Systematic review of sex work interventions in sub-Saharan Africa: Examining combination prevention approaches

OBJECTIVE: The incidence of HIV and sexually transmitted infections is disproportionately high among sex workers (SW). We aimed to update the evidence on the effectiveness of SW interventions in sub-Saharan Africa and to provide more insights into combination prevention. METHODS: Systematic review following PRISMA guidelines in a search of PUBMED and POPLINE for peer-reviewed literature published between January 1, 2000 and July 22, 2016 (registration number on PROSPERO: CRD42016042529). We considered cohort interventions, randomized controlled trials, and cross-sectional surveys of SW programs. A framework was used in the description and mapping of intervention to desired outcomes. RESULTS: 26 papers (reporting on 25 studies) were included. A strategy that empowered peer educator leaders to steer community activities showed a twofold increase in coverage of behaviour change communication and utilization of health facility among SW. Brief alcohol harm reduction effort demonstrated a significant effect on sexual violence and engagement in sex trading. A risk reduction counselling intervention among drug-injecting SW showed an effect on alcohol, substance use and engagement in sex work. No study on a promising intervention like PrEP among SWs was found. We observed that interventions that combined some structural components, biomedical and behavioural strategies tend to accumulate more desired outcomes. CONCLUSION: The evidence base that can be considered in intervention designs to prevent HIV in SW in SSA is vast. The health sector should consider interventions to reduce binge alcohol intake and intravenous drug use among sex workers. Programs should staunchly consider multi-component approaches that explore community-based structural approaches. This article is protected by copyright. All rights reserved

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Sex workers
  • General HIV- population
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Sexual risk behaviour
  • Drug use behaviours/harm reduction
  • Biomedical interventions
  • Education/media campaigns