Table 1.
Key characteristics of included studies, systematic review of HIV prevalence among female sex workers in the United States
| Location and reference |
Years of data collection |
HIV prevalence, n/N tested |
Study design and sampling strategy |
Eligibility criteria* | HIV testing method | Demographics | Proportion with any drug use, including injection drugs |
Setting and characteristics of sex work |
|---|---|---|---|---|---|---|---|---|
| Baltimore [8] |
1988-1989 | 28.4 % (60/ 211) |
Cohort study on the natural history of HIV infection among IDU. Convenience sample; recruitment was done via word-of-mouth within community service organizations. Participants were tested at baseline and periodically thereafter |
Participants were older than 17 years of age, had a history of injecting drugs within past 10 years, and did not have an AIDS-defining illness. Analyses done among baseline data for sub-group of women who exchanged sex for drugs in the past 10 years |
Serum specimens were tested with an IA (Genetic Systems, Seattle, WA) and WB confirmation (DuPont, Wilmington, DE) |
Age: NR, most under 35 years Race: 87 % African American |
100 % with history of injection drug use in past 10 years |
Duration of sex work: NR Condom use with clients and other partners: NR Number of sex partners: In 10 years prior to the interview: 31 % 1–49 partners (169/538), 8 % 50 or more partners (42/538) Setting were sex work occurred: NR Sexual practices traded: NR |
| Baltimore [18] |
2005-2007 | 13.6 % (17/ 125) |
Randomized controlled trial of HIV prevention intervention among high-risk individuals. Convenience sample; participants were recruited through advertisement and community and clinic referrals. Participants were followed over time |
Eligibility included: ages 18-55 years, no injection drug use in the past 6 months, sex with a man in past 6 months, and >1 sexual risk factor (>2 sex partners in past 6 months, STD diagnosis in past 6 months, or high-risk sex partner in past 90 days). Analyses done among baseline data for sub-group of women who reported one or more exchange partner in the past 90 days (N = 128) |
Oral specimens tested with Intercept, OraSure Technologies, Bethlehem, PA |
Median age: 41 years (range 37–7) Race: 98 % African American |
In past 6 months, 77 % crack/cocaine, 51 % heroin; 0 % reported injection drug use in past 6 months |
Duration of sex work: NR Condom use with clients and other partners: NR Number of sex partners: NR Setting were sex work occurred: NR Sexual practices traded: NR |
| California, Bay Area [49] |
1989-1990 | 7.7 % (14/ 182) |
Cross-sectional study to evaluate an AIDS prevention program for sex workers. Convenience sample. Field staff, many of whom were former sex workers, recruited current female sex workers as part of California Prostitutes' Education Project and Association for Women's AIDS Research an Education projects |
Eligibility criteria not reported | Serum specimens tested with unspecified tests |
Mean age: 30 years (SD 7) (range 18-50) Race: 74 % African American, 17 % White, 6 % Hispanic, 4 % other |
66 % with history of crack cocaine use; 39 % with history of injection drug use |
Duration of sex work: NR Condom use with clients: 54 % always, 40 % sometimes, 6 % never (out of 181) Condom use with regular partners: 5 % always, 20 % sometimes, 76 % never (out of 168 with regular partners) Number of sex partners: NR Setting were sex work occurred: 100 % street Sexual practices traded: NR |
| California, Northern [14] |
1996-1998 | 0.3 % (NR) | Cross-sectional study examining differences in health indicators among low income individuals. Single stage cluster population-based study in five counties in northern California in census block groups with median household incomes less than the 10th percentile for each of the five counties. Recruitment was door-to-door |
Women between 18 and 29 who spoke English or Spanish and resided in a low income neighborhood in the target area. Analyses done among sub-group of women who reported ever having exchanged sex (N = 226) |
Serum specimens tested using one of two IA (Organon Technika Corporation, Durham, NC or HIVAb HIV- 1 EIA, Abbott Laboratories, North Chicago, IL) and immunofluorescent antibody (IFA) confirmation (Waldheim Pharmazeutika GmbH, Vienna, Austria) with WB (Cambridge Biotech Corporation, Rockville, MD) to resolve any discrepancy. “Some” testing was performed using Orasure (Organon Teknika, Durham NC) during last two study months |
Median age: 26 years (range 18-30) Race: 67 % African American, 11 % Hispanic, 13 % White, 1 % Asian/ Pacific Islander |
In past 6 months, 65 % used marijuana, 37 % cocaine, 14 % speed, 11 % heroin; 20 % with history of injection drug use |
Duration of sex work: NR Condom use with clients and other partners: (at last vaginal sex) 66 % with new partner (95 % CI 49.6 to 81.5), 56% with casual partner (CI 42.3 to 69.4), 25 % with regular partner (CI 18.5-31.9) Median number of lifetime male sexual partners: 25 (range: 10-98) Setting were sex work occurred: NR Sexual practices traded: NR |
| California, San Francisco [44] |
1986-1987 | 9.9 % (7/71) |
Cross-sectional study to assess risk factors for HIV among drug users. Convenience sample; participants were recruited from community- based drug treatment programs |
Analyses done among sub- group of women with history of prostitution |
Serum specimens tested with an unspecified IA and WB confirmation |
NR | 100 % with history of injection drug use |
Duration of sex work: NR Condom use with clients and other partners: NR Number of sex partners: NR Setting were sex work occurred: NR Sexual practices traded: NR |
| Miami [50] | 1987-1990 | 21.7 % (132/607) |
Cross-sectional study to determine prevalence and incidence of HIV in women convicted of prostitution. Convenience sample; participants were tested under a mandatory testing program legislated by Florida statute |
Participants were tested under a mandatory testing program legislated by Florida statute |
Serum specimens tested with an unspecified IA and WB confirmation |
Race: 43 % White, mean age: 28 years; 44 % African American, mean age: 26 years; 10 % Hispanic, mean age: 30 years; 3 % other/NR, mean age NR |
NR | Duration of sex work: NR Condom use with clients and other partners: NR Number of sex partners: NR Setting were sex work occurred: NR Sexual practices traded: NR |
| Miami [33] | 2001-2004 | 20.8 % (156/750) |
Randomized controlled trial of HIV prevention intervention for drug-using female sex workers who solicited clients for exchange sex on targeted prostitution strolls. Participants were recruited through targeted sampling strategies including peer recruitment. 3 month and 6 month follow-up assessments were conducted |
Eligibility included: ages 18-50 years, heroin and/or cocaine use at least three times weekly in the past 30 days and sold sex at least 3 times in last 30 days. Analyses done among baseline data (N = 806) |
Serum specimens tested with unspecified tests |
Mean age: 37 years (SD 8) Race: 63 % African American, 19 % White, 15 % Hispanic, 3 % other |
100 % reported drug use in past 30 days |
Duration of sex work: NR Mean number of unprotected vaginal sex acts in past 30 days: 9.9 (SD 27.9); Mean number of unprotected oral sex acts in past 30 days: 10.9 (SD 35.4) Number of sex partners: NR Setting were sex work occurred: 100 % street Sexual practices traded: NR |
| Multiple [46] |
NR-1987 | 11.7 % (98/835) |
Multi-center cross-sectional study to determine the prevalence of HIV infection among female sex workers. Convenience sample; volunteers recruited through prisons (Los Angeles, Miami); sexually transmitted infection clinics (Colorado Springs, Las Vegas); methadone maintenance clinics (New Jersey); advertisement (Atlanta, San Francisco) |
Eligibility included: age at least 18 years, exchanged sex for money or drugs at least once since 1978 |
Serum specimens tested with an unspecified IA and WB confirmation |
NR | 50 % with history of injection drug use (of 568 interviewed) |
Duration of sex work: NR Condom use (not defined) with regular partners during vaginal sex: 16 %, condom use with clients during vaginal sex: 78 %, 4 % reported condom use with each vaginal exposure during past 5 years Number of sex partners: NR Setting were sex work occurred: NR Sexual practices traded: NR |
| Multiple [43] |
1991-1992 | 25 % (NR) |
Multi-center cross-sectional study among crack users to determine risk factors for HIV infection. Convenience sample; participants were recruited on the street in urban neighborhoods by outreach workers in Miami, San Francisco, and New York |
Eligible participants were ages 18-29 years. Analyses done among sub-group of women who reported exchanging sex for drugs or money in the previous 30 days (N = 337) |
Serum specimens tested with an unspecified IA and WB confirmation |
Ages: 35 % 18-24, 65 % 25-29 Race: 85 % African American, 12 % Hispanic, 3 % other |
100 % used drugs 3 or more days per week in the past 30 days 10 % reported injection drug use within past 30 days |
Duration of sex work: NR Consistent condom use with non-paying partner: 23 % vaginal sex (45/192), 11 % oral sex (12/105), 17 % anal sex (3/18), consistent condom use with paying partner: 46 % vaginal sex (150/329), 31 % oral sex (66/215), 53 % anal sex (9/17) Number of sex partners: NR Setting were sex work occurred: 41 % hotels, 18 % apartments without drugs, 12 % apartments with drugs, 10 % cars, 6 % vacant lots, 3 % crack houses, 3 % hallways Sexual practices traded: 98 % vaginal, 64 % oral, 5 % anal |
| New York City [41] |
1986-1987 | 1.3 % (1/78) |
Cross-sectional study evaluating HIV transmission among high- risk heterosexuals. Current female sex workers affiliated with escort services and massage parlors were recruited through snowball sampling |
Women were included if they had been performing sexual services for pay but had never solicited clients on the street |
Serum specimens tested with IA (Abbott Laboratories, North Chicago, IL) and WB confirmation (New York Blood Center, New York, NY) |
Mean age: 32 years (range 18-58) Race: 83 % White, 10 % African American, 4 % Asian, 3 % Hispanic |
8 % with history of injection drug use since January 1977 |
Duration of sex work: mean 5.1 years (range: 0.4-18.0 years) Currently (not defined) using condoms (82 %, 64/78), vaginal sex only (47 %, 37/78), oral sex only (0 %, 0/78), both oral and vaginal (32 %, 25/78) Number of sex partners: Mean number in past 12 months 256, median 200 Setting were sex work occurred: 100 % escort service or masseur agencies, never street Sexual practices traded: 100 % vaginal and oral sex |
| New York City [47] |
2010 | 17.0 % (NR) |
Cross-sectional study to monitor HIV risk behaviors, testing history exposure to and use of HIV prevention services and HIV prevalence among groups at high risk for HIV. Heterosexuals at high risk of HIV infection were recruited through respondent-driven sampling |
Eligibility included: ages 18-60 years, low income or low education, New York City residence, opposite-sex vaginal or anal sex in the past 12 months, and English or Spanish comprehension. Analyses done among sub- group of black women who reported exchange sex in the past 12 months (N = 53) |
Serum specimens tested with IA (Genetic Systems HIV-1/ HIV-2 Plus “O” EIA; Bio- Rad Laboratories, Hercules, CA) and WB confirmation (Genetic Systems; Bio-Rad Laboratories, Hercules, CA) |
Age: NR; Race: 100 % African American |
NR | Duration of sex work: NR Condom use with clients and other partners: NR Number of sex partners: NR Setting were sex work occurred: NR Sexual practices traded: NR |
| Puerto Rico [16] |
1984 | 16.3 % (13/80) |
Cross-sectional study conducted to evaluate the prevalence of sexually transmitted diseases in female sex workers. Sampling strategies were not described |
Researchers enrolled sex workers currently engaged in sex work (N = 171). Additional inclusion criteria not reported |
Serum specimens tested with IA (Abbott Laboratories, North Chicago, IL) and EIA confirmation (ENVACORE; Abbott Laboratories, North Chicago, IL) |
Mean age: 26 years (range 17–1) Race: NR |
NR | Duration of sex work: NR Condom use with clients and other partners: 14 % always used condoms (8/56), 73 % used condoms some of the time but not always (41/56) Number of sex partners: (each week) 21 % 1-5 partners (12/ 56), 66 % 6-10 partners (37/ 56), 9 % 21-30 partners (5/ 56), 4 % over 40 partners (2/ 56) Setting were sex work occurred: 100 % street or bar with room rental (n = 56) Sexual practices traded: 70 % oral sex, 18 % anal sex (n = 56) |
| Puerto Rico [45] |
1992-1994 | 32.1 % (35/109) |
Cross-sectional study to examine the association between sex workers' psychological status and their HIV serostatus and risk behaviors. Convenience sample; participants were recruited via outreach in brothels and street locations |
Females reported risk behaviors within last 6 months and researchers enrolled current sex workers (N = 127). Additional inclusion criteria not reported |
Serum tested with unspecified tests |
Mean age: 32 years (range 18-60) Race: NR |
47 % with history of injection drug use |
Duration of sex work: NR; Uses condom with sex: 39 % not always (46/118), always 61 % (72/118), uses condom with oral sex: not always 45 % (47/104), always 55 % (57/104) Number of sex partners: NR Setting were sex work occurred: 41 % brothel 59 % street Sexual practices traded: NR |
| Puerto Rico [42] |
1995 | 29.6 % (NR) |
Cross-sectional study to describe female sex workers. Convenience sample; participants were recruited through street outreach from low-income, urban neighborhoods with visible drug trafficking |
Eligibility included: females ages 18-34 years who identified current commercial sex work as a major source of their income. By study design, 50 % had to report current use of heroin or cocaine (N = 311) |
Serum tested with unspecified IA and WB confirmation |
Mean age: 28 years (range 19-39) Race: NR |
39 % with history of crack cocaine, 35 % history of powder cocaine, 61 % history of heroin, 56 % history of speedball 45 % with history of injection drug use |
Years active in sex work: 17 % <1,50 % 1-5, 18 % 6-10, 15 % 11 + Condom use with clients and other partners: NR Number of sex partners: NR Setting were sex work occurred: 68 % street, 8 % bars, 2 % drug-dealing site, 1 % brothel (out of 241) Sexual practices traded: NR |
IDU Injection drug user; IA immunoassay; WB western blot; NR not reported; CI confidence internal; SD standard deviation
*
Sample size provided if different from total number HIV tested