268 The Global HIV Epidemics among Sex Workers
other national or sex work specific data were also obtained through national reports and country experts, when necessary (see Modeling Chapter). Unique to this analysis, the prevalence of violence was calculated using data from peer-reviewed publications for Kenya (Chersich, Luchters et al. 2007); this estimate is specific to sexual violence. For Ukraine, a weighted violence prevalence was calculated drawing on Ukraine-based data (Sex Workers Rights Advocacy 2009), as well as Russia as a proxy (Sex Workers Rights Advocacy 2009; Decker, Wirtz et al. 2012) given the small sample size for Ukraine data; this estimate reflects physical or sexual violence. The baseline prevalence reported in Table 6.1 represents the prevalence estimates of violence among sex workers in each country obtained through this review. Table 6.1 Modeling Scenarios for Violence among Female Sex Workers in Kenya and Ukraine Description Status quo
Baseline prevalence of violence held constant among FSW (2011–16; past year)a
Kenya
Ukraine
32.4%
39.0%
85.0%
58,000
18.4%
25.0%
85.0%
58,000
2.4%
9.0%
Scale-up in coverage of ART by 2016 according to country estimations (% coverage or number)a Scenario Interpolated decline in violence among FSW from 1: 2011 levels by 14% in 2016 Scale-up in coverage of ART by 2016 according to country estimations (% coverage or number)a
Scenario Interpolated decline in violence among FSW from 2: 2011 levels by 30% in 2016 Scale-up in coverage of ART by 2016 according to country estimations (% coverage of number)
85.0%
Impact of FSW violence on condom non-use
58,000
69.0%
Source: Authors. Note: ART = antiretroviral therapy; FSW = female sex worker. a. ART scale-up among adults based on country UNAIDS projections estimates.
Model inputs related to HIV transmission associated with violence drew on a WHO systematic review of violence and HIV risk (WHO/Shannon 2012), which identified 15 quantitative papers concerning violence and HIV risk; these papers were supplemented by a manuscript from Brazil (Kerrigan, Telles et al. 2008) that was not included in the review but included associations of violence with condom non-use. A wide range of outcomes were assessed including condom non-use, condom failure, and STI infection and symptoms. Only one study provided a direct estimate linking violence with HIV, and demonstrated the partial mediation by injection drug use (Ulibarri, Strathdee et al. 2011). Qualitative evidence demonstrates that violence heightens HIV