HIV Prevalence and Related Factors among Female Sex Workers in Iran: Findings of a Nationwide Bio-Behavioral Survey, 2023-2024.

Female sex workers (FSW) remain a key population for HIV prevention. In this cross-sectional study, we used respondent-driven sampling among 1,516 FSW in 13 Iranian cities (2023-2024) to assess HIV prevalence and associated factors. The HIV prevalence was 1.32% (95% confidence interval [CI]: 0.24; 2.39). In a multivariable model, higher education was protective (adjusted odds ratio [aOR] = 0.17), while polydrug use (aOR = 5.53) and sex with people who inject drugs (aOR = 3.27) increased HIV odds. Sufficient HIV knowledge was also associated with infection (aOR = 7.29), likely reflecting post-diagnosis education as all participants with HIV were previously diagnosed. These findings underscore that despite progress, FSW remain a high-risk group in Iran. Prevention strategies must prioritize the integration of harm reduction and substance use services to effectively address the overlapping risks that continue to drive the HIV epidemic in this population.