Official websites use. Share sensitive information only on official, secure websites. The incidence of HIV infection among female sex workers and their clients in the Middle East and north Africa is not well known. We aimed to assess HIV incidence, the contribution of heterosexual sex work networks to these numbers, and the effect of interventions by use of mathematical modelling.
In this modelling study, we developed a novel, individual-based model to simulate HIV epidemic dynamics in heterosexual sex work networks. Model-input parameters were provided through a systematic review of HIV prevalence, sexual and injecting behaviours, and risk group size estimates of female sex workers and clients. Model output was number of incident HIV infections under different modelling scenarios for each country. Summary statistics were generated on these model output scenarios.
Incidence in heterosexual sex work networks was distributed roughly equally among female sex workers, clients, and client spouses. The model output predicted that any of the programmed interventions would substantially reduce incidence.
Even when a subpopulation did not benefit directly from an intervention, it benefited indirectly through reduction in onward transmission, and indirect impact was often half as large as the direct impact.
Substantial HIV incidence occurs in heterosexual sex work networks across the Middle East and north Africa with client spouses being heavily affected, in addition to female sex workers and clients.
