Durban - Researchers say female sex workers that work on South African streets remain extraordinarily at risk of being infected by HIV.
They also emphasise the need to sustain and strengthen efforts to reduce risk and provide adequate care. This is according to a paper published in the Lancet HIV journal.
Researchers spread across six institutions: the University of Cape Town (UCT), University of the Witwatersrand, African Potential Consulting, Stellenbosch University, the South African Medical Research Council, and the National Institute for Communicable Diseases, published a new analysis of data gathered from the first national survey of female sex workers in South Africa accessible through sex worker programmes.
According to their survey of 100 female sex workers, between four and seven are highly expected to become infected within a year.
Dr Reshma Kassanjee of UCT’s Centre for Infectious Diseases Epidemiology and Research (CIDER), who is also the chief analyst and lead author of the paper, says, ideally, to measure infection rates, one would recruit people who are initially not infected, and then test them repeatedly and note how rapidly infections occur in this group.
She says one indirect way of extracting the same information at a single time would be to find out when people most recently tested negative for HIV and then see which and how many of these people now test positive.
“Interestingly, the estimate we obtained using this approach was much higher than the three mutually overlapping estimates we obtained from the three other methods of estimation we used. This inflation in the estimate is consistent with a possible social desirability bias in the reporting of recent previous negative tests.”
Dr Jenny Coetzee, principal investigator of the female sex worker study at the Perinatal HIV Research Unit, University of the Witwatersrand and African Potential Consulting, explains that their survey had numerous aims.
She says they had previously written about designing the study of female sex workers, HIV prevalence and the HIV cascade of care, experience of violence, mental health and access to health care – particularly treatment for HIV and pre-exposure prophylaxis services.
“This additional analysis grapples with the question of estimating HIV incidence, for which there is no obvious, straightforward approach in such a setting.
“This level of risk is despite broad gains in HIV programmes targeting the population and offering access to pre-exposure prophylaxis and rapid antiretroviral therapy initiation, emphasising the need to strengthen efforts across age groups. Clients of sex workers not only present the primary risk of infection to female sex workers but also bridge to the general population, and no programmes exist to target this key population in South Africa,” says Coetzee.