Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Dec 2;19(12):e0313868.
doi: 10.1371/journal.pone.0313868. eCollection 2024.

Prevalence and associated factors of HIV among female sex workers in Eastern and Southern Africa: Systematic review and meta-analysis

Tigabu Kidie Tesfie  1 , Getaneh Awoke Yismaw  1 , Bantie Getnet Yirsaw  1 , Habtamu Wagnew Abuhay  1 , Meron Asmamaw Alemayehu  1 , Nebiyu Mekonnen Derseh  1 , Gebrie Getu Alemu  1 , Muluken Chanie Agimas  1
Affiliations
Meta-Analysis

Prevalence and associated factors of HIV among female sex workers in Eastern and Southern Africa: Systematic review and meta-analysis

Tigabu Kidie Tesfie et al. PLoS One. .

Abstract

Background: Female sex workers (FSWs) are marginalized groups of the population who have limited access to healthcare and a higher risk of HIV infection due to biobehavioral and structural risk factors. Although it is known that the Eastern and Southern African region is affected by the highest HIV incidence and prevalence, understanding the burden among FSWs in the region remains limited. We aimed to assess the pooled prevalence and associated factors of HIV in this vulnerable population.

Methods: Relevant studies were searched on PubMed, Embase, Scopus, ScienceDirect, Hinari, African Journals Online (AJOL), Google, and Google Scholar. The searching mechanism was constructed using keywords identified by CoCoPop (Condition, Context, and Population) framework and medical subject heading terms to recruit studies published between January 1, 2015 and March 30, 2024. Observational studies that estimate the prevalence or incidence or associated factors of HIV among FSWs, even if FSWs were not the main focus of the study, were included. The quality of included studies was assessed using Joana Brigg's Institute checklist. Data were extracted and analyzed using STATA 17 software. To estimate the pooled effect sizes with their 95% confidence intervals, a random effect model was fitted. The I2 statistic was used to evaluate heterogeneity. Funnel plot and Egger's regression test were utilized to assess the small study effect. Publication bias was managed using trim-and-fill analysis. Subgroup and sensitivity analysis were considered to handle heterogeneity among studies.

Results: A total of 54 articles with 78,747 FSWs who had successful HIV biological test were included in the analysis. The pooled prevalence of HIV among FSWs in Eastern and Southern Africa was 36.0% (95% CI: 31.0%-41.0%). Regionally, the pooled prevalence was 59.0% (95% CI: 53.0%-64.0%) and 29.0% (95% CI: 25.0%-34.0%) in Southern and Eastern Africa, respectively. Age above 35 (POR = 7.35; 95% CI: 5.26, 10.28) and 25-34 years (POR = 2.91; 95% CI: 2.02, 4.21), being married (POR = 1.33; 95% CI: 1.07, 1.66), divorced (POR = 1.72; 95% CI: 1.39, 2.13), and widowed (POR = 2.70; 95% CI: 2.09, 3.49), primary education (POR = 1.29; 95% CI:1.08, 1.55), history of sexually transmitted infection (POR = 1.51; 95% CI: 1.20, 1.90), syphilis (POR = 2.57; 95% CI: 1.66, 3.98), Hepatitis B infection (POR = 2.60; 95% CI: 1.07,6.32), drinking alcohol (POR = 1.21; 95% CI: 1.01, 1.45) and injectable drug use before sex (POR = 1.75; 95% CI: 1.24, 2.47) were found significantly associated with the increased risk of HIV infection among FSWs.

Conclusion: These data suggest an urgent need to improve access to HIV prevention programs for FSWs. Providing behavioral interventions including reduction of alcohol and injectable drug use before sex, initiating tailored healthcare services, strengthening the psychosocial and legal support network, and fostering partnership might reduce the burden in the region. Clinicians could facilitate early detection and treatment of STIs, and Hepatitis B virus infection.

Trial registration: Protocol registration: The protocol for this systematic review and meta-analysis was registered in the PROSPERO with registration number CRD42024509200.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart describing identification, screening, and inclusion of articles for systematic review and meta-analysis on pooled prevalence and associated factors of HIV among female sex workers in Eastern and Southern Africa.
Fig 2
Fig 2. Forest plot for pooled prevalence of HIV among female sex workers in Eastern and Southern Africa.
Fig 3
Fig 3. Forest plot for pooled prevalence of HIV among female sex workers in Eastern and Southern Africa by publication year.
Fig 4
Fig 4. Forest plot for pooled prevalence of HIV among female sex workers in Eastern and Southern Africa by region.
Fig 5
Fig 5. Sensitivity analysis forest plot for pooled prevalence of HIV among female sex workers in Eastern and Southern Africa.
See this image and copyright information in PMC

References

    1. UNAIDS. Global HIV statistics fact sheet: World AIDS Day 2023. Geneva; 2023.
    1. Ochieng BO, Khagayi S, Otieno M, Were JA, Nyothach EA, Hawi S, et al. The long-term impact of HIV/AIDS on socio-economic status: a comparative analysis of households headed by HIV-positive and HIV-negative individuals in Western Kenya. AIDS care. 2023;35(8):1107–15. doi: 10.1080/09540121.2023.2214863 - DOI - PubMed
    1. Taraphdar P, Guha RT, Haldar D, Chatterjee A, Dasgupta A, Saha B, et al. Socioeconomic consequences of HIV/AIDS in the family system. Nigerian medical journal: journal of the Nigeria Medical Association. 2011;52(4):250–3. doi: 10.4103/0300-1652.93798 - DOI - PMC - PubMed
    1. Kumah E, Boakye DS, Boateng R, Agyei E. Advancing the Global Fight Against HIV/Aids: Strategies, Barriers, and the Road to Eradication. Annals of global health. 2023;89(1):83. doi: 10.5334/aogh.4277 - DOI - PMC - PubMed
    1. UNAIDS. Global HIV/AIDS Response: epidemic update and health sector progress towards universal access. Geneva: United Nations; 2011.