HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis

This paper notes that whereas the Brazilian response towards the AIDS epidemic is well known, the absence of a systematic review of vulnerable populations ? men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. This systematic review and meta-analysis assesses HIV prevalence among MSM, FSW and DU, and summarises factors associated with the pooled prevalence for each group.

Key findings of this study are:

• among FSW, there is consistently higher condom use with sexual clients than with occasionaland stable partners.
• the combined HIV prevalence for FSW was 6.2.
• unprotected anal intercourse was commonly reported, but with great variability according tothe nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex.
• pooled HIV prevalence for MSM was13.6.
• injection drug use and syringe/needle sharing is a key predictor of HIV-infection, as well as engagement in sex work and male-to-male sex.
• The combined HIV prevalence among DUs was 23.1.

Key conclusions of this study are:

• FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%).
• vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs.
• finally, programs that provide the above services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.