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Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis

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  • Catherine E Oldenburg
  • Amaya G Perez-Brumer
  • Sari L Reisner
  • Jason Mattie
  • Till Bärnighausen
  • Kenneth H Mayer
  • Matthew J Mimiaga

Abstract

Background: Men who engage in transactional sex, the exchange of sex for money, goods, or other items of value, are thought to be at increased risk of HIV, but there have been no systematic attempts to characterize HIV burden in this population. We undertook a systematic review and meta-analysis to quantify the burden in this population compared with that of men in the general population to better inform future HIV prevention efforts. Methods: We searched seven electronic databases, national surveillance reports, and conference abstracts for studies of men who engage in transactional sex published between 2004–2013. Random effects meta-analysis was used to determine pooled HIV prevalence and prevalence ratios (PR) for the difference in HIV prevalence among men who engage in transactional sex as compared to general population men. Findings: Of 66 studies included representing 31,924 men who had engaged in transactional sex in 28 countries, pooled biological assay-confirmed HIV prevalence was 10.5% (95% CI = 9.4 to 11.5%). The highest pooled HIV prevalence was in Sub-Saharan Africa (31.5%, 95% CI = 21.6 to 41.5%), followed by Latin America (19.3%, 95% CI = 15.5 to 23.1%), North America (16.6%, 95% CI = 3.7 to 29.5%), and Europe (12.2%, 95% CI = 6.0 to 17.2%). Men who engaged in transactional sex had an elevated burden of HIV compared to the general male population (PR = 20.7, 95% CI = 16.8 to 25.5). Conclusions: The global burden of HIV is disproportionately high among men who engage in transactional sex compared with the general male population. There is an urgent need to include this population in systematic surveillance as well as to scale-up access to quality HIV prevention programs.

Suggested Citation

  • Catherine E Oldenburg & Amaya G Perez-Brumer & Sari L Reisner & Jason Mattie & Till Bärnighausen & Kenneth H Mayer & Matthew J Mimiaga, 2014. "Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-1, July.
    • Handle: RePEc:plo:pone00:0103549
    DOI: 10.1371/journal.pone.0103549
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    References listed on IDEAS

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    1. Eric P F Chow & Ka I Iu & Xiaoxing Fu & David P Wilson & Lei Zhang, 2012. "HIV and Sexually Transmissible Infections among Money Boys in China: A Data Synthesis and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-16, November.
    2. Stefan Baral & Frangiscos Sifakis & Farley Cleghorn & Chris Beyrer, 2007. "Elevated Risk for HIV Infection among Men Who Have Sex with Men in Low- and Middle-Income Countries 2000–2006: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 4(12), pages 1-11, December.
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    1. Luh Putu Lila Wulandari & Rebecca Guy & John Kaldor, 2020. "The burden of HIV infection among men who purchase sex in low- and middle-income countries – a systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-23, September.

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