Long term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa

Article in BMC Public Health 2011, 11:700.


Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women.

Loss of follow-up among HIV infected female sex workers receiving antiretrovirals in Dakar, Senegal

Article in the Journal of AIDS and HIV Research Vol. 3(5), pp. 100-102, May 2011.

A better understanding of the significance and determinants of loss of follow-up and key potential related outcome measures, such as death and missed study visit would assist program evaluation and provide basis for future interventions. Senegal has one of Africa’s lowest HIV/AIDS infection rate, less than 1%. But vulnerable groups such as sex workers have higher HIV prevalence. Currently, HIV infection among legal sex workers in Dakar has risen to 27.1%, compared to 1% 20 years ago, (Fact sheet, 2004). The prostitution in Senegal has been regulated since 1969. Sex workers register at public health clinics like ours, where they receive photo identity cards and make monthly visits for medical checkups. However, many operate outside the system. We estimate that more than 80% of Senegal sex workers do not register. In a retrospective cohort analysis, loss of follow-rates and death were assessed among HIV infected female sex workers receiving antiretroviral drugs at the “Institute d'Hygiene Social” (IHS) of Dakar, Senegal. Records of 74 HIV infected female sex workers receiving antiretroviral treatment, and followed at the IHS from April 2001 to August 2008 were reviewed. Overall, 15 patients (20.3%) died and 42 (57%) were lost during an average follow-up period of 26 months (18.9). The mean age of patients was 46.6 years old (SD = 7.8) and the mean CD4 count at entry was 215 (SD = 68.6). Using Cox Regression models, we did not find a significant relationship between age, ethnicity, CD4 count at entry or HIV-1 vs. HIV-2 type and loss of follow-up. These findings indicate the need to obtain better longitudinal follow-up data for optimal assessment of the reasons for loss-of follow up among HIV infected female sex workers receiving ARV in Senegal.

(Abstract authors' own)

HIV treatment as prevention—it works

Article in the Lancet,  Volume 377, Issue 9779, Page 1719, 21 May 2011.

This article gives more detail on the recent trial of HIV treatment as a form of HIV prevention.

HIV Treatment reduces transmission by 96%

Woman offering HIV treatment

The news that people living wtih HIV who are on antiretoviral therapy will have a huge effect on HIV programming for sex workers. It  suggests that ARV therapy rather than condom promotion may account for the huge reduction in HIV transmissions during commercial sex over recent years.  It also raises the question of whether voluntary testing should be replaced by routine testing. What it definitely raises is the importance of free access to ARVs, nutrition and adherence support for all. 

Recognize sex work as legitimate work

sex worker rights demonstration

An article by Reynaga, E. in the HIV/AIDS Policy Law Review, 2008 Dec;13(2-3):97-8. It is accompanied by a PowerPoint presentation of Elena Reynaga's plenary address at the International AIDS Conference.

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