title: Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis.
abstract: BACKGROUND
  Men who engage in transactional sex, the exchange of sex for money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts.
  
  
  METHODS
  We searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional sex published between 2004-2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional sex as compared to general population men.
  
  
  RESULTS
  Of 66 studies included representing 31,924 men who had engaged in transactional sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5).
  
  
  CONCLUSIONS
  The global burden of HIV is disproportionately high among men who engage in transactional sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.
authors: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America; The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America.
authors: Catherine E
authors: CE
authors: Oldenburg
authors: Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, New York, United States of America.
authors: Amaya G
authors: AG
authors: Perez-Brumer
authors: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America; The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America.
authors: Sari L
authors: SL
authors: Reisner
authors: The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America.
authors: Jason
authors: J
authors: Mattie
authors: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America; Africa Centre for Health and Population Science, Mtubatuba, South Africa.
authors: Till
authors: T
authors: Bärnighausen
authors: The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America; Department of Medicine, Beth Israel Deaconess, Boston, Massachusetts, United States of America.
authors: Kenneth H
authors: KH
authors: Mayer
authors: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America; The Fenway Institute, Fenway Community Health, Boston, Massachusetts, United States of America; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors: Matthew J
authors: MJ
authors: Mimiaga
mesh_terms: D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D060386:Sex Workers / Q000706:statistics & numerical data*; D012747:Sexual Partners