| Female sex workers are at high risk for infection with HIV, and their
clients may act as a bridging population by spreading HIV to the general
population. Comprehensive HIV surveillance among sex workers includes surveillance
of HIV infection, of sexually transmitted infections and of risk behavior.
Surveillance of HIV infection among sex workers is critical for countries
with low-level or concentrated HIV epidemics, and can help in monitoring
the response to the HIV epidemic in countries with a generalized epidemic.
Sex workers are a vulnerable population, and particular attention needs
to be paid to human rights issues including consent, confidentiality and
stigma. Collaborations with key players in the local sex work scene--sex
workers themselves in the first place--and alliances with salient institutions
and groups are key to the success of surveillance among sex workers. Surveillance
activities should have a strong link to interventions targeted at sex workers.
Surveillance for HIV infection among sex workers can be institution- or
community-based. Institutional settings include screening programs for
registered sex workers, of sexually transmitted diseases clinics, and re-education
camps. Specific sources of bias need to be considered in different settings,
and must be measured--through the collection of socio-demographic and behavioral
data -- to allow a correct interpretation of prevalence data and time trends.
Community-based HIV infection surveillance can be conducted in a probability
sample of the sex worker population, thereby reducing selection bias. This
requires the mapping of sex workers' contact venues, and drawing a random
sample from the resulting sampling frame.
PMID: 11421180 [PubMed - indexed for MEDLINE]
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