The Global HIV Epidemics Among Sex Workers
Report by International Bank for Reconstruction and Development/The World Bank, 2013
Authors: Deanna Kerrigan, Andrea Wirtz, Stefan Baral, Michele Decker, Laura Murray,
Tonia Poteat, Carel Pretorius, Susan Sherman, Mike Sweat, Iris Semini,
N’Della N’Jie, Anderson Stanciole, Jenny Butler, Sutayut Osornprasop,
Robert Oelrichs, and Chris Beyrer
Key Policy Relevant Findings:
• HIV prevalence is significantly higher (13.5 times greater in pooled
analyses) across geographic settings among female sex workers than among
women in the general adult population. However service coverage levels
for HIV prevention services among sex workers are low (generally <50%).
HIV prevention services for male and transgender sex workers are almost
non-existent, as are programs for male clients.
• HIV incidence can be significantly reduced among sex workers and the
general population across settings by scaling up community empowermentbased, comprehensive HIV prevention services and earlier initiation of ART.
• Where sex worker rights organizations have partnered effectively with
government the response to HIV among sex workers has been particularly
effective and sustainable. This has meant prevention services which involve
significant sex worker leadership in their design and implementation and
which attend to structural barriers to safe sex.
• Empowerment-based, comprehensive HIV prevention among sex workers
is cost-effective, particularly in higher prevalence settings where it becomes
cost-saving. The cost per client for the intervention ranges from $102 to
$184, with Ukraine having the lowest and Brazil the highest cost per client.
Labor costs are the major expense, and account for the majority of variation
• Violence, stigma and discrimination against sex workers are extremely
prevalent. By reducing violence against sex workers, additional significant
HIV prevention gains in terms of new infections averted will also be
observed across settings. Addressing violence, stigma and discrimination
against sex workers is also a human rights imperative.
• There is a good justification based on the analyses presented herein to more
equitably allocate HIV prevention funding to interventions focused on sex
workers, such as the comprehensive community empowerment intervention.