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Review
. 2014 Mar;9(2):174-82.
doi: 10.1097/COH.0000000000000042.

HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed

Kate Shannon  1 , Shira M Goldenberg, Kathleen N Deering, Steffaine A Strathdee
Affiliations
Review

HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed

Kate Shannon et al. Curr Opin HIV AIDS. 2014 Mar.

Abstract

Purpose of review: This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors.

Recent findings: Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work.

Summary: Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.

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Conflict of interest statement

CONFLICTS OF INTEREST

The views in this article are solely those of the authors and do not necessarily reflect the view of funding bodies. This work is partially supported by funding from the National Institutes of Health (R01DA028648 and R01DA033147), Canadian Institutes of Health Research and Michael Smith Foundation for Health Research.

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1. Structural HIV Determinants Framework
Conceptual Framework adapted from Blanchard and Aral [3,17], Connell [11], Diez Roux [5], Overs [7], Rhodes [6,9]. The framework consists of multilevel structural determinants, interpersonal and individual risks, organized with relative proximity to HIV transmission dynamics and acting iteratively and dynamically to produce HIV risks or protections among sex workers.
See this image and copyright information in PMC

References

    1. WHO. Guidelines: prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries. Geneva: World Health Organization; 2012. This WHO report, together with UNFPA, UNAIDS and NSWP, provides key evidence- based HIV/STI guidelines that call for the critical need to address structural factors, both risks and protections, alongside biomedical and behavioural interventions. - PubMed
    1. Baral S, Beyrer C, Muessig K, et al. Burden of HIV among female sex workers in low- income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:538–549. This systematic review and meta-analyses reveals the high burden of HIV among female sex workers compared to women of reproductive age, both in concentrated and generalized epidemic settings. - PubMed
    1. Blanchard JF, Aral SO. Emergent properties and structural patterns in sexually transmitted infection and HIV research. Sex Transm Infect. 2010;85(Suppl 3):iii4–iii9. - PubMed
    1. Blankenship KM, Bray S, Merson MH. Structural interventions in public health. AIDS. 2000;14(Suppl A):s11–s21. - PubMed
    1. Diez Roux AV, Aiello AE. Multilevel analysis of infectious diseases. J Infect Dis. 2005;191(Suppl 1):s25–s33. - PubMed

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