Abstract
Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23% (95% confidence interval [CI] 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran.
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References
Abu-Raddad, L. J., Hilmi, N., Mumtaz, G., Benkirane, M., Akala, F. A., Riedner, G., & Wilson, D. (2010). Epidemiology of HIV infection in the Middle East and North Africa. AIDS,24(Suppl. 2), S5–S23. https://doi.org/10.1097/01.aids.0000386729.56683.33.
Azim, T., Bontell, I., & Strathdee, S. A. (2015). Women, drugs and HIV. International Journal of Drug Policy,26(Suppl. 1), S16–S21. https://doi.org/10.1016/j.drugpo.2014.09.003.
Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A. L., Decker, M. R., & Kerrigan, D. (2012). Burden of HIV among female sex workers in low-income and middle-income countries: A systematic review and meta-analysis. The Lancet Infectious Diseases,12(7), 538–549. https://doi.org/10.1016/S1473-3099(12)70066-X.
Beyrer, C., Crago, A.-L., Bekker, L.-G., Butler, J., Shannon, K., Kerrigan, D., & Wirtz, A. L. (2015). An action agenda for HIV and sex workers. The Lancet,385(9964), 287–301. https://doi.org/10.1016/S0140-6736(14)60933-8.
Borenstein, M., Hedges, L. V., Higgins, J., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods,1(2), 97–111. https://doi.org/10.1002/jrsm.12.
Bowring, A., Veronese, V., Doyle, J., Stoove, M., & Hellard, M. (2016). HIV and sexual risk among men who have sex with men and women in Asia: A systematic review and meta-analysis. AIDS and Behavior,20(10), 2243–2265. https://doi.org/10.1007/s10461-015-1281-x.
Chen, Y., Shen, Z., Morano, J. P., Khoshnood, K., Wu, Z., Lan, G., & Liu, W. (2015). Bridging the epidemic: A comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi province, China. PloS ONE,10(2), e0115311. https://doi.org/10.1371/journal.pone.0115311.
Darougar, S., Aramesh, B., & Gibson, J. A. (1983). Chlamydial genital infection in prostitutes in Iran. British Journal of Venereal Diseases,59(1), 53–55. https://doi.org/10.1136/sti.59.1.53.
Decker, M. R., Yam, E. A., Wirtz, A. L., Baral, S. D., Peryshkina, A., Mogilnyi, V., & Beyrer, C. (2013). Induced abortion, contraceptive use, and dual protection among female sex workers in Moscow, Russia. International Journal of Gynecology and Obstetrics,120(1), 27–31. https://doi.org/10.1016/j.ijgo.2012.07.026.
Fahimfar, N., Sedaghat, A., Hatami, H., Kamali, K., & Gooya, M. (2013). Counseling and harm reduction centers for vulnerable women to HIV/AIDS in Iran. Iranian Journal of Public Health,42(Suppl. 1), 98–104.
Gökengin, D., Doroudi, F., Tohme, J., Collins, B., & Madani, N. (2016). HIV/AIDS: Trends in the Middle East and North Africa region. International Journal of Infectious Diseases,44, 66–73. https://doi.org/10.1016/j.ijid.2015.11.008.
Haeri, S. (1992). Temporary marriage and the state in Iran: An Islamic discourse on female sexuality. Social Research,59(1), 201–223.
Hoefnagels, C., Hospers, H. J., Hosman, C., Schouten, L., & Schaalma, H. (2006). One measure, two motives. Prediction of condom use and interaction between two prevention goals among heterosexual young adults: Preventing pregnancy and/or sexually transmitted diseases. Prevention Science,7(4), 369–376. https://doi.org/10.1007/s11121-006-0048-z.
Iversen, J., Page, K., Madden, A., & Maher, L. (2015). HIV, HCV and health-related harms among women who inject drugs: Implications for prevention and treatment. Journal of Acquired Immune Deficiency Syndromes,69(1), S176. https://doi.org/10.1097/QAI.0000000000000659.
Jahani, M. R., Alavian, S. M., Shirzad, H., Kabir, A., & Hajarizadeh, B. (2005). Distribution and risk factors of hepatitis B, hepatitis C, and HIV infection in a female population with “illegal social behaviour”. Sexually Transmitted Infections,81(2), 185. https://doi.org/10.1136/sti.2004.011114.
Karamouzian, M., Foroozanfar, Z., Ahmadi, A., Haghdoost, A. A., Vogel, J., & Zolala, F. (2016a). How sex work becomes an option: Experiences of female sex workers in Kerman, Iran. Culture, Health and Sexuality,18(1), 58–70. https://doi.org/10.1080/13691058.2015.1059487.
Karamouzian, M., Haghdoost, A. A., & Sharifi, H. (2014a). Addressing the needs of sexual partners of people who inject drugs through peer prevention programs in Iran. International Journal of Health Policy and Management,2(2), 81–83. https://doi.org/10.15171/ijhpm.2014.19.
Karamouzian, M., Madani, N., Doroudi, F., & Haghdoost, A. A. (2017a). Improving the quality and quantity of HIV data in the Middle East and North Africa: Key challenges and ways forward. International Journal of Health Policy and Management,6(2), 65–69. https://doi.org/10.15171/ijhpm.2016.112.
Karamouzian, M., Madani, N., Doroudi, F., & Haghdoost, A. A. (2018). Tackling HIV in MENA: Talk is not enough—It is time for bold actions: A response to recent commentaries. International Journal of Health Policy and Management,7(2), 199–200. https://doi.org/10.15171/ijhpm.2017.110.
Karamouzian, M., Mirzazadeh, A., Rawat, A., Shokoohi, M., Haghdoost, A. A., Sedaghat, A., & Sharifi, H. (2017b). Injection drug use among female sex workers in Iran: Findings from a nationwide bio-behavioural survey. International Journal of Drug Policy,44, 86–91. https://doi.org/10.1016/j.drugpo.2017.03.011.
Karamouzian, M., Mirzazadeh, A., Shokoohi, M., Khajehkazemi, R., Sedaghat, A., Haghdoost, A. A., & Sharifi, H. (2016b). Lifetime abortion of female sex workers in Iran: Findings of a national bio-behavioural survey in 2010. PLoS ONE,11(11), e0166042. https://doi.org/10.1371/journal.pone.0166042.
Karamouzian, M., Nasirian, M., Sedaghat, A., & Haghdoost, A. A. (2014b). HIV in Iran. The Lancet,383(9922), 1040. https://doi.org/10.1016/S0140-6736(14)60518-3.
Kassaian, N., Ataei, B., Yaran, M., Babak, A., & Shoaei, P. (2011). Hepatitis B and C among women with illegal social behavior in Isfahan, Iran: Seroprevalence and associated factors. Hepatitis Monthly,11(5), 368–371.
Kassaian, N., Ataei, B., Yaran, M., Babak, A., Shoaei, P., & Ataie, M. (2012). HIV and other sexually transmitted infections in women with illegal social behavior in Isfahan, Iran. Advanced Biomedical Research,1(5), 1–4. https://doi.org/10.4103/2277-9175.94427.
Kayembe, P. K., Mapatano, M. A., Busangu, A. F., Nyandwe, J. K., Mashinda, D. K., Musema, G. M., & Mayala, G. M. (2008). Determinants of consistent condom use among female commercial sex workers in the Democratic Republic of Congo: Implications for interventions. Sexually Transmitted Infections,84(3), 202–206. https://doi.org/10.1136/sti.2007.028324.
Kazerooni, P. A., Motazedian, N., Motamedifar, M., Sayadi, M., Sabet, M., Lari, M. A., & Kamali, K. (2014). The prevalence of human immunodeficiency virus and sexually transmitted infections among female sex workers in Shiraz, South of Iran: By respondent-driven sampling. International Journal of STD and AIDS,25(2), 155–161. https://doi.org/10.1177/0956462413496227.
Larney, S., Mathers, B. M., Poteat, T., Kamarulzaman, A., & Degenhardt, L. (2015). Global epidemiology of HIV among women and girls who use or inject drugs: Current knowledge and limitations of existing data. Journal of Acquired Immune Deficiency Syndromes,69(Suppl. 2), S100. https://doi.org/10.1097/QAI.0000000000000623.
Li, Q., Li, X., & Stanton, B. (2010). Alcohol use among female sex workers and male clients: An integrative review of global literature. Alcohol and Alcoholism,45(2), 188–199. https://doi.org/10.1093/alcalc/agp095.
Mahapatra, B., Lowndes, C. M., Mohanty, S. K., Gurav, K., Ramesh, B. M., Moses, S., & Alary, M. (2013). Factors associated with risky sexual practices among female sex workers in Karnataka, India. PloS ONE,8(4), e62167. https://doi.org/10.1371/journal.pone.0062167.
Malta, M., Magnanini, M. M., Mello, M. B., Pascom, A. R. P., Linhares, Y., & Bastos, F. I. (2010). HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A systematic review and meta-analysis. BMC Public Health,10(1), 317. https://doi.org/10.1186/1471-2458-10-317.
Ministry of Health and Medical Education. (2015). Islamic Republic of Iran AIDS Progress Report. Retrieved January 15, 2019, from www.unaids.org/sites/default/files/country/documents/IRN_narrative_report_2015.pdf.
Mirzazadeh, A., Shokoohi, M., Khajehkazemi, R., Hosseini Hooshyar, S., Karamouzian, M., Nadji, S., … Haghdoost, A. A. (2016). HIV and Sexually Transmitted Infections Among Female Sex Workers in Iran: Findings From the 2010 and 2015 National Surveillance Surveys. Retrieved January 15, 2019, from www.programme.aids2016.org/Abstract/Index.
Moayedi-Nia, S., Bayat Jozani, Z., Esmaeeli Djavid, G., Entekhabi, F., Bayanolhagh, S., Saatian, M., & Mohraz, M. (2016). HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling. AIDS Care,28(4), 487–490. https://doi.org/10.1080/09540121.2015.1109582.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine,151(4), 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.
Munn, Z., Moola, S., Lisy, K., Riitano, D., & Tufanaru, C. (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. International Journal of Evidence-based Healthcare,13(3), 147–153. https://doi.org/10.1097/XEB.0000000000000054.
Nasirian, M., Kianersi, S., Hoseini, S. G., Kassaian, N., Yaran, M., Shoaei, P., & Jalilian, M. R. (2017). Prevalence of sexually transmitted infections and their risk factors among female sex workers in Isfahan, Iran: A cross-sectional study. Journal of the International Association of Providers of AIDS Care,16(6), 608–614. https://doi.org/10.1177/2325957417732836.
Navadeh, S., Mirzazadeh, A., Mousavi, L., Haghdoost, A., Fahimfar, N., & Sedaghat, A. (2012). HIV, HSV2 and syphilis prevalence in female sex workers in Kerman, south-east Iran; Using respondent-driven sampling. Iranian Journal of Public Health,41(12), 60–65.
Paz-Bailey, G., Noble, M., Salo, K., & Tregear, S. J. (2016). Prevalence of HIV among US female sex workers: Systematic review and meta-analysis. AIDS and Behavior,20(10), 2318–2331. https://doi.org/10.1007/s10461-016-1332-y.
Poon, A. N., Li, Z., Wang, N., & Hong, Y. (2011). Review of HIV and other sexually transmitted infections among female sex workers in China. AIDS Care,23(Suppl. 1), 5–25. https://doi.org/10.1080/09540121.2011.554519.
Rehm, J., Probst, C., Shield, K. D., & Shuper, P. A. (2017). Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect. Population Health Metrics,15(1), 4. https://doi.org/10.1186/s12963-017-0121-9.
Rostamzadeh, E., Rahim, R. A., & Mohseni, F. (2016). Historical background of prostitution and typology: A social-legal perspective. Mediterranean Journal of Social Sciences,7(5), 232–240. https://doi.org/10.5901/mjss.2016.v7n5p232.
Sajadi, L., Mirzazadeh, A., Navadeh, S., Osooli, M., Khajehkazemi, R., Gouya, M. M., … Haghdoost, A. A. (2013). HIV prevalence and related risk behaviours among female sex workers in Iran: Results of the national biobehavioural survey 2010. Sexually Transmitted Infections,89(Suppl. 3), iii37–iii40. https://doi.org/10.1136/sextrans-2013-051028.
Shahesmaeili, A., Karamouzian, M., Shokoohi, M., Kamali, K., Fahimfar, N., Nadji, A., & Mirzazadeh, A. (2018). Symptom-based versus laboratory-based diagnosis of five sexually transmitted infections in female sex workers in Iran. AIDS and Behavior,22(Suppl. 1), 19–25. https://doi.org/10.1007/s10461-018-2130-5.
Shannon, K., Strathdee, S. A., Goldenberg, S. M., Duff, P., Mwangi, P., Rusakova, M., & Pickles, M. R. (2015). Global epidemiology of HIV among female sex workers: Influence of structural determinants. The Lancet,385(9962), 55–71. https://doi.org/10.1016/S0140-6736(14)60931-4.
Sharifi, H., Karamouzian, M., Baneshi, M. R., Shokoohi, M., Haghdoost, A., McFarland, W., & Mirzazadeh, A. (2017). Population size estimation of female sex workers in Iran: Synthesis of methods and results. PloS ONE,12(8), e0182755. https://doi.org/10.1371/journal.pone.0182755.
Shokoohi, M., Karamouzian, M., Bauer, G., Sharifi, H., Hosseini, S., & Mirzazadeh, A. (2019). Drug use patterns and associated factors among female sex workers in Iran. Addictive Behaviors,90, 40–47. https://doi.org/10.1016/j.addbeh.2018.09.037.
Taghizadeh, H., Taghizadeh, F., Fathi, M., Reihani, P., Shirdel, N., & Rezaee, S. M. (2015). Drug use and high-risk sexual behaviors of women at a drop-in center in Mazandaran province, Iran, 2014. Iranian Journal of Psychiatry and Behavioral Sciences,9(2), e1047. https://doi.org/10.17795/ijpbs1047.
Todd, C. S., Alibayeva, G., Khakimov, M. M., Sanchez, J. L., Bautista, C. T., & Earhart, K. C. (2007). Prevalence and correlates of condom use and HIV testing among female sex workers in Tashkent, Uzbekistan: Implications for HIV transmission. AIDS and Behavior,11(3), 435–442. https://doi.org/10.1007/s10461-006-9155-x.
UNAIDS. (2018). Country Factsheet: Islamic Republic of Iran. Retrieved January 15, 2019, from www.unaids.org/en/regionscountries/countries/islamicrepublicofiran.
Vafaei, H., Asadi, N., Foroughinia, L., Salehi, A., Kuhnavard, S., Akbarzadeh, M., & Kasraeian, M. (2015). Comparison of abnormal cervical cytology from HIV positive women, female sex workers and general population. International Journal of Community Based Nursing and Midwifery,3(2), 76–83.
Wang, C., Hawes, S. E., Gaye, A., Sow, P. S., Ndoye, I., Manhart, L. E., & Kiviat, N. B. (2007). HIV prevalence, previous HIV testing, and condom use with clients and regular partners among Senegalese commercial sex workers. Sexually Transmitted Infections,83(7), 534–540. https://doi.org/10.1136/sti.2007.027151.
Xu, Y., Chen, X., & Wang, K. (2017). Global prevalence of hypertension among people living with HIV: A systematic review and meta-analysis. Journal of the American Society of Hypertension,11(8), 530–540. https://doi.org/10.1016/j.jash.2017.06.004.
Zirak-Zadah, T., Delavarian, H., Bahavar, M., Majidi, V., Yaminifar, R., & Masoumi, P. (1977). Penicillin-resistant strains of Neisseria gonorrhoeae in Shahre-Now. Tropical Doctor,7(2), 57–58. https://doi.org/10.1177/004947557700700204.
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Mohammad Karamouzian is supported by the Vanier Canada Graduate Scholarship (Vanier CGS) and the Pierre Elliott Trudeau Doctoral Scholarship.
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All authors contributed to the study conception and design. A literature search was performed by MK and SG. Data analysis was performed by MK, MN, and AM. The first draft of the manuscript was written by MK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Karamouzian, M., Nasirian, M., Ghaffari Hoseini, S. et al. HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis. Arch Sex Behav 49, 1923–1937 (2020). https://doi.org/10.1007/s10508-019-01574-0
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DOI: https://doi.org/10.1007/s10508-019-01574-0