Background: The lives of female sex workers (FSW) in the US are typically marked by violence and instability, traumatic life events, victimization, substance abuse, mental illness, and poverty. FSW are at high risk for acquiring and transmitting HIV and other STDs via inconsistent condom usage, sex with partners of unknown serostatus or concurrent partnerships with risky sexual partners, and injection drug or crack use. Little is known about estimates of HIV/STD among FSW in the US, but estimates of HIV range from 10.9% among 700 FSW in NYC jails to 22.4% among 536 drug-using FSW.
Methods: The purpose of this systematic review was to examine HIV/STD behavioral interventions conducted in the US and published between 1988 and 2012 that aimed to reduce sexual or drug-related risk behavior among US-based FSW in order to summarize important factors that have been addressed and highlight gaps for future research. Nineteen unique interventions met our selection criteria and were eligible for review: 5 interventions that exclusively targeted FSW, 2 interventions that stratified data by FSW, and 12 interventions that included at least 50% FSW.
Results: Our review indicated that 15 interventions provided HIV/STD prevention information and 13 provided substance abuse prevention information, but few tailored this content for issues facing FSW. Only four interventions addressed mental health, 1 addressed homelessness, and 2 addressed job training. The majority of included interventions were published over 10 years ago and only 2 have been identified by CDC as Evidence-Based Interventions.
Conclusions: These findings suggest that current HIV prevention efforts do not adequately address the needs of FSW in the US. Interventions may include a greater emphasis on structural and psychosocial factors, including mental health, recovery from victimization, and economic resources. An expansion of the definition of FSW is also considered.