Patterns and Epidemiology of Illicit Drug Use Among Sex Workers Globally: A Systematic Review

Abstract

Introduction: Sex workers who use drugs represent two distinct populations, yet programmatic and policy responses are siloed and failed to acknowledge the ways in which populations overlap and needs intersect. Although prevalence of drug use among sex workers is believed to be higher than the general population, no published estimates of global prevalence exist. We aimed to estimate the prevalence of lifetime illicit drug use among sex workers overall, by gender (cis, transgender, and non-binary), and sub-region.

Methods: We searched electronic databases for studies measuring the prevalence of illicit drug use among sex workers from the past decade [2009–2018]. Data were combined to generate pooled prevalence and associated 95% confidence intervals of lifetime use using a random effects model. Countries were categorised into geographic sub-regions, and sub-regional pooled estimates of lifetime use among female sex workers generated and mapped.

Results: Among 86 studies in 46 countries, pooled prevalence of lifetime illicit drug use among sex workers was 35% (95% CI 30–41%). There was significant diversity ( I ² > 90.0%, P < 0.01), and prevalence ranged from 1.2% to 84%. Most studies reported lifetime drug use among female sex workers (32 studies from 20 countries), and pooled prevalence in this sub-group was 29% (95% CI 24–34%). Insufficient data precluded generation of estimates for male and transgender sex workers.

Conclusions: Our review identified significant gaps in data quality and availability. Future research in partnership with sex workers is necessary to explore the diversity of populations and contexts in which drug use and sex work intersect, inform more accurate estimates of prevalence, identify differences in risks and exposures, and guide the creation, implementation, and evaluation of programmes and services.