Can targeted interventions on sex workers reduce HIV incidence?
This review has found a number of peer reviewed studies and grey literature on interventions targeted at sex workers for HIV prevention. Several were systematic reviews, some comprehensive reviews and policy papers. A number of individual studies focused on cost effectiveness are presented.
Two interventions in India are considered particularly effective and scalable interventions. A number of studies on these is presented. Both of these programmes focus on community mobilisation, and involve female sex workers (FSWs), as well as other key groups.
The key messages identified are:
- The evidence for the cost-effectiveness of FSW interventions is strong, particularly for areas with concentrated HIV epidemics, with an estimated average cost of $102 to $184 per participant. Cost analyses demonstrate the cost-effectiveness of scaling up HIV prevention and treatment among sex workers, particularly in higher prevalence settings where it becomes cost-saving.
- Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. Additionally, programmes should be holistic and complementary.
- HIV prevention strategies should target the social determinants of health and inequality. The literature on HIV interventions targeting FSWs underscores the inextricable connections between gender, political-legal, and economic structures on the vulnerability of FSWs and their susceptibility to HIV.
- Community empowerment is an essential approach, as is community participation and leadership.
- Ultimately, structural and legal changes that align public health and human rights are needed. In the short term, interventions targeted at sex workers could contribute to reducing HIV risk.
- Evidence is primarily available for interventions with FSWs.