AIDS and Behavior

, Volume 22, Issue 4, pp 1113–1121 | Cite as

High Burden of HIV, Syphilis and HSV-2 and Factors Associated with HIV Infection Among Female Sex Workers in Tanzania: Implications for Early Treatment of HIV and Pre-exposure Prophylaxis (PrEP)

  • Lung Vu
  • Kavita Misra
Original Paper


This paper estimates population-based prevalence of HIV, syphilis, HSV-2 and factors influencing HIV infection using a national sample of 1914 female sex workers (FSWs) in 7 regions in Tanzania. Additionally, HIV incidence was estimated by comparing biological HIV results with self-reported HIV status. The average HIV prevalence among FSWs in all 7 regions was 28%, ranging from 14% in Tabora to 38% in Shinyanga. HIV incidence was found to be 13 per 100 person-years. Syphilis prevalence was 8% with significantly higher burden found in Iringa (11%), Mbeya (13%), and Shinyanga (12%). Nearly 60% of the study population was infected with HSV-2. The high HIV prevalence and incidence coupled with suboptimal condom use indicate an urgent need to roll out the “Treat-All” approach and provide antiretroviral therapy to FSWs living with HIV regardless of their CD4 count. In addition, antiretroviral-based prevention technologies such as oral pre-exposure prophylaxis and microbicides should be piloted and evaluated.


Female sex workers (FSWs) HIV prevalence HIV incidence Syphilis HSV-2 Tanzania 


Este documento estima la prevalencia de VIH, la sífilis, el VHS-2 y los factores que contribuyen a la infección por el VIH, utilizando una muestra nacional de 1.914 trabajadoras sexuales femeninas (TSF) en 7 regiones de Tanzania. Además, se estimó la incidencia del VIH comparando el resultado biológico del VIH con el resultado de la autoevaluación individual. La prevalencia promedio de VIH entre las TSF en las 7 regiones fue del 28%, desde el 14% en Tabora hasta el 37.5% en Shinyanga. La incidencia del VIH fue de 13 en 100 persona-años. La prevalencia de sífilis fue del 8% con una incidencia significativamente mayor en Iringa (11%), Mbeya (13%) y Shinyanga (12%). Casi el 60% de la población estudiada estaba infectado con VHS-2. La alta prevalencia e incidencia del VIH junto con niveles subóptimos de uso del condón indican una necesidad urgente de implementar el enfoque “Treat-All” en donde inmediatamente después de un diagnóstico de VIH positivo los pacientes inician la terapia antirretroviral, y proporcionar terapia antirretroviral a las TSF que viven con VIH, independientemente de su recuento de CD4. Es también importante que los métodos de prevención basados en el uso de antirretrovirales, como la profilaxis oral previa a la exposición (PrEP) y los microbicidas, sean sometidos a prueba y evaluación.



The study was implemented by Population Services International (PSI) in collaborations with National AIDS Control Program (NACP), Ministry of Health, Community Development, Gender, Elderly and Children (Tanzania). LV and KM were employed by PSI during the time of the study and provided significant technical assistance and oversight of the study, including development of the research protocol, standard operating procedures (SOPs), and data collection tools, training on bio-behavioral data collection, data analysis and final report. We would like to thank Amy Herman-Roloff for her initial development of the protocol, and all participants, study coordinators, and interviewers. Special thanks to Neema Makyao (NACP), Bongo Mgeni (PSI), Daniel Michael (PSI), and Anya Fedorova (PSI) for the successful implementation of the study. The findings and recommendations of this study are those of the authors and do not reflect the views of the funders or the government of Tanzania.


The study was funded by the United States Agency for International Development (USAID) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria (The Global Fund).

Compliance with Ethical Standards

Conflict of interest

We have no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the National Institute for Medical Research (NIMR, Dar es Salaam, Tanzania) and PSI Research Ethics Boards (Washington DC, USA).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.HIV and AIDS Program, Population CouncilWashingtonUSA
  2. 2.Bureau of HIV/AIDS Prevention and ControlNew York City Department of Health and Mental HygieneNew YorkUSA

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