HIV prevalence and correlates among male and transgender sex workers: an international meta-analytic review
Background: Previous studies on male sex workers (MSW) and male-to-female transgender sex workers (TSW) have reported significant health disparities, including high prevalence of HIV. Current research on MSW and TSW has been generally limited to small convenience samples in urban populations. In this study, published data on these samples were aggregated in order to utilize a meta-analytic approach assessing gender-specific, overall and regional HIV prevalence and correlates for these populations.
Methods: This review was initiated using standardized search terms between October and December 2007. Public search engines (e.g., PubMed, Google Scholar) were cross-referenced for the following domains: a) HIV/AIDS; b) prevalence; c) sex workers or prostitution; d) male or transgender. Sex work was defined as having ever received money, drugs, food, or shelter in exchange for sex. Studies were included in the meta-analysis if they were published in English, peer-reviewed, and reported HIV prevalence for MSW or TSW. Fisher´s exact testing was used to compare means of HIV prevalence between and among MSW and TSW. Multivariate logistic regression was used to analyze correlates of sex work.
Results: 55 independent studies, corresponding to 19 countries, met the search criteria. Data from these studies were collected from 1986-2004 and included serological results or self-reported HIV status for 14,800 MSW and 2,233 TSW. TSW experienced significantly higher HIV prevalence than MSW (33.5% vs. 7.1%, p<.001). South and North American TSW suffered the highest HIV prevalence. Gay-identified MSW experienced significantly higher HIV prevalence than non-gay-identified MSW (p<.001). Regional, sociodemographic, and risk-related correlates of MSW, TSW, and HIV prevalence will be discussed.
Conclusions: Over the last 20 years, MSW and TSW have had high HIV prevalence rates. TSW and gay-identified MSW have experienced significantly higher HIV prevalence than non-gay-identified MSW. The development and funding of targeted interventions is urgently needed for these populations, particularly for TSW in the Americas.
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