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Table 5 Results of meta-analyses on studies reporting HIV prevalence in FSWs and their clients (or proxy populations of clients such as male STI clinic attendees) in the Middle East and North Africa (MENA) by epidemic type

From: HIV epidemiology among female sex workers and their clients in the Middle East and North Africa: systematic review, meta-analyses, and meta-regressions

  

Country

Studies (N)

Samples

HIV prevalence

Pooled mean HIV prevalence**

Heterogeneity measures

Tested

HIV positive

Median* (%)

Range* (%)

%

95% CI

Q (p value)†

I2‡ (%; 95% CI)

Prediction interval£ (95%)

FSWs

Low-level⁑

Afghanistan

9

3578

7

0

0–0.90

0.03

0.00–0.18

7.59 (p = 0.4744)

0.0 (0.0–62.9)

0.00–0.22

Bahrain

1

724

6

0.83

–

0.83¥

0.30–1.80

–

–

–

Egypt

33

7222

16

0

0–1.49

0.03

0.00–0.14

36.26 (p = 0.2765)

12.8 (0.0–43.4)

0.00–0.34

Iran

32

17,277

211

0.02

0–14.00

0.99

0.34–1.88

569.63 (p < 0.0001)

94.6 (93.2–95.6)

0.00–8.84

Iraq

29

15,852

1

0

0–0.07

0.00

0.00–0.00

6.24 (p = 1.0000)

0.0 (0.0–0.0)

0.00–0.00

Jordan

7

1024

4

0

0–1.33

0.00

0.00–0.31

3.43 (p = 0.7537)

0.0 (0.0–48.9)

0.00–0.48

Lebanon

11

11,589

12

0.07

0–2.40

0.00

0.00–0.07

18.82 (p = 0.0426)

46.9 (0.0–73.6)

0.00–0.33

Pakistan

81

26,678

217

0

0–8.80

0.35

0.18–0.57

368.57 (p < 0.0001)

78.3 (73.3–82.3)

0.00–3.06

Syria

56

97,071

12

0

0–0.20

0.00

0.00–0.00

32.37 (p = 0.9936)

0.0 (0.0–0.0)

0.00–0.00

Tunisia

53

22,224

59

0

0–2.30

0.02

0.00–0.11

124.81 (p < 0.0001)

58.3 (43.6–69.2)

0.00–0.89

Yemen

10

1767

34

0.25

0–7.00

0.82

0.00–2.91

63.01 (p < 0.0001)

85.7 (75.6–91.7)

0.00–11.67

Intermediate-intensity⁑

Algeria

33

4241

179

2.00

0–20.00

2.39

1.02–4.15

215.22 (p < 0.0001)

85.1 (80.1–88.9)

0.00–15.05

Libya

4

1249

28

8.43

1.08–18.18

4.86

0.81–11.37

34.41 (p < 0.0001)

91.3 (80.8–96.0)

0.00–47.09

Morocco

200

40,507

804

1.07

0–52.90

1.11

0.83–1.41

851.66 (p < 0.0001)

76.6 (73.3–79.6)

0.00–5.98

Somalia

17

2015

57

0.35

0–47.06

1.64

0.42–3.39

61.50 (p < 0.0001)

74.0 (57.7–83.8)

0.00–10.24

Sudan€

22

7207

128

0.95

0–7.70

1.30

0.76–1.96

98.06 (p < 0.0001)

78.6 (68.1–85.6)

0.00–5.26

Concentrated ⁑

Djibouti

68

22,028

4618

18.75

0–70.00

17.89

13.62–22.60

5127.36 (p < 0.0001)

98.7 (98.6–98.8)

0.00–63.91

South Sudan

8

5466

1108

18.50

2.82–37.90

17.32

8.66–28.14

554.81 (p < 0.0001)

98.7 (98.3–99.1)

0.00–61.99

All countries

674

287,719

7501

0.26

0–70.00

1.44

1.14–1.76

24,605.29 (p < 0.0001)

97.3 (97.2–97.4)

0.00–16.49

Clients of FSWs

Low-level⁑

Egypt

6

1362

3

0.17

0–0.80

0.09

0.00–0.42

4.82 (p = 0.4386)

0.0 (0.0–73.7)

0.00–0.60

Kuwait

6

6505

1

0

0–0.02

0.00

0.00–0.04

0.36 (p = 0.9963)

0.0 (0.0–0.0)

0.00–0.07

Pakistan

12

6498

9

0

0–1.10

0.00

0.00–0.10

14.93 (p = 0.1857)

26.3 (0.0–62.6)

0.00–0.42

Yemen

1

30

0

0

–

0.00¥

0.00–11.57

–

–

–

Intermediate-intensity⁑

Algeria

7

728

22

7.29

0–25.80

3.51

0.32–8.90

39.79 (p < 0.0001)

84.9 (70.8–92.2)

0.00–27.63

Morocco

84

10,348

47

0

0–8.00

0.00

0.00–0.05

76.30 (p = 0.6854)

0.0 (0.0–19.9)

0.00–0.05

Somalia

11

1010

21

0.94

0–9.62

1.38

0.25–3.11

25.74 (p = 0.0041)

61.1 (25.0–79.9)

0.00–8.46

Sudan€

4

791

14

1.61

0–2.51

1.22

0.16–2.97

7.02 (p = 0.0711)

57.3 (0.0–85.8)

0.00–11.65

Concentrated⁑

Djibouti

15

2222

217

2.20

0–34.60

5.36

1.53–10.81

244.98 (p < 0.0001)

94.3 (92.0–95.9)

0.00–35.23

South Sudan

1

37

5

13.5

–

13.5¥

4.54–28.77

–

–

–

All countries

147

29,531

339

0

0–34.60

0.38

0.14–0.71

977.96 (p < 0.0001)

85.1 (82.9–87.0)

0.00–6.60

  1. Abbreviations: CI confidence interval, FSWs female sex workers
  2. *These medians and ranges are calculated on the stratified HIV prevalence measures
  3. **Missing sample sizes for measures (or their strata) were imputed using median sample size calculated from studies with available information. Analyses excluding these studies had no impact on study findings
  4. †Q—the Cochran’s Q statistic is a measure assessing the existence of heterogeneity in effect size (here, HIV prevalence) across studies
  5. ‡I2—a measure assessing the magnitude of between-study variation that is due to the differences in effect size (here, HIV prevalence) across studies rather than chance
  6. £Prediction interval—a measure estimating the 95% interval of the distribution of true effect sizes (here, HIV prevalence)
  7. ⁑Based on results of meta-analyses for FSWs, countries were classified as having low-level HIV epidemic (prevalence < 1%), intermediate-intensity HIV epidemic (prevalence 1–5%), and concentrated HIV epidemic (prevalence > 5%)
  8. ¥Point estimate as only one study was available
  9. €Before 2011, South Sudan was part of Sudan, and thus, earlier measures from Sudan were based on studies that may have included participants from both Sudan and South Sudan
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