HIV risk and prevention among sex workers: a focus on structural determinants and interventions

HIV disproportionately affects female sex workers (FSWs), so it is unlikely that an effective and sustained HIV response will be achieved without effective HIV prevention strategies and interventions for FSWs. Emerging evidence highlights the important role of structural factors, such as violence, in risk of HIV acquisition and transmission among FSWs, so structural prevention approaches will be crucial for an effective HIV response in FSWs. To inform the design and implementation of effective structural HIV prevention approaches for FSWs, it is essential to better understand the patterns and effects of structural HIV determinants, and the effectiveness of different types of structural interventions on reducing HIV transmission. In this thesis, I investigate violence against FSWs, a key and pervasive structural determinant of HIV in the sex work context. I use a combination of statistical analysis and mathematical modelling to investigate the burden and determinants of violence against FSWs, to better understand the effects of violence against FSWs and contribution of violence against FSWs to HIV transmission, and to estimate the potential impact of violence interventions for FSWs on HIV transmission. The statistical analyses I conduct and the dynamic mathematical models of violence and HIV I develop and utilise in this thesis are focussed in two settings: Mombasa, Kenya and Vancouver, Canada. In Mombasa, Kenya, my statistical analyses focus specifically on young FSWs. Taken together, the work and findings in this thesis, add to the limited literature on the burden and effects of violence among young FSWs, and extend the emerging field of modelling structural HIV determinants and structural HIV interventions in the sex work context. The findings have important implications for the HIV response among FSWs, and provide some insights for future modelling studies of violence and HIV.