title: HIV due to female sex work: regional and global estimates.
abstract: BACKGROUND
  Female sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse.
  
  
  METHODS
  Population attributable fractions of HIV prevalence due to female sex work were estimated for 2011. A systematic search was conducted to retrieve required input data from available sources. Data gaps of HIV prevalence in FSWs for 2011 were filled using multilevel modeling and multivariate linear regression. The fraction of HIV attributable to female sex work was estimated as the excess HIV burden in FSWs deducting the HIV burden in FSWs due to injecting drug use.
  
  
  RESULTS
  An estimated fifteen percent of HIV in the general female adult population is attributable to (unsafe) female sex work. The region with the highest attributable fraction is Sub Saharan Africa, but the burden is also substantial for the Caribbean, Latin America and South and Southeast Asia. We estimate 106,000 deaths from HIV are a result of female sex work globally, 98,000 of which occur in Sub-Saharan Africa. If HIV prevalence in other population groups originating from sexual contact with FSWs had been considered, the overall attributable burden would probably be much larger.
  
  
  CONCLUSIONS
  Female sex work is an important contributor to HIV transmission and the global HIV burden. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. These must be scaled up.
  
  
  CONCLUSIONS
  FSWs suffer from high HIV burden and are a crucial core population for HIV transmission. Surveillance, prevention and treatment of HIV in FSWs should benefit both this often neglected vulnerable group and the general population.
authors.affiliation: Department of Public Health and Environment, World Health Organization, Geneva, Switzerland. pruessa@who.int
authors.forename: Annette
authors.initials: A
authors.lastname: Prüss-Ustün
authors.forename: Jennyfer
authors.initials: J
authors.lastname: Wolf
authors.forename: Tim
authors.initials: T
authors.lastname: Driscoll
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Maria
authors.initials: M
authors.lastname: Neira
authors.forename: Jesus Maria Garcia
authors.initials: JM
authors.lastname: Calleja
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001210:Asia, Southeastern / Q000453:epidemiology; D017691:Caribbean Region / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D015999:Multivariate Analysis; D015995:Prevalence; D060386:Sex Workers; D055815:Young Adult