Background This study addresses the gap in our understanding of HIV epidemiology among female sex workers (FSWs) and clients in the Middle East and North Africa (MENA) region.
Methods An exhaustive systematic review of population-size estimation and of HIV prevalence studies was conducted. Findings were reported following PRISMA guidelines. The pooled mean HIV prevalence was estimated using random-effects meta-analyses. Associations with prevalence, sources of heterogeneity, and temporal trends were investigated using meta-regressions.
Results We identified 270 size-estimation studies in FSWs and 42 in clients, as well as 485 HIV prevalence studies on 287,719 FSWs, and 69 on 29,531 clients/proxy populations (male sexually transmitted infections clinic attendees). The median proportion of reproductive-age women reporting current/recent sex work was 0.7% (range=0.2–2.4%), and of men reporting currently/recently buying sex was 5.7% (range=0.3–13.8%). HIV prevalence ranged from 0-70% in FSWs (median=0.1%), and 0–34.6% in clients (median=0.4%). The regional pooled mean HIV prevalence was 1.4% (95% CI=1.1–1.8%) in FSWs and 0.4% (95% CI=0.1–0.7%) in clients. Country-specific pooled HIV prevalence in FSWs was <1% in most countries, 1–5% in North Africa and Somalia, 17.3% in South Sudan, and 17.9% in Djibouti. Meta-regressions identified strong subregional variations in prevalence, where compared to Eastern MENA, the adjusted odds ratios (AORs) ranged from 0.2 (95% CI=0.1–0.4) in Fertile Crescent to 46.3 (95% CI=25.9–82.6) in Horn of Africa. There was also strong evidence for increasing prevalence post-2003, at a rate of 14% per year (AOR=1.14, 95% CI=1.08–1.20).
Conclusion HIV epidemics among FSWs are emerging in MENA, with some already in an established phase, though still some countries have limited epidemic dynamics. The epidemic has been growing for over a decade, with strong regionalization and heterogeneity.
Disclosure No significant relationships.
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