Background: 

Epidemiological data are needed to characterize the age-specific HIV burden and engagement in HIV services among young, marginalized women in sub-Saharan Africa.

Setting: 

Women aged ≥18 years who reported selling sex were recruited across 9 countries in Southern, Central, and West Africa through respondent driven sampling (N = 6592).

Methods: 

Individual-level data were pooled and age-specific HIV prevalence and antiretroviral therapy (ART) coverage were estimated for each region using generalized linear mixed models. HIV-service engagement outcomes (prior HIV testing, HIV status awareness, and ART use) were compared among women living with HIV across age strata (18–19, 20–24, and ≥25 years) using generalized estimating equations.

Results: 

By age 18%–19%, 45.4% [95% confidence interval (CI): 37.9 to 53.0], 5.8% (95% CI: 4.3 to 7.8), and 4.0% (95% CI: 2.9 to 5.4) of young women who sell sex were living with HIV in Southern, Central, and West Africa respectively. Prevalence sharply increased during early adulthood in all regions, but ART coverage was suboptimal across age groups. Compared with adult women ≥25, young women aged 18–19 were less likely to have previously tested for HIV [prevalence ratio (PR) 0.76; 95% CI: 0.72 to 0.80], less likely to already be aware of their HIV status (PR 0.48; 95% CI: 0.35 to 0.64), and less likely to be taking ART (PR 0.67; 95% CI: 0.59 to 0.75).

Conclusions: 

HIV prevalence was already high by age 18–19 in this pooled analysis, demonstrating the need for prevention efforts that reach women who sell sex early in their adolescence. ART coverage remained low, with women in the youngest age group the least engaged in HIV-related services. Addressing barriers to HIV service delivery among young women who sell sex is central to a comprehensive HIV response.

中文翻译：

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卖淫的年轻女性中艾滋病毒的高流行和艾滋病毒/艾滋病的低参与度：对9个撒哈拉以南非洲国家的汇总分析

背景： 

需要流行病学数据来表征撒哈拉以南非洲年轻，边缘化妇女在特定年龄段的艾滋病毒负担和参与艾滋病服务的情况。

设置： 

通过受访者驱动的抽样（N = 6592）在南部，中部和西非的9个国家/地区招募了年龄在18岁以上且报告有性交易的女性。

方法： 

汇总个人水平数据，并使用广义线性混合模型估算每个地区的特定年龄的HIV患病率和抗逆转录病毒疗法（ART）覆盖率。HIV -service参与的结果（前HIV检测，HIV状况的认识和使用ART）间比较女性与生活HIV整个使用广义估计方程年龄层（18-19，20-24，和≥25岁）。

结果： 

到18岁至19％，45.4％[95％置信区间（CI）：37.9至53.0]，5.8％（95％CI：4.3至7.8）和4.0％（95％CI：2.9至5.4）卖性的妇女分别在南部，中部和西非感染艾滋病毒。在成年早期，所有地区的患病率均急剧增加，但各个年龄段的抗逆转录病毒治疗覆盖率均未达到最佳。与≥25岁的成年女性相比，年龄在18-19岁之间的年轻女性此前接受过HIV检测的可能性较小[患病率（PR）0.76；95％CI：0.72至0.80]，不太可能已经知道自己的艾滋病毒状况（PR 0.48； 95％CI：0.35至0.64），也不太可能接受抗病毒治疗（PR 0.67； 95％CI：0.59至0.75） ）。

结论： 

在这项汇总分析中，到18-19岁，艾滋病毒的患病率已经很高，这表明需要采取预防措施，使在青春期早期卖淫的妇女受益。抗逆转录病毒疗法的覆盖率仍然很低，年龄最小的妇女从事艾滋病相关服务的人数最少。解决在卖淫的年轻女性中提供艾滋病毒服务的障碍是全面应对艾滋病毒的关键。