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HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed

Shannon, Katea,b; Goldenberg, Shira M.a,b; Deering, Kathleen N.a,b; Strathdee, Steffaine A.c

Current Opinion in HIV and AIDS: March 2014 - Volume 9 - Issue 2 - p 174–182
doi: 10.1097/COH.0000000000000042
EPIDEMIOLOGY: CONCENTRATED EPIDEMICS: Edited by Chris Beyrer, Stefan D. Baral, and Patrick S. Sullivan

Purpose of review This article reviews the current state of the epidemiological literature on female sex work and HIV from the past 18 months. We offer a conceptual framework for structural HIV determinants and sex work that unpacks intersecting structural, interpersonal, and individual biological and behavioural factors.

Recent findings Our review suggests that despite the heavy HIV burden among female sex workers (FSWs) globally, data on the structural determinants shaping HIV transmission dynamics have only begun to emerge. Emerging research suggests that factors operating at macrostructural (e.g., migration, stigma, criminalized laws), community organization (e.g., empowerment) and work environment levels (e.g., violence, policing, access to condoms HIV testing, HAART) act dynamically with interpersonal (e.g., dyad factors, sexual networks) and individual biological and behavioural factors to confer risks or protections for HIV transmission in female sex work.

Summary Future research should be guided by a Structural HIV Determinants Framework to better elucidate the complex and iterative effects of structural determinants with interpersonal and individual biological and behavioural factors on HIV transmission pathways among FSWs, and meet critical gaps in optimal access to HIV prevention, treatment, and care for FSWs globally.

aGender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS

bDepartment of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

cGlobal Health Sciences, University of California San Diego School of Medicine, San Diego, USA

Correspondence to Kate Shannon, PhD, Associate Professor of Medicine, University of British Columbia, Director, Gender and Sexual Health Initiative, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Tel: +1 604 806 9044; e-mail:

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