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Female sex workers in low- and middle-income countries are nearly 14 times more likely to become infected with HIV than other women in these countries, according to a literature review by US scientists.

The review was carried out by researchers at the Johns Hopkins Bloomberg School of Public Health and published in The Lancet Infectious Diseases journal (15 March). 

The authors analysed 102 previous studies representing almost 100,000 female sex workers in 50 developing countries. They found that in Asia, sex workers were 29 per cent more likely to be infected than other women in the region. In Africa and Latin America, sex workers were 12 times more likely to be infected than other women – and India, the female sex worker community was at a massive 50-fold higher risk of HIV infection than the rest of the country's female population.

India, along with Kenya and Brazil have, however, made some inroads into reducing infection levels among sex workers.

"We believe that these examples represent countries adopting necessary approaches," said Stefan Baral, the study's lead author.

Brazil's National STD/AIDS Programme works closely with sex workers to prevent new HIV infections. As well as running campaigns to promote prevention, Brazil offers free antiretroviral treatment.

"Because of their vulnerability, sex workers are a priority group, and we have projects specifically for them," Juny Kraiczyk of the Brazilian Ministry of Health told SciDev.Net.

"We act to strengthen sex workers' networks" and this involves "programmes of peer education and prevention in prostitution areas," he said, adding that such strategies had also helped reduce the stigma associated with the disease that would otherwise discourage women from coming forward for testing and treatment.

This need to destigmatise HIV infection led to Brazil turning down a US$40-million grant from the US Agency for International Development (USAID) in 2005 because it included a clause condemning prostitution.

"We work under the principle of not criminalising prostitution. We see these people as vulnerable, and not to be blamed for their increased risk. There are [other] factors, such as discrimination and poverty, which result in higher vulnerability for them," explained Kraiczyk.

The Lancet Infectious Diseases study found that in India, the country's Avahan and Sonagachi programmes have successfully tackled a range of structural challenges, through community empowerment, campaigns to address stigma, and the targeting of high-risk sexual practices with prevention messages.

"The disproportionate burden of HIV among sex workers … emphasises the need to increase coverage by increasing scale of prevention programmes and decreasing barriers to access," the study stated.

India is making the Avahan programme, which is funded by the Bill & Melinda Gates Foundation, a national initiative.

"Avahan has shared its approaches, tools, methods and strategies with the government, and many aspects have been incorporated into the national programme," Shelley Thakral, communications officer of the Bill & Melinda Gates Foundation in India, told SciDev.Net.

Link to abstract