Women's Global Health Imperative, RTI International, Berkeley, California, USA.
Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Int AIDS Soc. 2022 Oct;25(10):e26028. doi: 10.1002/jia2.26028.
Young women who sell sex (YWSS) are at heightened risk of HIV acquisition and transmission and are among the least engaged in HIV services. There is insufficient epidemiologic evidence characterizing the burden of HIV among YWSS, particularly as compared to older WSS. These data are needed to design and tailor effective HIV prevention and treatment programmes for this population.
We conducted two parallel systematic reviews and meta-analyses to define both the immediate and long-term HIV risks for YWSS, including among women engaged in sex work, survival sex and transactional sex. In the first review, we identified and synthesized published studies of HIV incidence comparing estimates for cisgender women ≤24 years of age versus >24. In the second review, we identified and synthesized studies of HIV prevalence, comparing estimates for cisgender women who initiated selling sex <18 versus ≥18 years. In both reviews, we completed a search of four databases for articles in any language and any geographic area published from 1 January 1980 until 12 February 2021. Included articles were assessed for quality and a random effects model was used to calculate pooled effect estimates for each review.
We identified 12 studies for the HIV incidence review and 18 studies for the HIV prevalence review. In a meta-analysis, HIV incidence was elevated in younger (5.3 per 100 person-years [PY]; 95% confidence interval [CI]: 3.5, 7.1) compared to older women (2.8 per 100 PY; 95% CI: 1.7, 3.9), although CIs overlapped. HIV prevalence among those who initiated selling sex <18 years of age (28.8; 95% CI: 18.9, 38.7) was higher than those who initiated later (20.5; 95% CI: 12.4, 28.6).
These companion reviews offer an important perspective on the relative HIV risk of engaging in selling sex at a younger age. Our findings highlight the unique and intersectional challenges YWSS face, and the importance of ensuring that health services are tailored to meet their specific needs. Research and programming should routinely stratify data into meaningful age bands to differentiate and intervene within this population.
年轻女性性工作者（YWSS）感染艾滋病毒的风险更高，并且参与艾滋病毒服务的程度最低。目前，关于 YWSS 艾滋病毒负担的流行病学证据不足，尤其是与年长的性工作者相比。这些数据对于为该人群设计和定制有效的艾滋病毒预防和治疗方案是必要的。
我们进行了两项平行的系统评价和荟萃分析，以确定 YWSS 中的近期和长期艾滋病毒风险，包括从事性工作、生存性交易和交易性性交易的女性。在第一项综述中，我们确定并综合了比较 24 岁及以下和 >24 岁的顺性别女性艾滋病毒发病率的已发表研究。在第二项综述中，我们确定并综合了比较 18 岁以下和 >18 岁开始从事性交易的顺性别女性艾滋病毒流行率的研究。在这两项综述中，我们在四个数据库中搜索了从 1980 年 1 月 1 日至 2021 年 2 月 12 日发表的任何语言和任何地理区域的文章。纳入的文章进行了质量评估，并使用随机效应模型计算了每篇综述的汇总效应估计值。
我们确定了 12 项 HIV 发病率综述和 18 项 HIV 流行率综述的研究。在荟萃分析中，年轻女性（每 100 人年 5.3 例；95%置信区间[CI]：3.5，7.1）的 HIV 发病率高于年长女性（每 100 人年 2.8 例；95%CI：1.7，3.9），尽管 CI 有重叠。18 岁以下开始从事性交易的女性中 HIV 流行率（28.8%；95%CI：18.9，38.7）高于 18 岁以后开始从事性交易的女性（20.5%；95%CI：12.4，28.6）。
这两项配套综述提供了一个关于年轻时期从事性交易的相对艾滋病毒风险的重要视角。我们的研究结果突显了 YWSS 面临的独特和交叉挑战，以及确保卫生服务针对其特定需求进行调整的重要性。研究和规划应定期将数据分层到有意义的年龄组中，以区分和干预该人群。
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