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Table 1 Summary of reviewed related quantitative and qualitative studies (N = 19)

From: Social network and HIV risk behaviors in female sex workers: a systematic review

Author (s), location Sample size Study design Functional/Tie characteristicsa Structural characteristicsb Quality scorec Main findings
Rothenberg et al., USA [72] 595 persons at high risk for HIV, 133 FSWs, 129 their paying partners, 47 non-paying partners, 200 injecting drug users, 41 their sex partners. Longitudinal study Network size density stability 1.62 There was a negative correlation between the total network size and the stability index.
This correlation was significant for sexual relations (r = − 0.28, P < 0.01) and social (r = − 0.26, P < 0.01) networks, but not for drug-using network (r = − 0.13, P > 0.10)
Klovdahl et al., USA [71] 111 persons at high risk for infectious disease including HIV, 48 FSWs, 35 their partners, 24 injecting drug users, 4 their sex partners Longitudinal study - network size density Reachability 1.38 The median of network size was 11.7 (range 0, 54). Of the relationships involving risk behaviors, about 25% were reported to be sexual (anal & non-anal), 23% involved in drug sharing (non-?A3B2 show $132#?>needle), and 6% needle-sharing. The participants were found to be highly interconnected. The adjusted density of network connection was 0.046. Reachability was 1. Of the three observed HIV positive persons, one was in the connected region and was a paying partner of FSWs. Based on the graph-theoretic terms, they can reach their three personal associates directly in one step and the entire core of the connected region in six steps.
Woodhouse et al., USA [73] 595 persons at high risk for HIV, 133 FSWs,129 their paying partners, 47 non-paying partners, 200 injecting drug users, 41 their sex partners Longitudinal study Network position
Network component
1.62 The 595 respondents identified 5162 people to which they belonged as network members. More than 70% of respondents perceived themselves to be at low risk for HIV infection. Network analytic methods showed 147 separate connected components. Eight of the 19 HIV-positive persons in the network were placed in smaller components remote from the largest connected component.
Dandona et al., India [63] 6648 FSWs Cross- sectional Study Social support 1.9 Inconsistent condom use with clients was associated with low social support (OR = 2.60; 95% CI = 2.17, 3.12) and not participating in FSW support group (OR = 2.02; 95% CI = 1.50, 2.70).
Li et al., China [62] 318 FSWs Cross- sectional Study Social support 1.7 Perceived gatekeeper support was positively associated with consistent condom use with clients (OR = 1.80, 95% CI = 1.08, 3.03).
Yang et al., China [61] 454 establishment-based FSWs Cross- sectional Study Social support 1.9 Perceived gatekeeper support was associated with condom communication (with clients: Adjusted OR = 1.99 (95% CI = 1.35, 2.95); with stable partners: Adjusted OR = 1.44 (95% CI = 1.02, 2.06)), and consistent condom use (with clients: Adjusted OR = 1.45 (95% CI = 1.07, 1.96); with stable partners: Adjusted OR = 1.5 (95% CI = 1.09, 2.08)). However, it was not associated with proper use of condoms.
Kerrigan et al., Dominican Republic [74] 288 FSWs Cross- sectional Study Intimacy 1.7 After controlling for socio demographic characteristics of participants, low perceived intimacy with the most recent regular paying partner (OR = 7.20 (95% CI = 3.49, 14.83)) was significantly associated with condom use prevention in multivariate analysis.
Reisner et al., Boston, Massachusetts [79] 11 Transgender male-to-female sex workers Qualitative-Mixed method Study Social support 1.4 Social networks play an especially vital role in the lives of transgender women, who face ongoing stigma and discrimination in negotiating their identities, and remain socioeconomically disadvantaged. These factors may affect access to clinical care and/or disclosure of behavioral HIV risks to medical and mental health providers. Participants overwhelmingly discussed support groups or other avenues of networking with other transgender women as an area of interest for HIV prevention.
Tucker et al., South china [65] 34 low-income FSWs, 28 Health outreach Qualitative Study Frequency of contact Trust 1.6 Sex workers Laoxiang (hometown social network contact, women who migrated from the same region) influenced condom use through several mechanisms such as promoting wholesale condom purchasing, mediating condom use with clients, and providing options for managing clients who refused condom use. Outreach members observed that sex workers accompanied by their Laoxiang were often more willing to accept STI/HIV testing and trust local sexual health services.
Chen et al., Shanghai, China [67] 21 Female entertainment workers (16 from large venues and 5 from small venues) Qualitative Study Type of contact
Network role
Social support
1.8 There were several personal networks in both large and small entertainment establishments in Shanghai, China that based on unique conditions were efficient for the diffusion of safer sex messages. Madams, who act as intermediaries between FSWs and clients, had a main role in FSWs’ social networks, but did not act as information disseminators and support the FSWs for condom use due to a conflict of interest between safer sex and maximizing profits. Messages about safer sex and condom use appeared to be more easily disseminated when the information could be present from people working at different levels in the venues.
Lau et al., China [75] 158 FSW -Non Injecting Drug Users (FSW-NIDUs) and 218 FSW-IDUs Cross- sectional Study Social support 1.5 According to multivariate analysis results, lack of social support was significantly associated with inconsistent condom use during commercial sex among FSW-IDUs but not among the FSW-NIDUs (Adjusted OR = 2.93, 95% CI = 1.28–6.70).
Ye et al., China [38] 504 FSWs Cross- sectional Study Social support 1.7 After controlling for socio-demographic characteristics in multivariate analyses, an environmental-structural support variable (which was measured by a scale composed of as “enabling and
reinforcing factors supporting condom use in the establishment including perceived level of safe sex information exchange among employees (FSWs); support from the establishment owner (gatekeeper) about the important of condom use during commercial sexual services; accessibility of condoms in the establishment for condom use”) was the most significant positive predictor of consistent condom use (OR, 3.96; CI, 2.52–6.22) among FSWs and their regular paying partners.
Urada et al., Philippines [64] 143Female entertainment workers trading sex Cross- sectional Study Frequency of contact Social influence Informational support 1.8 Among participants, those who had less frequent contact with their managers (Adjusted OR = 0.46 (95% CI = 0.27, 0.78)) and were not following their co-workers’ advice to use condoms (Adjusted OR = 0.13 (95% CI = 0.04, 0.44)), used condoms less consistently.
Fonner et al., Swaziland [77] 324 FSWs Cross- sectional Study Social capital 1.8 Social cohesion among female sex workers was associated with consistent condom use with all partners in the past week (Adjusted OR = 2.25 (95% CI = 1.30, 3.90)). Social participation was associated with always using condoms with non-paying partners (Adjusted OR = 1.99 (95% CI = 1.13, 3.51)).
Januraga et al., Indonesia [66] 34 FSWs Qualitative Study Social capital
Reciprocity Solidarity
1.7 Newcomer sex workers often experienced intensely competitive working environments fueled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. The lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. Therefore, these increase their HIV risk.
Hao et al., China [68] 63 older FSWs (28 street-based and 35 venue-based sex workers) and 53 pimps, roadside salon and hotel owners Qualitative Study Social support size, density, frequency of contact, role of network members 1.5 Based on the functional and structural characteristics of FSWs’ social network as size, density, frequency of contact, role of network members and social support, family networks (children and husbands) and workplace networks (peers, clients, pimps, and owners) differently influenced (promoted or deterred) FSWs’ condom use.
Gu et al., China [69] 200 FSWs who are injection drug users Cross- sectional Study Social support 1.7 In final multivariate model, after adjusting for socio-demographic variables, perceived social support from family members and friends (OR = 0.39, 95 %CI = 0.12–0.44) had significant association with condom use.
Cruz Serena, Uganda [80] FSWs who live in slums and brothel Qualitative Study-ethnography Intimacy
Social support Social capital
1.6 Social network through intimacy, trust, social support and social capital provides a basis for managing daily risk related living in brothel and HIV risk behaviors related sex work. Social relationships especially with other FSWs and their social support in brothel can help the FSWs when they encounter insecurity with money, physical harm, and illness.
Yang et al., China [70] 1916 female entertainment sex workers Repeated Cross- sectional Study Social support 1.5 In final multivariate model, after adjusting for other individual and social covariates, only peer support for condom use remains a significant and independent correlate of consistent condom use in sex with a non-stable partner (OR = 1.08, P < 0.01). Peer support can promote a normative environment supportive of safe sex and reinforce risk reduction behavior.
  1. aFunctional characteristics include functions of interaction between network members, e.g., social support and social capital. Tie characteristics are characteristics of ties or interactions between people in a network including frequency of contact, duration of tie, intimacy between network members, etc. In this review some of the included studies considered some of these functional and also some of these tie characteristics
  2. bA network in which people interact with each other has structural characteristics including size (the number of members in a network), density (to what extent people are connected to each other), centrality, homogeneity (to what extent people are similar to each other in a network), etc.
  3. cMean quality score was calculated as quality score of each article divided by number of items in related critical appraisal forms. Attainable range score 0–26 for the longitudinal studies and 0–20 for the cross-sectional and qualitative studies