Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

Mehrdad Khezri; Fatemeh Tavakoli; Azam Bazrafshan; Hamid Sharifi; Mostafa Shokoohi

doi:10.1097/JNC.0000000000000305

Condomless Sex With Partners and Clients Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

J Assoc Nurses AIDS Care. 2022 Jan-Feb;33(1):63-77. doi: 10.1097/JNC.0000000000000305.

Authors

Mehrdad Khezri¹, Fatemeh Tavakoli, Azam Bazrafshan, Hamid Sharifi, Mostafa Shokoohi

Affiliation

¹ Mehrdad Khezri, MSc, is a Research Assistant, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Fatemeh Tavakoli, MSc, is a Research Assistant, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Azam Bazrafshan, MSc, is a Research Assistant, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Hamid Sharifi, PhD, is a Professor, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Mostafa Shokoohi, PhD, is a Senior Methodologist, HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, and a Postdoctoral Fellow, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 34939989
DOI: 10.1097/JNC.0000000000000305

Abstract

Condomless sex is the most proximal risk for HIV acquisition among female sex workers (FSWs). We performed a systematic review and meta-analysis to summarize the evidence for the prevalence of condomless sex among FSWs in Iran. A random-effect meta-analysis model was used to pool the prevalence estimates and their 95% confidence intervals (CIs). The pooled prevalence of condomless sex at last sex with a paying client and a nonpaying partner was 34.23% (95% CI: 27.83-40.93) and 48.34 (95% CI: 38.43-58.32), respectively. Last-month inconsistent condom use was 49.01% (95% CI: 21.64-76.71) with paying clients and 60.21% (95% CI: 31.27-85.73) with nonpaying partners. The pooled prevalence of lifetime condom nonuse with any partners/clients was 15.26% (95% CI: 10.68-20.49). These findings indicate that a substantial proportion of FSWs engage in high-risk sexual practices. Community-led programs should be stimulated to improve consistent condom use among FSWs.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Condoms
Cross-Sectional Studies
Female
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Iran / epidemiology
Prevalence
Sex Workers*
Sexual Behavior
Sexual Partners
Unsafe Sex