Grant: Operating Grant

Female sex workers (FSWs) experience a much higher risk of HIV than the general population, and programs targeted to FSWs are a critical component of HIV prevention globally. However, preventive interventions for FSWs only reach women after they identify as sex workers. Evidence suggests that young women may also exchange sex for money, drugs, or gifts (undeclared transactional sex) prior to identifying as a sex worker. The goal of this research project is to (i) estimate HIV risk, and characterize the behaviours (such as undeclared transactional sex) that influence HIV risk, during the transition period from first sex until self-declared entry into sex work; (ii) estimate HIV risk during the first two years of "formal" sex work, if before access to local HIV prevention services (access gap); and (iii) explore the importance of this early HIV risk for epidemic control. We will use innovative geographic mapping tools and perform a cross-sectional biological and behavioural survey of young women residing in established sex work "hot spots" in south India, Kenya, and Ukraine. Mathematical modelling will use these data to replicate diverse HIV epidemics in each of the three study sites, to understand how HIV infection acquired before "formal" entry into sex work or during the access gap could potentially limit the ability of existing programs to protect FSWs and the general population from HIV, and to estimate the added benefit of feasibly expanding existing programs to prevent these early HIV infections. The findings will contribute significantly to our understanding of HIV risk in young, high-risk women and self-identified FSWs, and will inform the strategic design and expansion of HIV prevention programs in regions where "formal" sex work and undeclared transactional sex fuel and sustain HIV epidemics.