To determine HIV prevalence among female sex workers in the Gambia and HIV risk factors.

Participants (n = 251) were accrued through peer-referral and venue-based recruitment. Blood samples were screened for HIV. Participants were administered a questionnaire. Bivariate and multivariate logistic regression identified factors associated with HIV status.

Forty respondents (15.9%) were HIV-positive, with 20 (8.0%) infected with HIV-1 only, 10 (4.0%) with HIV-2 only, and 10 (4.0%) with both HIV-1 and HIV-2; 12.5% (n = 5/40) knew their status. Condom usage at last sex was 97.1% (n = 170/175) with new clients and 44.2% (n = 53/120) with non-paying partners. Having a non-paying partner, living with relatives or friends, having felt scared to walk in public, selling sex in multiple locations, and recent depressive symptoms were positively associated with HIV under multivariate regression.

Female sex workers have a higher prevalence of HIV compared to the general Gambian population. Interventions should be rights-based, promote safer sex practices and regular testing for female sex workers and linkage to HIV treatment and care with adherence support for those living with HIV. In addition, service providers should consider non-paying partners of female sex workers, improve knowledge and availability of condoms and lubricant, and address safety and mental health needs.