The role of sex work laws and stigmas in increasing HIV risks among sex workers

Carrie E. Lyons (), Sheree R. Schwartz, Sarah M. Murray, Kate Shannon, Daouda Diouf, Tampose Mothopeng, Seni Kouanda, Anato Simplice, Abo Kouame, Zandile Mnisi, Ubald Tamoufe, Nancy Phaswana-Mafuya, Bai Cham, Fatou M. Drame, Mamadú Aliu Djaló and Stefan Baral
Additional contact information
Carrie E. Lyons: Johns Hopkins School of Public Health
Sheree R. Schwartz: Johns Hopkins School of Public Health
Sarah M. Murray: Johns Hopkins School of Public Health
Kate Shannon: University of British Columbia
Daouda Diouf: Enda Santé, Senegal
Tampose Mothopeng: People’s Matrix Association
Seni Kouanda: Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique
Anato Simplice: ONG Arc-en-Ciel, B.P.
Abo Kouame: Ministère de la Sante et de l’Hygiène Publique
Zandile Mnisi: Ministry of Health
Ubald Tamoufe: Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP
Nancy Phaswana-Mafuya: North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom
Bai Cham: Actionaid, Banjul The Gambia
Fatou M. Drame: Enda Santé, Senegal
Mamadú Aliu Djaló: Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n
Stefan Baral: Johns Hopkins School of Public Health

Nature Communications, 2020, vol. 11, issue 1, 1-10

Abstract: Abstract Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011–2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.

Date: 2020
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DOI: 10.1038/s41467-020-14593-6

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