Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.

<h4>Introduction</h4>Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer...

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Autores principales:	Andrea L Wirtz, Carel Pretorius, Chris Beyrer, Stefan Baral, Michele R Decker, Susan G Sherman, Michael Sweat, Tonia Poteat, Jennifer Butler, Robert Oelrichs, Iris Semini, Deanna Kerrigan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8e1a6890e2ea40f792cc4142f3ad2da8
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spelling	oai:doaj.org-article:8e1a6890e2ea40f792cc4142f3ad2da82021-11-18T08:33:28ZEpidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.1932-620310.1371/journal.pone.0088047https://doaj.org/article/8e1a6890e2ea40f792cc4142f3ad2da82014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24516580/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented.<h4>Methods</h4>We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant.<h4>Results</h4>Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size.<h4>Discussion</h4>A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings.Andrea L WirtzCarel PretoriusChris BeyrerStefan BaralMichele R DeckerSusan G ShermanMichael SweatTonia PoteatJennifer ButlerRobert OelrichsIris SeminiDeanna KerriganPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 2, p e88047 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Andrea L Wirtz Carel Pretorius Chris Beyrer Stefan Baral Michele R Decker Susan G Sherman Michael Sweat Tonia Poteat Jennifer Butler Robert Oelrichs Iris Semini Deanna Kerrigan Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
description	<h4>Introduction</h4>Sex workers have endured a high burden of HIV infection in and across HIV epidemics. A comprehensive, community empowerment-based HIV prevention intervention emphasizes sex worker organization and mobilization to address HIV risk and often includes community-led peer education, condom distribution, and other activities. Meta-analysis of such interventions suggests a potential 51% reduction in inconsistent condom use. Mathematical modeling exercises provide theoretical insight into potential impacts of the intervention on HIV incidence and burden in settings where interventions have not yet been implemented.<h4>Methods</h4>We used a deterministic model, Goals, to project the impact on HIV infections when the community empowerment interventions were scaled up among female sex workers in Kenya, Thailand, Brazil, and Ukraine. Modeling scenarios included expansion of the comprehensive community empowerment-based HIV prevention intervention from baseline coverage over a 5-year period (5-65% in Kenya and Ukraine; 10-70% in Thailand and Brazil), while other interventions were held at baseline levels. A second exercise increased the intervention coverage simultaneously with equitable access to ART for sex workers. Impacts on HIV outcomes among sex workers and adults are observed from 2012-2016 and, compared to status quo when all interventions are held constant.<h4>Results</h4>Optimistic but feasible coverage (65%-70%) of the intervention demonstrated a range of impacts on HIV: 220 infections averted over 5 yrs. among sex workers in Thailand, 1,830 in Brazil, 2,220 in Ukraine, and 10,800 infections in Kenya. Impacts of the intervention for female sex workers extend to the adult population, cumulatively averting 730 infections in Thailand to 20,700 adult infections in Kenya. Impacts vary by country, influenced by HIV prevalence in risk groups, risk behaviors, intervention use, and population size.<h4>Discussion</h4>A community empowerment approach to HIV prevention and access to universal ART for female sex workers is a promising human rights-based solution to overcoming the persistent burden of HIV among female sex workers across epidemic settings.
format	article
author	Andrea L Wirtz Carel Pretorius Chris Beyrer Stefan Baral Michele R Decker Susan G Sherman Michael Sweat Tonia Poteat Jennifer Butler Robert Oelrichs Iris Semini Deanna Kerrigan
author_facet	Andrea L Wirtz Carel Pretorius Chris Beyrer Stefan Baral Michele R Decker Susan G Sherman Michael Sweat Tonia Poteat Jennifer Butler Robert Oelrichs Iris Semini Deanna Kerrigan
author_sort	Andrea L Wirtz
title	Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
title_short	Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
title_full	Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
title_fullStr	Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
title_full_unstemmed	Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.
title_sort	epidemic impacts of a community empowerment intervention for hiv prevention among female sex workers in generalized and concentrated epidemics.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/8e1a6890e2ea40f792cc4142f3ad2da8
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Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics.

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