Vaginal douching, condom use, and sexually transmitted infections among Chinese female sex workers

BACKGROUND AND OBJECTIVE: Vaginal douching has been hypothesized to increase a woman's risk for human immunodeficiency virus (HIV) infection. However, data on the prevalence of this practice and its association with condom use and sexually transmitted infections (STIs) are limited. STUDY: A cross-sectional survey among 454 female sex workers (FSWs) in a Chinese county. RESULTS: Vaginal douching was reported by 64.7% of the women. The prevalence of self-reported history of STI and that of current STI was 19.4% and 41.5%, respectively. Fifteen percent of the women reported consistent use of condoms with their clients and 8.4% with their regular partners. Vaginal douching was significantly associated with decreased use of condoms (with clients: OR = 0.31; with regular partner(s): OR = 0.22) and increased rate of self-reported STI history (OR = 1.95). However, there was no direct relation between douching and current STI. Over one third of the women believed that douching can prevent STI/HIV. CONCLUSION: Vaginal douching exposes FSWs to a high risk of STI/HIV. Medical professional and public health workers should correct women's misconception about the effectiveness of douching and discourage women from douching through educational activities.     

HIV and other sexually transmitted infections among female sex workers in Kinshasa, Democratic Republic of Congo, in 2002

OBJECTIVE: The objective of this study was to determine the prevalence and risk factors of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs) in Kinshasa, Democratic Republic of the Congo, in 2002. STUDY DESIGN: A cross-sectional study was conducted among FSWs presenting for the first time at the STI clinic of Matonge, Kinshasa. The women were interviewed about sociodemographic characteristics, type of sex work, and sexual behavior. Blood was taken for HIV, syphilis, and herpes simplex virus type 2 serology. Vaginal secretions were collected on swabs for the diagnosis of gonorrhea, chlamydia, and trichomoniasis. RESULTS: The overall HIV prevalence was 12.4% but varied within the different categories of FSWs: 11.8% in hotel-based, 24.0% in home-based, and 20.0% in street-based FSWs; 10.0% in homeless FSWs; and 6.6% in Masquées (clandestine sex workers). The overall herpes simplex virus type 2 seroprevalence was 58.5%. CONCLUSIONS: The prevalence of HIV and other STIs seems to have stabilized since the beginning of the project in 1988.     

Prevalence of Chlamydia trachomatis infection in registered female sex workers in northern Mexico

BACKGROUND: Little is known about the epidemiology of Chlamydia trachomatis infection in female sex workers (FSWs) in Mexico. GOAL: The goal of the study was to determine the prevalence of C trachomatis infection in registered FSWs from northern Mexico and to determine the sociodemographic characteristics associated with the infection. STUDY DESIGN: An enzyme immunoassay was used to test 354 FSWs in three northern Mexican cities for cervical C trachomatis infection. All participants were registered in a government health office. Recruitment was consecutive and voluntary. The association between clinical and sociodemographic characteristics of FSWs and infection was evaluated. RESULTS: The overall prevalence of C trachomatis infection among participants in the three cities was 12.4%. Women of low socioeconomic level and those younger than 25 years were the most frequently infected. Among FSWs in Durango, a higher frequency of C trachomatis infection was found for those who did not use condoms. CONCLUSION: C trachomatis is an important pathogen in the sexually transmitted diseases of registered FSWs in northern Mexico.     

HIV and STIs in clients and female sex workers in mining regions of Gejiu City, China

OBJECTIVE: To investigate HIV/sexually transmitted infections (STIs) among female sex workers (FSWs) and clients in a mining region of China. GOAL: To estimate HIV/STI prevalence and to identify HIV risk factors among FSWs and miner clients. STUDY DESIGN: A cross-sectional study of 96 FSWs and 339 miner clients. RESULTS: In FSWs, prevalence of HIV was 8.3%, herpes simplex virus-2 70.8%, syphilis 12.5%, Neisseria gonorrhoeae 36.8%, Chlamydia trachomatis 46.3%, Trichomonas vaginalis 22.1%, and 90.6% were infected with any STI. Illegal drug use was associated with HIV [adjusted odds ratio (OR) = 45.1, 95% confidence interval, 6.4-317.9] in FSWs, and 45.8% reported no condom use with the last client. In miner clients, HIV prevalence was 1.8%, herpes simplex virus-2 14.9%, syphilis 2.4%, N. gonorrhoeae 2.1%, C. trachomatis 6.5%, and 23.2% were infected with any STI. Never using condoms with FSWs and regular partners were reported in 61.2% and 84.1%, respectively. Independent risk factors for HIV in miner clients were illegal drug use (OR 190.2), symptoms of urethral discharge or frequent urination (OR 32.9), early sexual debut (OR 7.1), and visiting 4 or more FSWs in the last 12 months (OR 11.5). CONCLUSIONS: HIV/STI prevalence is high among FSWs and moderate among clients in mining regions of Gejiu City. Drug use is the most important factor placing FSWs and miner clients at risk for HIV in Gejiu City; risky sexual characteristics such as early sexual debut, frequent visits to FSWs, and STI symptoms are also important factors for miner clients. FSWs and miner clients may constitute bridging groups for HIV to low-risk populations.     

Impact of a community sexually transmitted infection/HIV intervention project on female sex workers in five border provinces of Vietnam

OBJECTIVES: To determine changes in the prevalence of sexually transmitted infection (STI)/HIV in female sex workers (FSWs) after a community HIV prevention intervention project in five border provinces of Vietnam. METHODS: The project focused on providing user-friendly STI services for FSWs using mobile teams operating at multiple sites depending on local client preferences. 911 FSWs were enrolled at baseline and 982 in the exit survey. Study participants were interviewed about sociodemographic characteristics, sexual behaviour, history of STIs and selected features of their husbands or cohabiting partners, and were tested for STIs. RESULTS: The overall prevalence rates of HIV, syphilis, herpes simplex virus 2 (HSV-2) antibodies, gonorrhoea (GC), Chlamydia trachomatis (CT), and GC and/or CT among FSWs in the five border provinces in 2004 were 3.6%, 12.9%, 24.9%, 2.9%, 9.1% and 11.3%, respectively. Compared with baseline values, GC and/or CT decreased significantly from 19.9% to 11.3%, GC from 10.7% to 2.9% and CT from 11.9% to 9.1%. HIV decreased from 4.5% to 3.6%, and HSV-2 antibodies from 27.7% to 24.9%. After adjustment for possible confounders, a significant overall decrease in having GC and/or CT (OR = 0.46, 95% CI 0.33 to 0.65; p<0.001) and GC alone (OR = 0.22, 95% CI 0.13 to 0.37; p<0.001) was found, and the overall prevalence of syphilis increased significantly (OR = 1.55, 95% CI 1.11 to 2.17 p = 0.011). A marked increase in syphilis from 1.0% to 14.1% was identified in the Lai Chau province. CONCLUSIONS: Implementation of the project was associated with a reduction in GC and/or CT infections in FSWs, more so with GC than with CT. A notable increase in syphilis in Lai Chau was identified. HIV/STI interventions in FSWs can be implemented by government services and should be intensified and expanded to other provinces.     

High prevalence of sexually transmitted infections among female sex workers in the eastern highlands province of Papua New Guinea: correlates and recommendations

BACKGROUND: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. GOAL: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. STUDY: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociodemographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. RESULTS: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. CONCLUSIONS: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.     

Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades

OBJECTIVE: The objective of this study was to address the role of heterosexual transmission of HIV in China. GOAL: The goal of this study was to explore the prevalence of unsafe sex and the likelihood of HIV spread heterosexually from core populations to others. STUDY: The authors conducted a review of behavioral studies. RESULTS: Drug users were more likely to be involved in higher-risk sexual behaviors than were those who abstained from using drugs. Most female drug users (52-98%) reported having engaged in commercial sex. Most female sex workers (FSWs) and individuals with sexually transmitted diseases (STDs) had concurrent sexual partners. Many continued to have unprotected sex after noticing STD symptoms in themselves or their sexual partners. From 5% to 26% of rural-to-urban migrants had multiple sexual partners and 10% of males patronized FSWs during migration. CONCLUSIONS: Factors such as high rates of FSW patronage, low rates of condom use during commercial sex, having sex with both commercial and noncommercial sexual partners, and high rates of STD infection may promote a heterosexual epidemic in China.     

Prevalence of sexually transmitted infections and high-risk sexual behaviors in heterosexual couples attending sexually transmitted disease clinics in Peru

OBJECTIVES: The objectives of this study were to determine the prevalence of sexually transmitted infection (STIs) in heterosexual couples and the sexual behaviors associated with their acquisition. GOAL: The goal of this study was to better direct educational efforts to decrease STI among heterosexual couples in Lima, Peru. STUDY DESIGN: We conducted a case-control study in 195 heterosexual couples without HIV infection who attended 2 sexually transmitted disease clinics in Lima, Peru. A case was defined as an individual with one or more newly diagnosed STIs such as gonorrhea, chlamydia, trichomoniasis, herpes simplex, syphilis, mycoplasma, or ureaplasma. RESULTS: Thirty-three percent of individuals (41 men and 89 women) had at least one STI and 26 couples (13%) had the same STI detected. Men who have sex with men (MSM) accounted for 13% of all men, had higher rate of STIs and higher risk behaviors than non-MSM. Ureaplasma infection was the most prevalent STI found in both men and women and was associated with oral sexual contact. In heterosexual pairs, condom use during anal sex occurred less than 10% of the time. CONCLUSIONS: The heterosexual couples in sexually transmitted disease clinics have high-risk behaviors and STIs are frequent. The educational effort concerning prevention of STIs requires higher effort.     

Characteristics of female sex workers with US clients in two Mexico-US border cities

BACKGROUND: HIV prevalence is increasing among female sex workers (FSWs) in Tijuana and Ciudad Juarez, 2 Mexican cities on the US border. Quasilegal prostitution in both cities attracts large numbers of sex tourists. We compared FSWs with and without US clients in both cities. METHODS: FSWs aged > or =18 years reporting unprotected sex with > or =1 client within the last 2 months, who were not knowingly HIV-infected, were enrolled in a behavioral intervention study. At baseline, participants underwent interviews, antibody testing for HIV and syphilis, and vaginal swabs for detecting gonorrhea and Chlamydia. Logistic regression identified factors associated with reporting >1 US client. RESULTS: Of 924 FSWs, 69% had US clients. Median age and duration in sex work were 32 and 4 years. Prevalence of HIV, infectious syphilis (titer > or =1:8), gonorrhea, Chlamydia, and any STI was 6%, 14%, 6%, 13%, and 27%, respectively. Compared with other FSWs, FSWs with US clients were more likely to have syphilis titers > or =1:8 (16% vs. 10%, P = 0.01), gonorrhea (8% vs. 2%, P <0.001) or any STI, including HIV (30% vs. 20%, P = 0.002). Factors independently associated with having US clients were: living in Tijuana, being younger, speaking English, being paid more for having sex without a condom, having >250 clients in the last 6 months, having syphilis titers > or =1:8, and injecting drugs. CONCLUSIONS: In these border cities, FSWs reporting US clients were more likely to have current STIs and to engage in higher-risk behaviors. Intensified binational prevention efforts involving both FSWs and their clients are urgently needed.     

Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America

OBJECTIVE: Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America. METHODS: Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests. RESULTS: The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries. CONCLUSIONS: Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.     

Risk factors and prevalence of HIV and sexually transmitted infections among low-income female commercial sex workers in Mongolia

BACKGROUND: Mongolia has very low HIV prevalence despite high rates of sexually transmitted infections (STIs). Low-income female sex workers (FSWs) may be at high risk for acquiring and spreading the disease in Mongolia. GOAL: The goal of this study was to assess the prevalence and risk factors associated with the acquisition of HIV, syphilis, gonorrhea, and trichomoniasis among low-income female commercial sex workers in 3 urban centers in Mongolia. STUDY DESIGN: One hundred seventy-nine low-income FSWs were tested for HIV (enzyme immunoassay) and 132 were tested for syphilis (Treponema pallidum hemagglutination-confirmed), gonorrhea (Gram stain and culture), and trichomoniasis (wet mount microscopy). Questionnaires detailing socioeconomic characteristics, sexual behaviors, drug and alcohol use, general health, and STI/HIV knowledge were completed by 149 women. RESULTS: No HIV infections were found in 179 women. Of 132 women, 57 (43%), 18 (14%), and 37 (28%) tested positive for syphilis, gonorrhea, and trichomonas, respectively; 88 (67%) tested positive for one or more STIs and 22 (17%) were multiply infected. Socioeconomic factors were correlated to reported condom use and infection status. CONCLUSIONS: Low-income FSWs in Mongolia represent a unique population of very high-risk individuals with very low rates of HIV infection. Interventions targeting this population represent a unique opportunity to prevent a potentially rapid increase of HIV infection in urban Mongolia.     

High prevalence of HIV and sexually transmitted infections among indirect sex workers in Cambodia

OBJECTIVES: The goal of this study was to assess the baseline prevalence of and risk factors for HIV and other sexually transmitted infections (STIs) among beer girls enrolled in a behavioral intervention in Battambang, Cambodia. METHODS: Ninety-two of 114 women participated in baseline interviewing, HIV/STI testing, and STI treatment. Blood specimens were tested for syphilis and HIV infection. Self-administered vaginal swabs were tested for trichomonas, bacterial vaginosis (BV), gonorrhea, and chlamydia infections. RESULTS: HIV prevalence was 26%. STI prevalences were: 14% chlamydia, 12% trichomonas, 3% gonorrhea, and 0% syphilis. The prevalence of BV was 43%. A history of sex work was reported by 82%. Consistent condom use with clients was reported by 39%. Increased number of partners and symptoms of STI were significantly associated with HIV infection. DISCUSSION: These data suggest high sexual risk among beer girls in Cambodia. Targeted and frequent HIV and STI interventions are urgently needed in this population.     

Alcohol use by men is a risk factor for the acquisition of sexually transmitted infections and human immunodeficiency virus from female sex workers in Mumbai, India

OBJECTIVE: We investigated whether men who were under the influence of alcohol when visiting female sex workers (FSW) were at greater risk for sexually transmitted infections (STI) and human immunodeficiency virus (HIV). STUDY: A cross-sectional analysis using baseline data from a randomized controlled trial of an HIV prevention intervention for high-risk men in Mumbai, India. RESULTS: The overall HIV prevalence among 1741 men sampled was 14%; 64% had either a confirmed STI or HIV; 92% reported sex with an FSW, of whom 66% reported having sex while under the influence of alcohol (SUI). SUI was associated with unprotected sex (odds ratio [OR]: 3.1; 95% confidence interval [CI], 2.3-4.1), anal sex (OR: 1.5; 1.1-2.0), and more than10 FSW partners (OR: 2.2; 1.8-2.7). SUI was independently associated with having either an STI or HIV (OR: 1.5; 1.2-1.9). CONCLUSION: Men who drink alcohol when visiting FSWs engage in riskier behavior and are more likely to have HIV and STIs. Prevention programs in India need to raise awareness of this relationship.     

Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population

BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.     

Sexually transmitted infections in male clients of female sex workers in Benin: risk factors and reassessment of the leucocyte esterase dipstick for screening of urethral infections

OBJECTIVES: (1) To assess risk factors for urethral infections with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among male clients of female sex workers (FSWs) in Benin; (2) to study the validity of LED testing of male urine samples compared to a highly sensitive gold standard (PCR) for the diagnosis of urethral infections with the organisms cited above. METHODS: Male clients of FSWs (n=404) were recruited on site at prostitution venues in Cotonou, Benin, between 28 May and 18 August 1998. A urine sample was obtained from each participant just before he visited the FSW, and tested immediately using a leucocyte esterase dipstick (LED) test. It was then tested for HIV using the Calypte EIA with western blot confirmation, and for C. trachomatis, N. gonorrhoeae, and T. vaginalis by PCR. After leaving the FSW's room, participants were interviewed about demographics, sexual behaviour, STI history and current symptoms and signs, and were examined for urethral discharge, genital ulcers, and inguinal lymphadenopathies. RESULTS: STI prevalences were: C. trachomatis, 2.7%; N. gonorrhoeae, 5.4%; either chlamydia or gonorrhoea 7.7%; T. vaginalis 2.7%; HIV, 8.4%. Lack of condom use with FSWs and a history of STI were independently associated with C. trachomatis and/or N. gonorrhoeae infection. Over 80% of these infections were in asymptomatic subjects. The overall sensitivity, specificity, positive and negative predictive values of the LED test for detection of either C. trachomatis or N. gonorrhoeae were 48.4%, 94.9%, 44.1%, and 95.7%, respectively. In symptomatic participants (n=22), all these parameters were 100% while they were 47.4%, 94.7%, 37.5%, and 96.4% in asymptomatic men (n=304). CONCLUSIONS: Since most STIs are asymptomatic in this population, case finding programmes for gonorrhoea and chlamydia could be useful. The performance characteristics of the LED test in this study suggest that it could be useful to detect asymptomatic infection by either C. trachomatis or N. gonorrhoeae in high risk men.     

Syphilis among female sex workers in southwestern China: potential for HIV transmission

OBJECTIVE: The objective of this study was to investigate the prevalence and risk factors of syphilis infection among female sex workers in a southwestern Chinese city along a drug trafficking route. METHODS: From December 2004 to January 2005, 343 female sex workers (FSWs) were recruited through community outreach and peer referring. Confidential questionnaire interviews were administered to collect information on sexual and other sexually transmitted diseases/HIV risk behaviors. Cervical and blood samples were collected to test for syphilis and HIV antibodies and Neisseria gonorrhoeae infection; Condyloma acuminatum infection was diagnosed clinically. RESULTS: Of 343 FSWs, 15.7% were infected with syphilis. The prevalence of HIV, gonorrhea, and C. acuminatum was 0.6%, 2.0%, and 1.5%, respectively. The subtype of 2 HIV-1 infections was both CRF 07BC. Nearly 10% of FSWs reported using illicit drugs. Consistent use, inconsistent use, and never use of condoms with commercial sex clients in the last month were reported by 53.9%, 38.5%, and 7.6% FSWs, respectively. Longer duration of sex work (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.08-3.62), working at low-end establishments (OR = 2.03; 95% CI = 1.10-3.76), and if primary sex partners had sex with other women in the past 6 months (OR = 2.06; 95% CI = 1.08-3.91) were independently associated with syphilis infection. CONCLUSIONS: High prevalence of syphilis and overlapped unprotected commercial sex and drug using behaviors among FSWs along a drug-trafficking route may suggest a potential for rapid spread of HIV from injection drug users to FSWs and then to the general population and underscore the urgency of preventive interventions to break the bridge of FSWs for HIV/sexually transmitted disease spread.     

HIV in female sex workers in five border provinces of Vietnam

OBJECTIVES: To determine the prevalence of HIV and associated risk factors among female sex workers (FSWs) in border provinces of Vietnam. METHODS: 911 FSWs in five border provinces of Vietnam (Lai Chau, Quang Tri, Dong Thap, An Giang, and Kien Giang) were enrolled in a cross sectional study. Subjects were interviewed using a standardised questionnaire about selected sociodemographic and behavioural characteristics, history of STIs, and information about their cohabiting partners (husbands or live-in partners). Serological tests were done for HIV and syphilis (TPHA+RPR) and urine tests (PCR) for chlamydia and gonorrhoea. Associations between HIV and selected features of FSWs and their partners were examined using univariate and multivariate logistic regression analysis. RESULTS: Overall, the prevalence of HIV among FSWs in the five provinces of Vietnam was 4.5%. The prevalence of HIV was higher in the southern border regions (4.0%-7.0%) than the northern (2%) and central (1%) regions. In multivariate analysis between HIV and selected features of FSWs, income < or =$33/month (OR 2.36, p = 0.04), age of first sex < or =15 (OR = 5.48, p = 0.005), and > or =9 clients per week (OR 2.80, p = 0.018) were associated with HIV infection. Positive syphilis serology achieved a borderline significant association with HIV (OR 2.30, p = 0.095). Having a regular non-paying partner (OR = 0.35, p = 0.060) was a borderline protective factor for HIV. CONCLUSION: Interventions to limit HIV transmission among FSWs in Vietnam should be implemented early and focus on young poor populations in these border areas.     

Identification of novel risks for nonulcerative sexually transmitted infections among young men in Kisumu, Kenya

OBJECTIVES: STI prevention interventions often aim to reduce HIV incidence. Understanding STI risks may lead to more effective HIV prevention. GOAL: To identify STI risks among men aged 18-24 in Kisumu, Kenya. STUDY DESIGN: We analyzed baseline data from a randomized trial of male circumcision. Participants were interviewed for sociodemographic and behavioral risks. Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were diagnosed by polymerase chain reaction assay and Trichomonas vaginalis (TV) by culture. The outcome for logistic regression analysis was infection with NG, CT, or TV. RESULTS: Among 2743 men, 214 (7.8%; 95% CI: 6.8%-8.8%) were infected with any STI. In multivariable analysis, statistically significant risks for infection were: living one's whole life in Kisumu (OR = 1.50; 95% CI: 1.12-2.01), preferring "dry" sex (OR = 1.47; 95% CI: 1.05-2.07), HSV-2 seropositivity (OR = 1.37; 95% CI: 1.01-1.86), and inability to ejaculate during sex (OR = 2.04; 95% CI: 1.15-3.62). Risk decreased with increasing age and education, and cleaning one's penis less than 1 hour after sex (OR = 0.51; 95% CI: 0.33-0.80). CONCLUSION: Understanding how postcoital cleaning, "dry" sex, and sexual dysfunction relate to STI acquisition may improve STI and HIV prevention.     

Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya

OBJECTIVE: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. METHODS: This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs. Consenting women were administered a questionnaire and screened for STIs. RESULTS: The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV infection was significantly associated with bacterial vaginosis (BV), trichomoniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was the fluid most often used (81%), followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). Douching in general and douching with soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increased frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs. CONCLUSION: The widespread habit of douching among African female sex workers was confirmed. The association between vaginal douching and BV is of concern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a direct association between douching and HIV infection. Further research is required to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.     

HIV infection among people of foreign origin voluntarily tested in Spain. A comparison with national subjects

OBJECTIVES: To describe exposure categories and HIV prevalence among subjects voluntarily tested in Spain by country of origin. METHODS: HIV prevalence and exposure categories were compared between national and non-Spanish subjects voluntarily tested in 18 sexually transmitted disease/HIV testing clinics from 16 Spanish cities in 2000. RESULTS: Of 8861 testers, 2810 (31.7%) came from foreign countries; 73.1% from Latin America, 9.1% from western Europe, 6.2% from central/eastern Europe, 4.4% from northern Africa, and 4.2% from sub-Sahara Africa. Among women from Latin America, 78% were sex workers compared to 5.5% Spanish women. HIV infection was diagnosed in 170 persons, 34.7% from foreign countries. HIV prevalence for Spanish subjects (23% for men and 1.0% for women) was significantly different from men and women from Latin America (11.3% and 0.3% respectively), Sub-Saharan Africa (9.1% and 7.5% respectively), and women from the north of Africa (11.8%). Compared with Spaniards, analyses of persons of the same exposure category showed higher HIV prevalence in men who had sex with men from Latin America (odds ratio: 4.1; 95% CI: 2.4-6.9), heterosexual men from sub-Sahara Africa (OR: 19.3; 95% CI: 6.4-58.0), and Latin America (OR: 9.4; 95% CI: 3.4-25.9), heterosexual women from sub-Sahara Africa (OR: 16.9; 95% CI: 3.5-82.4) and from northern Africa (OR: 15.3; 95% CI: 3.2-73.2). CONCLUSIONS: An important proportion of HIV testers from these clinics came from foreign countries and some groups showed a high prevalence of HIV infection. Specific prevention and testing programmes adapted to the needs of migrants in Spain should be developed.