Contact Admin. Box , Doha, Qatar. We addressed this gap through a comprehensive epidemiological assessment. Risk of bias ROB assessments were conducted for all included studies using various quality domains, as informed by Cochrane Collaboration guidelines. The pooled mean HIV prevalence was estimated using random-effects meta-analyses. Sources of heterogeneity and temporal trends were identified through meta-regressions. Most studies had low ROB in multiple quality domains.
The regional pooled mean HIV prevalence was 1. Meta-regressions identified strong subregional variations in prevalence. There was also a large variability in sexual and injecting risk behaviors among FSWs within and across countries.
The epidemic has been growing for over a decade, with strong regionalization and heterogeneity. The online version of this article Between and , the increase in the number of new infections was estimated at over a third, while that of AIDS-related deaths, at over threefold [ 1 β 3 ]. Despite recent progress in HIV research and surveillance in MENA [ 8 ], including the conduct of integrated bio-behavioral surveillance surveys IBBSS [ 5 , 9 ], many of these data are, at best, published in country-level reports, or never analyzed.
The majority of these epidemics emerged within the last two decades [ 10 , 11 ]. Although the size of commercial heterosexual sex networks is expected to be much larger than the risk networks of MSM and PWID [ 6 , 7 ], estimates for the population proportion of female sex workers FSWs , volume of clients they serve, and geographic and temporal trends in infection remain to be established.
This study characterizes HIV epidemiology among FSWs and their clients in MENA by 1 systematically reviewing and synthesizing all available published and unpublished records documenting population size estimates, population proportions, HIV incidence, and HIV prevalence including in proxy populations of clients such as male sexually transmitted infection STI clinic attendees ; 2 estimating, for each population, the pooled mean HIV prevalence per country and regionally; 3 identifying the regional-level associations with prevalence, sources of heterogeneity, and temporal trends; and 4 synthesizing the key measures of sexual and injecting risk behaviors.
