Although sex work is a recognized risk factor for HIV transmission, the specific population-level impact of heterosexual AI on HIV transmission, and particularly during sex work, has rarely been studied. AI prevalence during past year was indirectly derived from the question about condom use during AI over the past 12 months. Potential determinants of AI were considered that had few missing values, were accurately measured, and for which an association with AI was previously reported or was deemed plausible. Specifically, evidence suggests that condom use during AI is lower and breakage more frequent than during VI 3 , 12 — Although sex work intersects with injecting drug use in some settings, the primary mode of HIV acquisition and transmission for FSWs is thought to be vaginal intercourse VI. Even if only a small proportion of individuals practice AI during commercial sex, this effect could also extend beyond FSW-client partnerships through further sexual mixing of clients with women not engaging in sex work.
The association between AI exposure and HIV prevalence or sexually transmitted infection was also examined for different exposure definitions. We matched on covariates based on our a priori knowledge of potential confounders. The study design and recruitment procedure have been described elsewhere 20 , Based on the proportion of FSWs reporting AI during the past year in the RDS survey, women entering the sex trade are assumed to either engage in AI at a certain frequency or not until they retire from sex work recruitment in or out of sex work is independent of age. Targeted interventions among high-risk populations, such as FSWs performing receptive AI, could be an effective way to further curb HIV transmission The model was then calibrated to HIV prevalence and coverage of antiretroviral therapy, using a Bayesian framework with incremental mixture importance sampling Despite representing a small fraction of all sex acts, AI is an underestimated source of HIV transmission. These factors could further enhance HIV transmission during AI; understanding these vulnerability patterns remains important to prevention efforts. Potential determinants of AI were considered that had few missing values, were accurately measured, and for which an association with AI was previously reported or was deemed plausible. Specifically, evidence suggests that condom use during AI is lower and breakage more frequent than during VI 3 , 12 — Poisson regressions were used to identify AI determinants. Given the lack of balance between covariates between those reporting and not reporting AI, nearest-neighbor matching on the Mahalanobis distance was applied Even if only a small proportion of individuals practice AI during commercial sex, this effect could also extend beyond FSW-client partnerships through further sexual mixing of clients with women not engaging in sex work. This will enable us to assess the contribution of AI to the HIV epidemic and help inform prevention activities. Paradoxically, the role of heterosexual AI in HIV epidemics seems to have been minimized in prevention, assuming that AI contributes little to HIV transmission despite growing evidence that this behavior is quite common among heterosexual men and women of all ages 7 — 9. First the impact of AI alone was considered; second, the PAF also took into account the reduced condom use during AI by increasing condom use to the same fraction as for VI. Statistical analyses Descriptive statistics are presented as crude and adjusted estimates based on RDS sampling weights i. Briefly, RDS is a network-based technique used to sample hard-to-reach populations Two scenarios were investigated: In other words, we assumed that AI acts were substituted with VI acts. Advanced Search Abstract Current evidence suggests that anal intercourse AI during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus HIV epidemics has been investigated. The model was parameterized after a comprehensive review of the scientific and gray literature. Results from unmatched and matched Poisson regressions are presented. Upon completion of the questionnaire, a trained nurse provided HIV counseling and testing. To examine determinants of AI, univariate and multivariable Poisson regression models were used to estimate prevalence ratios. From this set of questions, we estimated AI prevalence and frequency during a normal week, and AI prevalence during the past month.
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