@article{47a9c039550c4be8bce48080534e0a2c,
title = "The role of sex work laws and stigmas in increasing HIV risks among sex workers",
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.",
author = "Lyons, {Carrie E.} and Schwartz, {Sheree R.} and Murray, {Sarah M.} and Kate Shannon and Daouda Diouf and Tampose Mothopeng and Seni Kouanda and Anato Simplice and Abo Kouame and Zandile Mnisi and Ubald Tamoufe and Nancy Phaswana-Mafuya and Bai Cham and Drame, {Fatou M.} and {Aliu Djal{\'o}}, Mamad{\'u} and Stefan Baral",
note = "Funding Information: We express our sincere appreciation to the participants of this study. In addition, we acknowledge the crucial role of the community groups that make great personal and professional sacrifices to serve the unmet health and advocacy needs of those most marginalized in the HIV response. We would also like to thank the data collection and study coordination teams across the different countries. The work was funded through USAID, PEPFAR, Global Fund to Fight AIDS, Tuberculosis and Malaria, and NIH. Work in Togo and Burkina Faso was supported by Project SEARCH, which was funded by the US Agency for International Development (USAID) under Contract GHH-I-00-07-00032-00 and by the President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR). Cameroon study was supported through the CHAMP project, which was led by CARE and funded by PEPFAR through USAID. Work in C{\^o}te d{\textquoteright}Ivoire was funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria through the Government of C{\^o}te d{\textquoteright}Ivoire National AIDS Control Program (PNPEC) contract to Enda Sant{\'e}, and subcontracted for technical assistance to Johns Hopkins University. Work in Guinea Bissau and The Gambia was funded through Global Fund to Fight AIDS, Tuberculosis and Malaria. Work in Senegal was funded through HIV Prevention 2.0 (HP2): Achieving an AIDS-Free Generation in Senegal and supported by the USAID under Cooperative Agreement No. AID-OAA-A-13-00089. Work in Lesotho was funded by USAID (AID-674-A-00-00001) and implemented by Population Services International/Lesotho (PSI). Work in eSwatini was funded by PEPFAR through the USAID Swaziland (GHH-I-00-07-00032-00). Work in South Africa was funded in part by a grant provided by the MAC AIDS Fund (grant No.GR-000001400). C.E.L.'s effort was supported by the Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program (5T32AI102623-08). S.B.'s effort was supported by the National Institute Of Mental Health of the National Institutes of Health under award number R01MH110358; and the National Institute Of Nursing Research of the National Institutes Of Health under award number R01NR016650. Publication was supported by The Foundation for AIDS Research (amfAR); the National Institute Of Mental Health of the National Institutes of Health under award number R01MH110358; the National Institute Of Nursing Research of the National Institutes Of Health under award number R01NR016650; The Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) project funded by PEPFAR and USAID and led by FHI360; and the CHAMP project. Finally, this publication was made possible by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2020, The Author(s).",
year = "2020",
month = dec,
day = "1",
doi = "10.1038/s41467-020-14593-6",
language = "English (US)",
volume = "11",
journal = "Nature communications",
issn = "2041-1723",
publisher = "Nature Publishing Group",
number = "1",
}