Peer-Education Strategies for Enhancing Sexual Health Services Among Female Sex Workers: A Scoping Review Publisher Pubmed



Navidi I ; Shakibazadeh E ; Akbarpour S ; Raisi F
Source: BMC Women's Health Published:2026

Abstract

Introduction: Female sex workers (FSWs) remain highly vulnerable to HIV, other sexually transmitted infections (STIs) and broader sexual and reproductive health challenges. Peer-led interventions are widely recommended, yet their specific contributions and implementation gaps are poorly synthesised. This scoping review mapped peer-education strategies used globally to promote sexual health among FSWs, with emphasis on intervention components, outcomes, and evidence gaps, including the role of peers. Methods: This scoping review followed the Joanna Briggs Institute (JBI) manual and Arksey and O’Malley’s methodological framework. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed studies published between January 1993 and December 2023. The search used the keywords “sex worker,” “sexual health,” and “peer education.” Eligible studies were required to focus on peer-led sexual health interventions among female sex workers (FSWs) and be published in English. The studies meeting these criteria were screened, charted, and narratively synthesized. Results: Of 15,488 records, 31 studies from 16 countries (97% in low- and middle-income settings) were included. All incorporated peer-led components and consistently showed positive effects across three outcome domains: behavioural (increased consistent condom use and reduced high-risk behaviours in 23 studies), clinical/biomedical (higher HIV/STI testing, clinic referrals and, in several large-scale programmes, reduced HIV/STI incidence in 12 studies), and psychosocial & structural (improved knowledge, self-efficacy, mental health, human rights awareness and reduced violence in 11 studies). However, peer recruitment, training, supervision and compensation were described in detail in only a minority of studies, no study addressed ethical concerns including burnout, payment inequity and potential exploitation of peer educators. Conclusion: Peer-led interventions are highly effective across behavioural, clinical/biomedical and psychosocial & structural domains among FSWs, primarily due to peers’ unique ability to build trust and access hidden networks. To strengthen evidence and equity, future research must systematically document peer processes, evaluate comparative effectiveness, and proactively address ethical and sustainability challenges for peer educators themselves. © The Author(s) 2025.