HIV and Related Risk Behaviors Among Female Sex Workers in Iran: Bias-Adjusted Estimates from the 2010 National Bio-Behavoral Survey
- 488 Downloads
In a national, facility-based survey of female sex workers in 14 cities of Iran (N = 872), HIV prevalence was measured at 4.5 % (95 % CI, 2.4–8.3) overall and at 11.2 % (95 % CI, 3.4–18.9) for FSW with a history of injection drug use. Using methods to correct for biases in reporting sensitive information, the estimate of unprotected sex in last act was 35.8 %, ever injecting drugs was 37.6 %, sexually transmitted disease symptoms was 82.1 %, and not testing for HIV in the last year was 64.0 %. The amount of bias correction ranged from <1 to >30 %, in parallel with the level of stigma associated with each behavior. Considering the current upward trajectory of HIV infection in the Middle East and North Africa region, as well as the ongoing high level of risky behaviors and considerable underreporting of many such behaviors in surveys, bias corrections may be needed, especially in the context of Iran, to obtain more accurate information to guide prevention and care responses to stop the growing HIV epidemic in this vulnerable group of women.
KeywordsFemale sex workers Behaviors HIV Iran Bias Middle East
The authors would like to give special thanks to the staff of the recruiting facilities for their assistance in implementing the survey. We recognize and are grateful to the Iranian HIV/AIDS National Office in the Center for Disease Control, Ministry of Health, for their technical assistance and financial support. This work (as a PhD thesis for AM) was supported jointly by HIV Research Trust (grant no. HIVRT11-052), Tehran University of Medical Sciences (grant no. 240/1626) and Regional Knowledge Hub for HIV/AIDS Surveillance WHO collaborating center based at Kerman University of Medical Sciences (grant no 90/122). Authors also received technical assistance, editorial input, and partial support through the University of California San Francisco from the following grants from the U.S. National Institutes of Health (NIH): Fogarty International Center (FIC) D43TW005799, National Institute for Mental Health (NIMH) P30 MH062246, R25MH064712, and the FIC AIDS International Training and Research Program (AITRP), D43TW000003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, NIMH or FIC.
- 1.UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2012. ISBN 978-92-9173-592-1. UNAIDS 2012.Google Scholar
- 5.Mirzazadeh A, Mansournia MA, Nedjat S, Navadeh S, McFarland W, Haghdoost AA, Mohammad K, et al. Bias analysis to improve monitoring an HIV epidemic and its response: approach and application to a survey of female sex workers in Iran. J Epidemiol Community Health. 2013;. doi: 10.1136/jech_2013_202521.PubMedGoogle Scholar
- 6.Mirzazadeh A. To compare classic and bayesian bias analysis methods to adjust the estimates of HIV sero-behavioral indicators in female sex workers survey conducted with non-probability sampling at health facility centers in Iran in 2010. PhD thesis, Tehran University of Medical Sciences, Tehran. 2011.Google Scholar
- 7.Ministry of Health; Center for Disease Control and Management, Regional Knowledge Hub for HIV/AIDS surveillance. HIV bio-behavioral surveillance survey (BBSS) among female sex workers I.R.Iran (2010)––Report in Farsi. Tehran E-published 2011.Google Scholar
- 9.Rothman K, Greenland S, Lash T, et al. Chapter 19––Bias analysis: modern epidemiology. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2008. p. 354–6.Google Scholar
- 11.Navadeh S, Mirzazadeh A, Mousavi L, Haghdoost A-A, Fahimfar N, Sedaghat A, et al. HIV, HSV2 and syphilis prevalence in female sex workers in Kerman, South-East Iran; using respondent-driven sampling. Iran J Publ Health. 2012;41(12):60–5.Google Scholar
- 13.UNAIDS. Middle East and North Africa; Regional report on AIDS. 2011.Google Scholar
- 17.Management MoHCfDCa. National HIV and AIDS case reporting surveillance––National Public Report in Farsi. Tehran (third quarter). 2012.Google Scholar