.AIDS and behavior · 2026Article
- Article
- Values and preferences of female sex workers in Zimbabwe for long-acting injectable pre-exposure prophylaxis and the dapivirine vaginal ring: results of a mixed-methods research study.BMJ global health · 2026Article
- Perceived Social Support, Contact Violence Experience, and Sexually Transmitted Infection Risk among Gambian Female Sex Workers: A LASSO-Guided, Causal Inference, and Multilevel Analysis.Journal of epidemiology and global health · 2026Article
- Impact and cost-effectiveness of the community-led AMETHIST intervention among female sex workers in Zimbabwe.Nature communications · 2025Article
- Decline in HIV prevalence among female sex workers in Zimbabwe between 2013 and 2023.Nature communications · 2025Article
- Electrospun Tenofovir/Emtricitabine-Zein Nanofibers for Pre-Exposure Prophylaxis Platform against HIV through Vaginal Delivery.ACS omega · 2025Article
- Effectiveness of the national HIV pre-exposure prophylaxis (PrEP) programme among female sex workers in Rwanda: a retrospective cohort study.Sexually transmitted infections · 2025Article
- The impact of cuts in the US President's Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study.The lancet. HIV · 2025Article
- Stakeholder Perspectives on a Community-Based Peer-Led Biomedical HIV Prevention Intervention for Women Who Engage in Sex Work in Southwestern Uganda: Results from a Qualitative Study.AIDS and behavior · 2025Article
- Syndemic Synergy of HPV, HIV, and HSV-2 for Oncogenic HPV Replication in Female Sex Workers.Tropical medicine and infectious disease · 2025Article
- Community leadership is key to effective HIV service engagement for female sex workers in Africa.Journal of the International AIDS Society · 2025Article
- Preventing HIV in women in Africa.Nature medicine · 2025Review
- Condomless sexual encounters among female sex workers included in a longitudinal coital diary study in Zimbabwe.BMC public health · 2025Article
- Recent infection testing to inform HIV prevention responses and surveillance in a programme context: lessons from implementation within a nationally scaled female sex worker programme in Zimbabwe.Journal of the International AIDS Society · 2024Article
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Abstract
backgroundWomen who engage in sex work in sub-Saharan Africa have a high risk of acquiring HIV infection. HIV incidence has declined among all women in sub-Saharan Africa, but trends among women who engage in sex work are poorly characterised. We synthesised data on HIV incidence among women who engage in sex work in sub-Saharan Africa and compared these with the total female population to understand relative incidence and trends over time.
methodsWe searched MEDLINE, Embase, Global Health, and Google Scholar from Jan 1, 1990, to Feb 28, 2024, and grey literature for studies that reported empirical estimates of HIV incidence among women who engage in sex work in any sub-Saharan Africa country. We calculated incidence rate ratios (IRRs) compared with total female population incidence estimates matched for age, district, and year, did a meta-analysis of IRRs, and used a continuous mixed-effects model to estimate changes in IRR over time.
findingsFrom 32 studies done between 1985 and 2020, 2194 new HIV infections were observed among women who engage in sex work over 51 490 person-years. Median HIV incidence was 4·3 per 100 person years (IQR 2·8-7·0 per 100 person-years). Incidence among women who engage in sex work was eight times higher than matched total population women (IRR 7·8 [95% CI 5·1-11·8]), with larger relative difference in western and central Africa (19·9 [9·6-41·0]) than in eastern and southern Africa (4·9 [3·4-7·1]). There was no evidence that IRRs changed over time (IRR per 5 years: 0·9 [0·7-1·2]).
interpretationAcross sub-Saharan Africa, HIV incidence among women who engage in sex work remains disproportionately high compared with the total female population. However, constant relative incidence over time indicates HIV incidence among women who engage in sex work has declined at a similar rate. Location-specific data for women who engage in sex work incidence are sparse, but improved surveillance and standardisation of incidence measurement approaches could fill these gaps. Sustained and enhanced HIV prevention for women who engage in sex work is crucial to address continuing inequalities and ensure declines in new HIV infections.
fundingBill & Melinda Gates Foundation, UK Research and Innovation, National Institutes of Health. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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