Size matters: the number of prostitutes and the global HIV/AIDS pandemic

PLoS One. 2007 Jun 20;2(6):e543. doi: 10.1371/journal.pone.0000543.


Background: HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from .06% in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country's results by the country's population.

Methodology/principal findings: Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis.

Conclusions/significance: This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth.

MeSH terms

  • Adult
  • Disease Outbreaks / statistics & numerical data*
  • Female
  • Global Health
  • HIV / pathogenicity*
  • HIV Infections / epidemiology*
  • HIV Infections / transmission*
  • Humans
  • Male
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Sample Size
  • Sex Work*
  • Unsafe Sex