Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa.
Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with female sex workers between β across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
In , development and scaling up HIV prevention, diagnostic, and treatment strategies collectively have slowed new HIV infections globally, but not to the extent earlier models had predicted 1. In part, this may be due to stable or growing HIV incidence among marginalized populations including sex workers in many settings. Across concentrated and generalized HIV epidemics, female sex workers consistently bear a disproportionate burden of HIV compared with other cisgender women of reproductive age 3.
Across low- and middle-income countries, sex workers have more than a 13 times increased odds of living with HIV compared with other women 3. Available data of HIV prevalence among sex workers has increased, with a review finding data points from countries 2.
Incidence data remain limited, but where available, suggest continued challenges in the coverage of effective HIV prevention and treatment interventions for sex workers 2. Furthermore, emerging evidence suggests that the unmet HIV prevention and treatment needs within sex work significantly contributes to overall HIV transmission even within generalized epidemics 4.
