Impact of violence on HIV outcomes among female sex workers: A global systematic review and meta-analysis.
Joshua Dawe, Khadimul Anam Mazhar, Saher Aijaz Khan et al.
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In 30 seconds
This global systematic review and meta-analysis examined associations between violence and HIV outcomes among female sex workers (FSW). It included 94 studies, 226 estimates and 186,613 FSWs across 39 countries. Violence exposure was associated with higher odds of prevalent HIV: pooled odds ratios were 1.31 (95% CI 1.16–1.48) for recent exposure and 1.35 (95% CI 1.23–1.48) for lifetime exposure. Recent violence was also associated with lower odds of ART use, while lifetime violence was associated with lower odds of viral suppression. No association was found with HIV incidence, testing or ART adherence.
Key findings
- Recent violence was associated with higher odds of prevalent HIV (pOR:1.31; 95% CI [1.16,1.48]; I2: 63%; n = 75 estimates).
- Lifetime violence was associated with higher odds of prevalent HIV (pOR:1.35; 95% CI [1.23,1.48]; I2: 39%; n = 68).
- Recent violence was associated with reduced odds of ART use (pOR:0.78; 95% CI [0.64,0.94]; I2: 8%; n = 17).
- Lifetime violence was associated with reduced odds of viral suppression (pOR:0.88; 95% CI [0.79,0.98]; I2: 20%; n = 6).
Why it matters
The findings link violence not only with prevalent HIV but also with poorer treatment outcomes among FSW. This supports attention to violence as a structural barrier when designing HIV prevention and care responses. The absence of detected associations for some outcomes also underscores that the relationship may differ across stages of the HIV care continuum.
What to keep in mind
Most included studies were cross-sectional, limiting causal interpretation. The authors also note heterogeneity in pooled estimates and difficulties measuring experiences of violence.