Decline in HIV prevalence among female sex workers in Zimbabwe between 2013 and 2023
HIV epidemic trends among female sex workers in sub-Saharan Africa are rarely known. We analysed HIV prevalence trends among 10,562 female sex workers aged 18-39 years, recruited through serial cross-sectional respondent-driven sampling surveys in 13 towns and 2 cities in Zimbabwe between 2013 and 2023. HIV prevalence remained stable from 2013 to 2016-2017 but declined significantly from 54.6% in 2016-2017 to 38.9% in 2021-2023 (cluster prevalence mean difference: 15.7%, prevalence ratio: 0.74; 95% CI: 0.68-0.79). This decline cannot be attributed to sampling bias or shifts in the characteristics of the female sex worker population. Mathematical modelling using the HIV Synthesis model and age cohort analysis also suggested lower HIV incidence in later years. While the availability of oral pre-exposure prophylaxis increased, there was little evidence of reduced risk behaviour over time. Increased treatment coverage among the male population likely contributed to the lower HIV incidence among female sex workers.
Authors
- Sungai T. Chabata (ORCID: https://orcid.org/0000-0001-7629-1543)
- Andrew N. Phillips (ORCID: https://orcid.org/0000-0003-2384-4807)
- Albert Takaruza (ORCID: https://orcid.org/0000-0003-2998-793X)
- M. Sanni Ali (ORCID: https://orcid.org/0000-0002-4192-7908)
- Richard Steen (ORCID: https://orcid.org/0000-0002-0798-022X)
- Harriet Jones (ORCID: https://orcid.org/0000-0003-4007-7144)
- Joanna Busza (ORCID: https://orcid.org/0000-0001-6334-0318)
- Raymond Yekeye
- Loveleen Bansi‐Matharu (ORCID: https://orcid.org/0000-0002-0233-7622)
- Frances Mary Cowan (ORCID: https://orcid.org/0000-0003-3087-4422)
- Fortunate Machingura (ORCID: https://orcid.org/0000-0003-4623-8180)
- Owen M. Mugurungi (ORCID: https://orcid.org/0000-0001-7779-5583)
- Primrose Matambanadzo (ORCID: https://orcid.org/0000-0002-9015-7049)
- James Hargreaves (ORCID: https://orcid.org/0000-0002-3509-3572)
- Tsitsi Hove (ORCID: https://orcid.org/0009-0004-0964-9778)
- Jeffrey Dirawo
Institutions
- Liverpool School of Tropical Medicine (GB)
- Ministry of Health and Child Welfare (ZW)
- Royal Society of Tropical Medicine and Hygiene (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Centre for Sexual Health and HIV AIDS Research (ZW)
- National AIDS Council (ZW)
- University College London (GB)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-12-05
- DOI
- https://doi.org/10.1038/s41467-025-65901-x
- Primary Topic
- Sex work and related issues
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- United States Agency for International Development
- Bill and Melinda Gates Foundation
- Wellcome Trust
- National Institute for Health and Care Research
- National Institutes of Health