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Identifying priority groups for pre-exposure prophylaxis among sex workers in Flanders, Belgium: insights into routine HIV and sexually transmitted infection data in community-based clinics
  1. Heleen Van Mieghem1,
  2. Christiana Nöstlinger1,
  3. Tom Smekens1,
  4. Anne-Sophie De Cannière2,
  5. Kris Keersmaekers3,
  6. Gert Scheerder1,
  7. Irith De Baetselier4,
  8. Bea Vuylsteke1
  1. 1 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  2. 2 Violett Ghent, Ghent, Belgium
  3. 3 Violett Antwerp, Antwerp, Belgium
  4. 4 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
  1. Correspondence to Dr Bea Vuylsteke, Public Health, Institute of Tropical Medicine, Antwerpen, Belgium; bvuylsteke.itg2{at}


Objectives The burden of HIV and other sexually transmitted infections (STIs) remains high in sex workers globally, calling for strengthening targeted prevention strategies, including HIV pre-exposure prophylaxis (PrEP). The study’s objective was to assess HIV and STI burden among female, male and transgender sex workers in Flanders, Belgium, to guide targeting of PrEP strategies for sex workers.

Methods We conducted a retrospective analysis of routine data collected between January 2016 and December 2019 by community-based organisations providing sexual healthcare services for sex workers in Flanders. HIV prevalence stratified by gender was assessed and associations with sociodemographic characteristics were explored using bivariable and multivariable logistic regression. Positivity rates of chlamydia, gonorrhoea and syphilis tests were used as proxy indicators for STI burden.

Results The study included a total of 6028 sex workers, comprising 5617 (93.2%) female, 218 (3.6%) male and 193 (3.2%) transgender sex workers. The HIV prevalence was 0.3% among female, 8.9% among male and 12.3% among transgender sex workers. Engaging in escort sex work and originating from South America or Sub-Saharan Africa were associated with a higher likelihood of having acquired HIV. The positivity rate for gonorrhoea was higher among male sex workers (5.2% vs 2.2%) and syphilis was more frequently detected among male and transgender sex workers (3.0% and 6.1% vs 0.5%), all compared with female sex workers.

Conclusions HIV combination prevention, including improved access to PrEP, should be strengthened among sex workers in Flanders, with particular attention to male and transgender sex workers.

  • HIV
  • Transgender
  • Sex Work

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Planning, data extraction and initial analysis: HVM; statistical analysis: TS; first draft manuscript: HVM, CN, A-SDC, KK, GS, IDB, BV; revision of manuscript: all authors; overall content: HVM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.