This volume presents an integrated epidemiologic, social, and economic analysis of the global epidemics of HIV among sex workers in low- and middle-income countries. The book provides a comprehensive review and synthesis of the available public health and social science data to characterize the nature, scope, and complexities of these epidemics. A community empowerment-based approach to HIV prevention, treatment, and care is outlined and demonstrated to be cost-effective across multiple settings, with a significant projected impact on HIV incidence among sex workers and transmission dynamics overall. The Global HIV Epidemics among Sex Workers seeks to assist governments, public health implementing agencies, donors, and sex worker communities to better understand and respond to the epidemics among a population facing heightened social and structural vulnerabilities to HIV. The book combines a systematic review of the global epidemiology of HIV among sex workers and in-depth case studies of the epidemiology, policy and programmatic responses and surrounding social contexts for HIV prevention, care and treatment in eight countries. The authors employ mathematical modelling and cost-effectiveness analysis to assess the potential country-level impact of a community empowerment-based approach to HIV prevention, treatment, and care among sex workers when taken to scale in four countries representing diverse sociopolitical contexts and HIV epidemics: Brazil, Kenya, Thailand, and Ukraine. In each setting, greater investment in prevention, treatment, and care for sex workers is shown to significantly reduce HIV. Together these findings underline the urgency of further global investment in comprehensive, human rights-based responses to HIV among sex workers.

Investing in Communities Achieves Results fills an important gap in the global knowledge on community level results and resources related to HIV and AIDS. While communities, in spite of their limited resources, have played a key role in the HIV/AIDS response, their contributions and innovative approaches to prevention, treatment, care, and support have not always been the focus of systematic and rigorous evaluations. To address this deficit, a series of studies-including evaluations in Burkina Faso, India, Kenya, Lesotho, Nigeria, Senegal, South Africa, and Zimbabwe-were undertaken over a three-year period (early 2009 to early 2012), helping to build a robust pool of evidence on the effects of community-based activities and programmes. A unique feature of this multicountry evaluation was the collaboration between two international organisations (the World Bank and the United Kingdom's Department for International Development) and a major civil society network (the U.K. Consortium on AIDS and International Development). Other attributes that contributed to the successful outcome were the sustained consultation process with civil society and stakeholders at the local, national, and global levels, and the collaboration among high-calibre, multi-disciplinary researcher teams. The book's findings are promising. At varying levels, depending on the country context, the HIV response in communities was shown to improve knowledge and behaviour and increase the use of health services- and even decrease HIV incidence. Evidence on social transformation was more mixed, with community groups found to be effective only in some settings. Each study in the evaluation provides a partial view of how communities shape the local response; however, taken together they constitute a significant pool of rigorous evidence on the contributions of communities, community groups, and civil society to the national and global HIV and AIDS response. The studies suggest that communities have produced significant results at the local level, which contribute to outcomes at the national level.