Segmentation of heterosexual prostitution into various forms: A barrier to the potential transmission of HIV

The results of an earlier Dutch study on prostitutes' clients, interviewed face-to-face, were cross-validated by means of telephone interviews, which both guaranteed anonymity and produced a larger sample of respondents (n = 559). Depending on their preference and financial resources, they had visited different types of prostitution; but about half of them had restricted themselves to one type. Inconsistent use of condoms was reported by 14% of the clients who had had vaginal or anal intercourse. Condoms were most frequently used in clubs, brothels and window prostitution, and least often in street, home and escort prostitution; in the last two sorts especially not with regular prostitutes. Whether or not prostitutes came from non-Western countries had no influence on protective behaviour of these clients. The formation of networks between different sorts of prostitution, through unsafe sexual contacts in two or more sorts, involved only 3% of respondents. Thus, prostitution in The Netherlands should be seen as a number of sparsely-connected networks rather than as a single network. The formation of networks between prostitution and the population at large is made possible by the 10% of the respondents who had had unsafe contacts with both commercial and private partners.     

卖淫妇女性行为特征调查

目的了解卖淫妇女的性行为特征,为实施性病/艾滋病的综合监测和有效的干预策略提供必要的信息.方法对济南市某收容所174例卖淫妇女,采用匿名调查方法进行问卷调查,内容包括一般情况、卖淫场所、首次性交及开始卖淫年龄,卖淫的年限,接待嫖客的频数,安全套的使用情况及吸毒史.结果调查人群中年龄最小15岁,主要在美容美发店、餐饮业及宾馆等服务场所从事卖淫活动,首次性交和开始卖淫年龄在15岁以下者分别占16.1%和14.4%,最长卖淫年限达23年,每月接待嫖客数可多达40个.每次性交均使用安全套者仅占5.6%,从未使用安全套者占13.0%.有吸毒史者占5.2%.结论卖淫人群存在不安全性行为和吸毒等高危行为,应加强对该人群的健康教育和健康促进策略,以减少艾滋病经性途径传播.     

Child prostitution: global health burden, research needs, and interventions

Child prostitution is a significant global problem that has yet to receive appropriate medical and public health attention. Worldwide, an estimated 1 million children are forced into prostitution every year and the total number of prostituted children could be as high as 10 million. Inadequate data exist on the health problems faced by prostituted children, who are at high risk of infectious disease, pregnancy, mental illness, substance abuse, and violence. Child prostitution, like other forms of child sexual abuse, is not only a cause of death and high morbidity in millions of children, but also a gross violation of their rights and dignity. In this article we estimate morbidity and mortality among prostituted children, and propose research strategies and interventions to mitigate such health consequences. Our estimates underscore the need for health professionals to collaborate with individuals and organisations that provide direct services to prostituted children. Health professionals can help efforts to prevent child prostitution through identifying contributing factors, recording the magnitude and health effects of the problem, and assisting children who have escaped prostitution. They can also help governments, UN agencies, and non-governmental organisations (NGOs) to implement policies, laws, and programmes to prevent child prostitution and mitigate its effects on children's health.     

Prostitute women and AIDS: anthropology

To understand the spread of AIDS among prostitutes, it is important to understand the distinctions among those who "sell" themselves for sex. In studying the anthropology of prostitutes, 3 general geographical boundaries and the characteristics of each should be considered: the West, Asia and sub-Saharan Africa. Distinctions also exist among societies where there is almost no visible separation in the activities of marriage or prostitution and in societies where the nature of work and filiation differ. The effects of HIV transmission, condom use, legal control, drug use, the client and economic and non-economic aspects are considered with each broad geographical area. Important measures in the control of HIV infection will be the distribution of condoms and clean needles. Preventive programs must make it of utmost importance to 1st strive to encourage prevention among the prostitution community. Programs should also not be limited to areas where there are larger communities of prostitution and will trace migrational routes of prostitution back to even smaller communities.     

Sexual behaviour and its relationship to drug-taking among prostitutes in south London

The precise manner in which the use of different types of drugs is related to prostitution has not been adequately researched. This study investigates patients of drug-taking and sexual behaviour among a group of women working as prostitutes in south London; it also looks at prostitution in which sex is offered in return for drugs, at the links between heroin, cocaine and alcohol use and sexual behaviour, and at the association between severity of dependence and sexual behaviour. All of the women in our sample (n? 51) were actively working as prostitutes. More than half of them had given sex for drugs, though this was a relatively infrequent occurrence. The majority of them were using heroin and many of them were moderately or severely dependent upon heroin. More than one-third had shared injecting equipment after it had already been used. Almost two-thirds reported that they only worked as a prostitute in order to fund their use of drugs (predominantly heroin), and that they would not continue working as a prostitute if they were not still using drugs. The more severely dependent upon heroin they were, the more likely they mere to report these links between heroin use and prostitution. About half of the women in our sample said that they first started to work as a prostitute in order to pay for drugs. The women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin. Very few women regularly used cocaine in association with their prostitution. There are grounds for concent about the alcohol consumption of these women. About one-quarter of the women said that they used alcohol every day; some of them reported drinking at levels which greatly exceed recommended limits for women, and some were drinking at levels which mere likely to be physically damaging.     

Estimating hidden populations: a new method of calculating the prevalence of drug-injecting and non-injecting female street prostitution

This paper outlines a new method we have developed for estimating the prevalence of streetworking prostitution and the proportions of female street-working prostitutes who are injecting drug users. This method is based on the capture/recapture approach and involves distinguishing new fieldwork contacts from repeat field work contacts. The size of the overall population can be modelled from records of the increasing ratio of repeat to new fieldwork contacts. The method may have a relevance beyond a concern with prostitution and drug injecting, and may be of value in estimating other hidden populations.     

Changes in prostitution and the AIDS epidemic in Thailand

The HIV/AIDS epidemic which broke out in Thailand 1988 was mainly caused by the widespread patronage of prostitutes. The Thai authorities responded with programmes which encouraged the use of condoms in commercial sex. These programmes were highly successful. However, prostitution has changed since the beginning of the epidemic, partly for economic and demographic reasons, but mainly because of the fear of AIDS. Fewer women practise prostitution, men patronize it less, and the price of commercial sex has risen. Prostitution is less likely to be practised in brothels and more likely to be practised in establishments like restaurants and bars. Moreover, as fewer native Thai women are willing to practise prostitution, foreign women are taking their place. In order to continue to control the epidemic, the authorities will have to adapt their programmes to the changing structure of commercial sex.     

201名暗娼艾滋病知识及性行为特征分析

目的 了解暗娼艾滋病病毒HIV感染情况及艾滋病知识、态度、信念、行为特征,为制定预防策略提供依据。方法对201名暗娼采取匿名调查方法进行问卷调查和HIV抗体榆测。结果 调查对象HIV抗体检测均为阴性,年龄最小为14岁,初中文化占50.7％;首次性交和卖淫平均年龄分别为18.3岁和18.9岁,21.4％卖淫时从不使用安全套,18.9％既卖淫又吸毒;72.1％听说过艾滋病,但艾滋病相关知识十分缺乏。结论 暗娼艾滋病相关危险行为发生率高,应加强宣传教育和安全套的推广使用,以减少HIV经性传播。     

Childhood Trauma and Adult Prostitution Behavior in a Multiethnic Heterosexual Drug‐Using Population

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects, higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.     

Concerns raised about Botswana's proposed HIV-disclosure law

On August 10, 2000, Botswana's Minister for Health, Joy Phumaphi, announced that the country is considering legislation making disclosure of one's HIV status to a sex partner mandatory. The legislation would make sexual activity without information a criminal offense. However, Phumaphi's statement has created worldwide concern. Ethicists Anna Mastroianni of the University of Washington and Jeffrey Kahn of the University of Minnesota argue that such a policy, if enacted, would further increase the spread of HIV/AIDS because people would not present for HIV testing. Moreover, Josef Decosas of the Southern Africa AIDS Training Programme, Harare, Zimbabwe adds that such legislation would disempower women and be used to criminalize prostitution and drive the industry further underground. He rather recommends regular access to sexual health care services and intensive support for consistent condom use in containing HIV epidemic in Botswana.     

Childhood trauma and adult prostitution behavior in a multiethnic heterosexual drug-using population

A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects,higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men.     

The income-generating behaviour of injecting drug-users in Oslo

Drug users’income-generating behaviours, such as prostitution, acquisitive crime and small-scale dealing, have a major influence on the harm caused w the non-using population. Using data on the drug use and income sources of 900 drug-injectors in Oslo, this paper has two aims: to present data on Oslo income-generating behaviours and compare these with those in the Netherlands and Scotland; and to explore conceptual issues in the comparison of self-reported dealing income with other sources. Eighty-three per cent of respondents reported income from social benefit, and 43% had sold drugs in the last month. Half the females reported income from prostitution. The income-generation differences found in the comparisons section do not seem to reflect variations in drug and other social policies, but may relate to differences in the profitability of dealing. Using self-reported dealing income to compare the contributions of different income sources may be misleading, however, since it does not reflect financial profit or the value of dealers’drug consumption. Adjusted figures show that theft accounts for 23% of total drugs expenditure, while the corresponding figures for dealing and prostitution are 42% and 21%, respectively.     

Injecting drug use and female street-working prostitution in Glasgow

There are considerable difficulties associated with calculating the prevalence of covert, illegal and stigmatized activities. This paper outlines new methods we have developed for calculating the prevalence of both drug-injecting street prostitution and non-injecting street prostitution in Glasgow. Our data indicate that Glasgow has a much higher level of injecting drug use than has been reported among prostitutes in other British cities.     

EFFECT OF ANO-RECEPTIVE HOMOSEXUAL PRACTICE ON T LYMPHOCYTES AND DELAYED HYPERSENSITIVITY IN TRANSSEXUALS

To determine whether ano-receptive sexual intercourse adversely affects a person's cellular immunity, we compared several immunological parameters among 100 transsexual male prostitutes and 40 heterosexual male controls, and also among different durations of prostitution. The mean ratios of CD-4 (helper/inducer) lymphocytes to CD-8 (suppressor/cytotoxic) lymphocytes and the delayed-type cutaneous hypersensitivity (DTH) scores were significantly lower in transsexuals than they were in heterosexual controls; these parameters also showed a decreasing trend with increasing duration of prostitution. Transsexuals have a significantly higher CD-8 lymphocyte count than have heterosexuals. No significant differences between transsexuals and heterosexuals were found for lymphocyte counts, pan T cells, and CD-4 cell counts. We postulate that in these subjects cellular immunity is progressively reduced, probably through repeated and prolonged antigenic challenge via receptive anal intercourse. The impairment in cellular immunity is associated with the duration of prostitution, independent of the man's age.     

HIV Knowledge and Sexual Risk Behaviors of Street Children in Takoradi, Ghana

A pilot survey was conducted among 100 street children aged 11–19 years and data collected regarding HIV knowledge, risk behaviors, home and sexual experiences, and factors that contributed to their relocation to the street environment. Data indicated that 80% of the street children had at least minimal knowledge of HIV and 54% perceived themselves to be at risk for contracting HIV. More than three-fourths of the females, and over half of the boys reported ever having sex. There were significant differences between males and females for sexual activity, physical and sexual abuse, and prostitution, as girls were more likely to be sexually active, physically abused, and involved in prostitution.     

Implication of Gender Differences in Heroin‐Assisted Treatment: Results from the German Randomized Controlled Trial

Despite a lower prevalence of opioid dependence among females, drug‐related problems and risk factors such as prostitution have a negative effect for women in treatment. This study was conducted with the purpose of analyzing gender differences in the German trial on heroin‐assisted treatment (HAT), which compared HAT with methadone maintenance treatment (MMT). Significant baseline gender differences were found, with females showing a greater extent of mental distress. Differences in retention and outcome were significant for male patients, but no differences between treatment options were found for female patients. Ongoing prostitution was found to influence drug use outcomes. Other outcome criteria may need to be stressed when assessing the effect of HAT for women. (Am J Addict 2010;00:1–7)     

Sexual risk behavior among heterosexual intravenous drug users: ethnic and gender variations

We analyzed the relationship of ethnicity and gender to high-risk sexual behavior among 457 male and female heterosexual intravenous drug users (IVDUs) interviewed in street and clinic settings in San Francisco. Over two-thirds said they never used condoms. More of the black respondents had not been enrolled in treatment. White IVDUs were more likely to report 10 or more partners, anal sex, and a steady drug-injecting partner; black respondents more often reported prostitution. More men said they never used condoms, and more women said they engaged in prostitution. These high-risk sexual behaviors were significantly and independently associated with ethnicity or gender when other sociodemographic variables were held constant. Sexual risk reduction for IVDUs, focusing on condom use, needs to be expanded to reach non-injecting partners. Intervention is critical for the black community, where a high proportion of IVDUs have steady non-injecting partners.     

Prevalence of HIV and other sexually transmitted infections,and risk behaviours in unregistered sex workers in Dakar,Senegal

OBJECTIVES: To estimate the prevalence rates of HIV and other sexually transmitted infections (STI) among unregistered sex workers, and to describe their sociodemographic characteristics and sexual behaviours, and the reasons why they were not officially registered as sex workers, in order to design specific public health interventions. METHODS: A one-stage cluster-sample survey was conducted in Dakar in 2000. Unregistered sex workers were interviewed in randomly selected establishments (official and clandestine bars, brothels and nightclubs), and blood, endocervical and vaginal samples were collected for laboratory diagnosis. RESULTS: A total of 390 women with a median age of 29 years were recruited. One-seventh of them were under the legal age for prostitution in Senegal (21 years). The median length of prostitution was 24 months and 73.5% of the women stated regular prostitution. Three-quarters of the women were found to have markers for at least one infection. The prevalence rates were as follows: HIV-1, 6.0%; HIV-2, 3.6%; HIV-1+2, 0.4%; syphilis, 23.8%; gonorrhea, 22.0%; chlamydial infection, 20.0%; trichomoniasis, 22.4%; candidiasis, 19.0%; and bacterial vaginosis, 28.8%. The main reported reason for non-registration was ignorance of the legal system and its procedures (19.4%); 18.9% of the women refused to register. One-third of the women reported that their clients used condoms inconsistently or never. CONCLUSION: This survey suggests that a multidimensional public health response is needed in Senegal, comprising legal information, downwards revision of the legal age for prostitution, and specific medical follow-up based on education, condom promotion and management of STI for non-registered sex workers.     

Charges for Criminal Exposure to HIV and Aggravated Prostitution Filed in the Nashville, Tennessee Prosecutorial Region 2000–2010

This paper examines comprehensive data on arrests for HIV-specific crimes within a single jurisdiction, the Nashville Tennessee prosecutorial region, over 11 years. There were 25 arrests for HIV exposure and 27 for aggravated prostitution. Eleven of the arrests for HIV exposure involved nonsexual behaviors; none alleged transmission. Sixteen of the arrests for HIV exposure involved sexual behavior; three alleged transmission. Aggravated prostitution cases (i.e. prostitution while knowing one has HIV) often involved solicitation of oral sex; none alleged transmission. Maximum sentences for HIV-specific crimes ranged from 5 to 8 years. We conclude that enforcement of US HIV-specific laws is underestimated. Fifty-two arrests over 11 years were recorded in one jurisdiction. Over half of the arrests involved behaviors posing minimal or no HIV transmission risk. Despite concerns about malicious, intentional HIV transmission, no cases alleged malice or intention.     

Gender Differences in Sex-Risk Behaviors,Economic Livelihood,and Self-Concept Among Drug Injectors and Crack Smokers

The authors compared male and female substance abusers and found that female substance abusers were at increased risk for HIV, relative to males, through sex-risk behaviors. Specifically, women were more likely to have had sexual relations with a drug injector and greater involvement in prostitution, including exchanging sex for drugs or money, than men. Women had fewer legitimate employment opportunities and were less likely to have received support through illegal sources, excluding prostitution, than men. Women bad significantly lower perceived self-concept, greater depression, and more anxiety than men. Gender, economic means of support, and self-concept were highly interrelated. These findings underscore the need for interventions that address the economically marginalized position of addicted women and their low self-concept.