HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis

  • Mohammad Karamouzian
  • Maryam NasirianEmail author
  • Shervin Ghaffari Hoseini
  • Ali Mirzazadeh
Original Paper


Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23% (95% confidence interval [CI] 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran.


Female Sex Workers Human Immunodeficiency Virus Sexually Transmitted Infections Meta-analysis Iran 



Mohammad Karamouzian is supported by the Vanier Canada Graduate Scholarship (Vanier CGS) and the Pierre Elliott Trudeau Doctoral Scholarship.

Author Contributions

All authors contributed to the study conception and design. A literature search was performed by MK and SG. Data analysis was performed by MK, MN, and AM. The first draft of the manuscript was written by MK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


Authors received no funding for conducting this study.

Compliance with Ethical Standards

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical Approval

This study used secondary data and no ethical approval was not required.

Informed Consent

Not Applicable (given the nature of the study).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mohammad Karamouzian
    • 1
    • 2
  • Maryam Nasirian
    • 3
    Email author
  • Shervin Ghaffari Hoseini
    • 4
  • Ali Mirzazadeh
    • 1
    • 5
  1. 1.HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
  2. 2.School of Population and Public Health, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.Biostatistics and Epidemiology Department, and Infectious Diseases and Tropical Medicine Research Center, School of Public HealthIsfahan University of Medical SciencesIsfahanIran
  4. 4.Cardiac Rehabilitation Research Center, Cardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
  5. 5.Department of Epidemiology and Biostatistics, Institute for Global Health SciencesUniversity of California San FranciscoSan FranciscoUSA

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