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Two authors (LP and LR) systematically searched MEDLINE, EMBASE, Global Health, Social Science Citation Index, Popline and CINAHL for studies published from 2005 to 20 October 2011.

To identify articles we combined five broad search themes with the Boolean operator “AND”.

Figure 1 summarises the papers searched and retained in the review.

Following full-text review 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine papers report multivariate or univariate2 risk factors for HIV/STI among FSWs.

We therefore undertook a narrative synthesis and described prevalence of HIV and STIs, presenting adjusted and unadjusted associations differentiating between structural and individual-level risk factors.

‘Individual’ level factors were defined as those endogenous to the individual and his or her agency or practices, whereas ‘structural’ factors were defined as those exogenous to the individual and/or indirectly linked to individual agency or practices.13 19 We therefore incorporate all forms of social and environmental factors potentially affecting risk within the category of ‘structural’.

While globally the number of new HIV infections has declined over the last decade, in Europe they have continued to increase.

By 2012 there were over 1.5 million individual HIV case reports, with over half a million diagnoses reported in the Past 5 years.1 The epidemiology of HIV in Europe suggests a concentrated epidemic with the burden of HIV cases among men who have sex with men in the West and people who inject drugs (PWID) in the East.2The epidemic in the East is fuelling the continuing increase in new HIV cases in Europe: between 20 an average of 273 cases per million people were recorded in the East compared with 74 and 11 in the West and Centre, respectively.3 While drug injecting is the main exposure category in the East, the number and proportion of cases linked with heterosexual exposure has increased within the last 5 years with over 60% of these cases among women.

Studies reviewed Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs.A FSW was defined as a woman who has ever exchanged sex for money, drugs or goods.Studies were included if they reported crude or adjusted associations.The fifth theme combined the MESH terms “sex worker” and “prostitute” with the free words “sex work*” “prostitut*”, “entertainment worker*”, “(exchang* adj3 sex)”, “(sell* adj3 sex)”, “(sold* adj3 sex)”, “(sex adj3 money)”, “(transaction* adj3 sex)”, “(commerc adj3 sex)”, “(surviv* adj3 sex)”, “(sex adj3 drug*)”, “sex trade”, “sex industry”, “(sex* servic*)”, “ brothel*”, “red-light”, “solicit*”, “bar girl*”, “hostess*”, “ escort*”, “ masseu*” with “OR”.Reference lists of found articles were also searched and experts in the field consulted to identify other relevant studies.

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One author (LP) extracted data on: survey year; recruitment location; sample size; geographical coverage; condom use with clients and non-paying partners; experience of violence from clients or police and injecting drug use.

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