Prevalence of HIV infection among female sex workers in the Eastern Mediterranean Region countries: a systematic review

Introduction: Female sex workers (FSWs) are one of the groups most affected by human immunodeficiency virus (HIV) infection. In Eastern Mediterranean (EM) countries, HIV prevalence among FSWs is often extremely high. However, no review has been conducted on FSWs in EM countries. The purpose of this systematic review was to estimate the prevalence of HIV infection among FSWs in EM countries. Material and methods: Articles published on the prevalence of HIV infection among FSWs in EM countries were searched until September 10, 2020. Appropriate keywords were used in Web of Science, Scopus, PubMed, EMBASE, Ovid, and IMEMER databases. References of each paper and conference abstracts were additionally searched. Papers were selected according to inclusion and exclusion criteria. Results: In total, 21 studies were selected, which were performed in 8 EM countries. The reported prevalence of HIV infection ranged from 0 to 16% among FSWs. The average time women worked as FSWs ranged from 2 to 6 years, and in some papers, FSWs never or rarely used condoms during sexual contact. However, the consistency of using condoms among FSWs was reported as high as 65% in Pakistan, 64% in Lebanon, and 62% In Iran. The prevalence of drug use was high among FSWs, and it ranged from 5% in Pakistan and Sudan, to 91% in Iran and 96.2 % in Egypt. Heterogeneity among the studies and sub-groups was very high, and meta-analysis was not done due to high heterogeneity. Conclusions: The reported prevalence of HIV infection varied differently among female sex workers’ populations in the Eastern Mediterranean Region. More studies are needed from different EM countries.