Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics(Article)(Open Access)
- aCenter for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- bDepartment of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, MD, United States
- cFutures Institute, Glastonbury, CT, United States
- dDepartment of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- eMedical University of South Carolina, Charleston, SC, United States
- fHIV and Key Populations, United Nations Population Fund, New York, NY, United States
- gHuman Development Network, World Bank, Washington, DC, United States
- hDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
Abstract
Introduction: Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented. Methods: We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant. Results: Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size. Discussion: A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings. © 2014 Wirtz et al.
Indexed keywords
| EMTREE drug terms: | antiretrovirus agent |
|---|---|
| EMTREE medical terms: | adultarticleBrazilcommunity carecommunity empowerment interventioncondom useepidemicfeasibility studyfemalehealth care accesshumanHuman immunodeficiency virus infectionhuman rightsinfection preventioninfection riskKenyamajor clinical studymathematical modelpathogen loadpopulation sizeprevalenceprostitutionrisk assessmentThailandUkrainebehaviordemographyEpidemicshighly active antiretroviral therapyHIV Infectionsincidenceprostitutionstatistics and numerical data |
| MeSH: | AdultAntiretroviral Therapy, Highly ActiveBehaviorBrazilEpidemicsFemaleHIV InfectionsHumansIncidenceKenyaPower (Psychology)Residence CharacteristicsSex WorkersThailandUkraine |
Funding details
| Funding sponsor | Funding number | Acronym |
|---|---|---|
| United Nations Population Fund | UNFPA |
-
1
The project was jointly conducted by Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights and the World Bank core team from the Health, Nutrition and Population Unit (HNP). We acknowledge and appreciate the work conducted by Laura Murray, Madeleine Schlefer, Susanne Stromdahl, and Olgashirin Kakayeva for their contribution to the systematic review. Futures Institute and the leadership of John Stover and Lori Bollinger are also thanked for their contribution of the updated Goals model and technical support during mathematical modeling analyses. We thank Sutayut Osornprasop, who contributed to the Thailand case study. Additional World Bank staff members who provided technical input throughout the project include F. Ayodeji Akala, Katie Bigmore, Marelize Gorgens, Jody Kusek and David Wilson. The team also thanks the following World Bank Staff for their expert and constructive criticism during the course of the parent project: Enias Baganizi, Daniel Cotlear, Eva Jarawan, Ajay Tandon, Damien de Walque. and Ethan Yeh. Thanks are also due to Nicole Klingen (Manager) and Cristian Baeza (Director) of HNP for their careful support and guidance. The work was undertaken in cooperation and with support from the United Nations Population Fund. We thank Ying Ru Lo (World Health Organization), Mariangela Simão (UNAIDS) and Clancy Broxton and Billy Pick (USAID) for their helpful technical inputs. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.
- ISSN: 19326203
- CODEN: POLNC
- Source Type: Journal
- Original language: English
- DOI: 10.1371/journal.pone.0088047
- PubMed ID: 24516580
- Document Type: Article
- Publisher: Public Library of Science
© Copyright 2014 Elsevier B.V., All rights reserved.
Cited by 44 documents
(2022) PLoS ONE
(2022) International Journal for Equity in Health
(2022) Archives of Sexual Behavior