Abstract
The Southern African Development Community (SADC) economic block is the most affected
region by HIV epidemic in Sub‑Saharan Africa (SSA). Despite programmatic interventions, HIV infections remain
unprecedentedly high among female sex workers (FSW) in the region. This review assesses the HIV burden
and the drivers associated with FSW in the SADC region. Methods: We systematically extracted and analyzed
HIV burden and other sexually transmitted infections (STIs) research data on FSW indexed in various journal
platform and reports from governmental and nongovernmental organizations between 2003 and 2015. Metaanalysis
technique was used to estimate the pooled prevalence of the HIV burden among FSW in the region.
Results: Of the 192 peer‑reviewed articles and reports addressing HIV burden, only 21 articles met eligibility
criteria totaling 14998 FSW. The combined overall pool HIV prevalence was estimated at 42.0% (95% CI 0.41–
0.43). The estimated pooled HIV prevalence ranged from 16% (95% CI 0.13–18) in Democratic Republic of
Congo, 59% (95% CI 0.57–0.62) in South Africa and 71% (95% CI 0.65–0.76) in Malawi. The most common
STIs reported were syphilis, Chlamydia, and gonorrhea with little emphasis on viruses. Structural factors such
as stigma and discrimination, access to healthcare services and various socioeconomic and political barriers
impeded treatment and prevention. Conclusion: The HIV prevalence among FSW was 5–30 times higher when
compared to the overall female reproductive age population in the SADC region. This signifies and necessitates
increase evidence based HIV/STIs research and programs among FSW in the SADC region.