Occupational barriers to HIV care in female sex workers living with HIV: structural or community solutions?

Abstract

The UNAIDS 90-90-90 targets, defined as 90% of people living with HIV aware of their status, among which 90% are on antiretroviral treatment (ART) and among which 90% have HIV viral suppression, have galvanised efforts worldwide to reduce HIV transmission with the goal of ending the HIV epidemic by 2030. Sex workers, who are particularly vulnerable to HIV, and their sexual partners account for more than half (54%) of new HIV infections globally.1 Available data suggest that the relative risk of HIV acquisition among sex workers globally was 21 times higher than it was among all adults aged 15–49 years in 2018.1 Still, ART utilisation is poor among female sex workers (FSWs) globally—with an estimated 38% and 57% pooled prevalence for current ART use and viral suppression, respectively.2 With the goal of ending the AIDS epidemic by 2030, the critical question is how to increase the 90-90-90 targets, including awareness of HIV status, initiation and adherence to ART among sex workers.