title: Estimating the impact of reducing violence against female sex workers on HIV epidemics in Kenya and Ukraine: a policy modeling exercise.
abstract: OBJECTIVE
  Female sex workers (FSWs) worldwide suffer disproportionate burdens of HIV and gender-based violence. Despite evidence linking these threats, little is known about the potential HIV epidemic impact of reducing abuse.
  
  
  METHODS
  The Goals model approximated the impact of reducing violence against FSWs on HIV epidemics in Ukraine and Kenya, measured by reductions in new infections among FSWs and adults. Cumulative infections averted over a 5-year period, in which violence declined was calculated, relative to a status quo with no reduction. Projections held HIV interventions constant at baseline levels; subsequently, scenarios adjusted for planned expansion of antiretroviral therapy (ART) coverage.
  
  
  RESULTS
  An approximate 25% reduction in incident HIV infections among FSWs was observed when physical or sexual violence was reduced; cumulative infections averted were 21,200 and 4700 in Kenya and Ukraine, respectively. Similar percent reductions were observed assuming ART coverage expansion, with approximately 18,200 and 4400 infections averted among FSWs in Kenya and Ukraine. New infections were also averted in the general population.
  
  
  CONCLUSIONS
  Reducing violence against FSWs appears to impart significant reductions in new infections among FSWs and in the general adult population in both generalized and concentrated epidemics. Limitations provide direction to improve the precision of future estimates.
authors: Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. mdecker@jhsph.edu
authors: Michele R
authors: MR
authors: Decker
authors: Andrea L
authors: AL
authors: Wirtz
authors: Carel
authors: C
authors: Pretorius
authors: Susan G
authors: SG
authors: Sherman
authors: Michael D
authors: MD
authors: Sweat
authors: Stefan D
authors: SD
authors: Baral
authors: Chris
authors: C
authors: Beyrer
authors: Deanna L
authors: DL
authors: Kerrigan
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008962:Models, Theoretical; D011050:Policy Making; D012742:Sex Offenses / Q000517:prevention & control*; D060386:Sex Workers; D014455:Ukraine / Q000453:epidemiology