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

TLDR

HIV incidence is slowing globally, yet epidemics among sex workers remain stable or increasing, and laws governing sex work are considered structural determinants of HIV, though individual-level data on this relationship are scarce. The study uses individual-level data to assess how sex work laws and stigmas increase HIV risk among female sex workers and to examine the mechanisms across diverse legal contexts in sub‑Saharan Africa. Interviewer‑administered socio‑behavioral questionnaires and biological testing were collected from 7,259 female sex workers across 10 sub‑Saharan African countries between 2011 and 2018. The findings indicate that increasingly punitive and non‑protective laws are linked to higher HIV prevalence, and that stigma and sex work laws synergistically elevate HIV risk, highlighting the need for evidence‑based, human‑rights affirming policies in HIV responses.

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.