Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis
Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis
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DOI：
10.1016/s1473-3099(12)70066-x
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发表时间：
2012-07-01
影响因子：
56.3
通讯作者：
Kerrigan, Deanna
中科院分区：
文献类型：
--
作者：
Baral, Stefan;Beyrer, Chris;Kerrigan, Deanna
女性性工作者是一群因生物、行为和结构性风险因素而处于艾滋病毒感染高风险的人群。然而，在艾滋病毒流行三十年后，对这些妇女艾滋病毒负担的了解仍然有限。我们的目的是评估艾滋病毒在这一人群中的负担与其他育龄妇女相比。方法我们检索了PubMed，Embase，全球健康，SCOPUS，PsycINFO，社会学摘要，CINAHL（护理和相关健康文献累积索引），Web of Science和POP Line，用于2007年1月1日之间发表的低收入和中等收入国家女性性工作者的研究，2011年6月25日。任何旨在衡量女性性工作者中艾滋病毒流行率或发病率的研究，即使性工作者不是研究的主要重点，也包括在内。荟萃分析进行了与Mantel-Haenszel方法与随机效应模型的特点的优势比之间的女性性工作者的艾滋病病毒的患病率相比，为所有妇女的生殖年龄。结果434选定的文章和监测报告，102被列入分析，代表99878女性性工作者在50个国家。总体HIV患病率为11.8%（95% CI 11.6-12.0），HIV感染的合并优势比为13.5（95% CI 10.0-18.1），合并HIV患病率和HIV感染优势比的区域内范围较宽。在26个国家中，背景的艾滋病毒感染率，30.7%（95%CI 30.2-31.3; 8627的28 075）的性工作者是艾滋病毒阳性和感染的优势比为11.6（95%CI 9.1-14.8）。解释虽然数据表征艾滋病毒的风险在女性性工作者是稀缺的，疾病的负担是不成比例的高。这些数据表明，迫切需要扩大获得高质量艾滋病毒预防方案的机会。需要考虑性工作者开展业务的法律的和政策环境，并采取行动解决针对女性性工作者的污名化、歧视和暴力的重要作用。
Background Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age.Methods We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POP Line for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age.Findings Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99 878 female sex workers in 50 countries. The overall HIV prevalence was 11.8% (95% CI 11.6-12.0) with a pooled odds ratio for HIV infection of 13.5 (95% CI 10.0-18.1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30.7% (95% CI 30.2-31.3; 8627 of 28 075) of sex workers were HIV-positive and the odds ratio for infection was 11.6 (95% CI 9.1-14.8).Interpretation Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed.