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Community Empowerment Among Female Sex Workers is an Effective HIV Prevention Intervention: A Systematic Review of the Peer-Reviewed Evidence from Low- and Middle-Income Countries

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We conducted a systematic review and meta-analysis of community empowerment interventions for HIV prevention among sex workers in low- and middle-income countries from 1990–2010. Two coders abstracted data using standardized forms. Of 6,664 citations screened, ten studies met inclusion criteria. For HIV infection, two observational studies showed a significantly protective combined effect [odds ratio (OR): 0.84, 95 % confidence interval (CI): 0.709–0.988]. For STI infection, one longitudinal study showed reduced gonorrhoea/chlamydia (OR: 0.51, 95 % CI: 0.26–0.99). Observational studies showed reduced gonorrhoea (OR: 0.65, 95 % CI: 0.47–0.90), but non-significant effects on chlamydia and syphilis. For condom use, one randomized controlled trial showed improvements with clients (ß: 0.3447, p = 0.002). One longitudinal study showed improvements with regular clients (OR: 1.9, 95 % CI: 1.1–3.3), but no change with new clients. Observational studies showed improvements with new clients (OR: 3.04, 95 % CI: 1.29–7.17), regular clients (OR: 2.20, 95 % CI: 1.41–3.42), and all clients (OR: 5.87, 95 % CI: 2.88–11.94), but not regular non-paying partners. Overall, community empowerment-based HIV prevention was associated with significant improvements across HIV outcomes and settings.


Conducimos una revisión sistemática y meta-análisis de las intervenciones de empoderamiento comunitario entre trabajadoras sexuales de países de bajo y medio-bajo ingreso a través de una búsqueda de bases de datos entre 1990–2010. Dos codificadores usaron formularios estandarizados. De los 6.664 citaciones revisados, 10 estudios llenaron los criterios de inclusión. Para infección de VIH, dos estudios observacionales mostraron un efecto protector significante combinado (OR: 0.84, 95 % CI: 0.709–0.988). Para las ITS, un estudio longitudinal mostro reducciones en gonorrea e clamidia (OR: 0.51, 95 % CI: 0.26–0.99). Un estudio observacional mostro reducciones en gonorrea pero efectos no significativos para clamidia y sífilis. Para el uso de condón, un RCT mostro mejoramientos con clientes en general (ß: 0.3447, p = 0.002). Un estudio longitudinal mostro mejoramientos con clientes regulares (OR: 1.9, 95 % CI: 1.1–3.3), pero no con clientes nuevos. Estudios observacionales mostraron mejoramientos con clientes nuevos (OR: 3.04, 95 % CI: 1.29–7.17), clientes regulares (OR: 2.20, 95 % CI: 1.41–3.42), y clientes en general (OR: 5.87, 95 % CI: 2.88–11.94), pero no con parejas fijas o parejas que no pagan. En general, empoderamiento comunitario estaba asociado con mejoramientos significativos relacionados con las diferentes resultados de VIH sobre diversos contextos geográficos.

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We would like to thank Antonio Gerbase for his leadership on the overall WHO guidelines development process, Elie Akl for his inputs on meta-analysis and GRADE, and Laura Stoff for her help formatting the manuscript. We also appreciate the input and feedback from the many WHO consensus conference participants, including representatives from the Network of Sex Work Projects (NSWP), researchers, and many diverse local and international organizations.

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Correspondence to Deanna L. Kerrigan.

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Kerrigan, D.L., Fonner, V.A., Stromdahl, S. et al. Community Empowerment Among Female Sex Workers is an Effective HIV Prevention Intervention: A Systematic Review of the Peer-Reviewed Evidence from Low- and Middle-Income Countries. AIDS Behav 17, 1926–1940 (2013).

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