Official websites use. Share sensitive information only on official, secure websites. Correspondence , Caroline A. Email: c. We determined if proximity to sex work sites is associated with HIV prevalence among the general population in Zimbabwe, a country with one of the highest HIV prevalence in the world. We calculated the shortest distance by road from each survey sample location to the nearest sex work site, for all sites and by type of sex work site, and conducted univariate and multivariate multilevel logistic regressions to determine the association between distance to sex work sites and HIV seropositivity, controlling for age, sex, male circumcision status, number of lifetime sex partners, being a FSW client or being a stable partner of an FSW client.
We found no significant association between HIV seroprevalence and proximity to the nearest sex work site among the general population in Zimbabwe, regardless of which type of site is closest city site adjusted odds ratio [aOR] 1. Sex work sites do not seem to directly affect HIV prevalence among the general population in surrounding areas. Prevention and control interventions for HIV at these locations should primarily focus on sex workers and their clients, with special emphasis on including and retaining mobile sex workers and clients into services.
However, whether the presence of sex work sites is associated with higher HIV prevalence in the general population, and thus can directly explain the observed geographical heterogeneity in the epidemic, has never been empirically tested. Zimbabwe is one of the countries with the highest HIV burden worldwide. CeSHHAR runs mobile clinics throughout Zimbabwe, offering services at 36 sex work sites [ 7 ], and has further mapped the locations of 19 other sex work sites in the country [ 7 ].
Data on the locations and typology of sex work sites, together with nationally representative geolocated survey data from the Demographic and Health Survey DHS on HIV prevalence and risk behaviour in the general population [ 2 , 8 ] create the unique opportunity to test whether the HIV prevalence in the general population of Zimbabwe is higher among those living in close proximity to sex work sites.
We determined if geospatial heterogeneity in HIV prevalence in the general population in Zimbabwe is associated with proximity to sex work sites. We first calculated travel distance between DHS sample locations and known sex work sites, and used univariate and multivariate logistic regression models to determine the association between distance to the nearest sex work site and HIV prevalence, controlling for demographic and sexual behavioural factors.
