Proximity to sex work sites is not associated with higher HIV prevalence in the general population in Zimbabwe

Abstract In Zimbabwe, as in other East and Southern African countries, HIV prevalence is largely geographically heterogeneous. We determined if, and to what extent, this heterogeneity is associated with proximity to sex work sites by type of site (city, economic growth point, international, seasonal, or transport), using Demographic and Health Surveys location-specific HIV prevalence data—including 16,121 individuals (aged 15-49 years) from 400 sample locations—and Centre for Sexual Health and HIV/AIDS Research data on locations of 56 sex work sites throughout Zimbabwe. We conducted univariate and multivariate multilevel logistic regression to determine the association between sex work proximity—calculated as the shortest distance by road from each survey sample location to the nearest sex work site—and HIV seropositivity. We found no association between locations of sex work and heterogeneity in HIV prevalence in the general population, possibly explained by the mobile nature of both female sex workers and their clients as individual-level indicators of sex work were still significantly associated with HIV.