Background: MSM, IDU and SW have been identified as being disproportionately affected by HIV, yet few South African research and intervention strategies explore, or cater for, their needs. A synthesized evaluation of the evidence pertaining to these populations is needed to inform policy, programming and future research.
Methods: We conducted a review of published data on MSM, IDU, SW and HIV in South Africa from peer-reviewed journals, grey-literature databases, the internet, conference proceedings, reference lists and data requests from researchers and lead agencies. The data analysis framework explored data by source, study type, findings, implications, limitations and recommendations.
Results: Overall 116 articles were analyzed (47 MSM, 48 SW, 21 IDU) around data pertaining to HIV prevalence and factors associated with vulnerability to HIV. HIV prevalence ranged between 10% – 40% among MSM; 20% – 35% among IDU and 45% – 60% among SW. Structural factors increasing vulnerability to HIV included legal and policy frameworks which limit access to health and criminal justice systems and gender and socio-economic inequality. Social factors increasing vulnerability and risk included stigma, power disparities, culture and violence. Individual risk factors included risky sexual practices, low levels of education, inaccessible health and criminal justice services, discrimination, substance use and mental health issues.
Conclusions: Data show high HIV prevalence among MSM, IDU and SW. Vulnerability to HIV is influenced by structural, social and individual factors. Legal reform needs to facilitate the criminalization of hate crimes and decriminalization of sex work. Policy is required to ensure access to health and justice systems and for the provision of evidence-based drug treatment programmes. A country-wide baseline survey among MSM, IDU and SW would build on initial epidemiological and qualitative data and inform the development of appropriate intervention strategies and form the baseline for monitoring their impact.
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