Mapping, population size estimation, and characteristics of venue-based female sex workers in Iran.

BACKGROUND

Female sex workers (FSWs) are one of the key populations affected by HIV. In Iran, the most recent population size estimate of FSWs is nine years old. This study aimed to estimate the number of street- and venue-based FSWs, map the geographical distribution of venues, and identify the characteristics of FSWs in three cities in Iran.

METHODS

This cross-sectional study was conducted among FSWs in Tehran, Shiraz, and Abadan from June 2019 to March 2020. Women 15 years and older who had a history of sex with more than one man in exchange for money, drugs, services, etc., in the last 12 months were recruited to the study. The number of FSWs in each city was estimated through FSW opinions, secondary key informants' opinions, observations/enumeration of study teams, and the service multiplier method.

RESULTS

During the mapping stage, 391 venues were identified in these cities, from where 633 FSWs were interviewed. The median (Interquartile Range) age of sex work initiation among them was 24 (20-30). The lifetime history of HIV testing was 90.3% (n = 558), and the prevalence of self-reported HIV infection was 3.0% (95% CI:1.5-4.4) among those who ever tested for HIV. The number of venue-based FSWs was 317 (95% Uncertainty Levels [UL]: 173-435) in Abadan, 415 (95% UL: 324-687) in Shiraz, and 503 (95% UL: 455-577) in Tehran.

CONCLUSION

This study provides a critical estimate of the population size and characteristics of street- and venue-based FSWs in three major cities in Iran. The findings highlight the need for targeted HIV prevention and intervention strategies, given the substantial number of FSWs engaged in drug use and frequent sex with clients, and the observed prevalence of self-reported HIV infection. Moreover, the findings highlight gaps in service coverage and can guide national HIV programming to better target priority populations and allocate resources more effectively.