168 The Global HIV Epidemics among Sex Workers
While initially promising, recent negative randomized controlled trial findings on the impact of PreP and vaginal microbicides on HIV outcomes for women in addition to NSWP rejection of the implementation of these interventions at the current time led the team not to include these HIV prevention interventions in mathematical modeling and costing analyses. Data on the effects of early initiation of ART on HIV incidence among serodiscordant couples was drawn from a recent peer-reviewed publication from the multi-center, HPTN 052 trial (Eshleman, Hudelson et al. 2011). In turn, the two major areas of intervention modeled here independently and in combination are: “community empowerment-based, comprehensive HIV prevention” and “Early initiation of ART”. Community-Empowerment-based, Comprehensive HIV Prevention The concept of community empowerment-based, comprehensive HIV prevention is understood here as a collective process through which structural constraints to health, human rights, and well-being are jointly addressed by sex workers to create new possibilities for social and behavioral change and access to health services to reduce their risk for acquiring HIV. The search upon which we relied for effect size data for community empowerment-based, comprehensive HIV prevention involved interventions emphasized the role of the sex worker community in organizing and mobilizing around sex worker priorities and needs. In such a community empowerment-based approach to HIV prevention among sex workers one often sees an initial focus placed on the creation of a safe space for and stimulating a sense of social cohesion among sex workers (Kerrigan, Moreno et al. 2006; Kerrigan, Telles et al. 2008), that can then later be built upon to advocate for increased collective power and control in society and to challenge power structures that deny sex workers access to social and materials resources including but not limited to HIV and health-related services (Lippman, Donini et al. 2010; Lippman, Chinaglia et al. 2012). The systematic review of sex worker, community empowerment HIV prevention interventions was conducted by searching electronic databases such as PubMed, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE from January, 1990-October, 2010, reviewing secondary references, and contacting experts to identify articles. Peer-reviewed studies were included in the analysis if they evaluated a community empowerment intervention among sex workers in a low- or middle-income country and if they provided pre-post or multi-arm measures of one of three key outcomes: HIV infection, STI infection, and