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The burden of HIV infection among men who purchase sex in low- and middle-income countries – a systematic review and meta-analysis

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  • Luh Putu Lila Wulandari
  • Rebecca Guy
  • John Kaldor

Abstract

Background: Since the start of the HIV epidemic, transactional sexual relationships have been considered to present a high risk of HIV transmission to both the client and the person offering the sexual service. However, prevention research and programs have focused predominantly on sex workers rather than on their clients, who are generally men. To support effective and targeted interventions, we undertook a systematic review and meta-analysis of the evidence of the prevalence of HIV infection among men who purchase sex (MWPS) in low- and middle-income countries (LMICs), and the association between HIV infection and purchase of sex. Methods: We included articles that reported from LMICs on the prevalence of HIV in MWPS and those that reported on HIV prevalence among both MWPS and non-MWPS in the same study, or any information which allowed calculation of the prevalence. We defined MWPS as heterosexual males (not men who purchase sex or individuals of other sexual orientation) who purchased sex mostly from women (and not men), or who have had sexual contact with female sex workers (FSWs). We searched Medline, Global Health, Scopus, Embase and Cinahl for articles published up until 1 March 2020. Meta-analysis was conducted using a random effects model to estimate the pooled HIV prevalence and the relative risk (RR) of HIV infection associated with purchasing sex. Results: Of 34862 studies screened, we included 44 studies (59515 men, 47753 MWPS) from 21 countries. The pooled HIV prevalence among MWPS was 5% (95%CI: 4%-6%; I2 = 95.9%, p

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0238639
    DOI: 10.1371/journal.pone.0238639
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    References listed on IDEAS

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    1. 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.
    2. Aurelio Tobias, 1999. "Assessing the influence of a single study in the meta-anyalysis estimate," Stata Technical Bulletin, StataCorp LLC, vol. 8(47).
    3. 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.
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