Changing behaviors and patterns among Cambodian sex workers: 1997-2003

OBJECTIVE: Identify patterns and behaviors among direct and indirect female sex workers (DFSWs and IDFSWs, respectively) across Cambodia's 5 major cities from 1997 to 2003. METHODS: Interviews with DFSWs and IDFSWs followed random selection from clusters in 5 cities. Individual characteristics and condom use with clients and other partners were assessed in univariate and multivariate analyses. RESULTS: From 1997 to 2003, consistent condom use with clients increased from 53% to 96% among DFSWs and from 30% to 84% among IDFSWs. DFSWs reported staying in their profession longer, had fewer clients per day, stayed longer in each brothel, were in increasingly larger brothels, and were tested more for HIV. For IDFSWs, there were significant changes: more reported practicing commercial sex and testing for HIV. In adjusted models, reported condom use with clients was significantly higher among DFSWs in later survey years (odds ratio [OR], 2.17) and who were never married (OR, 1.69), were in larger brothels (OR, 1.02), and charged more for sex (OR, 1.27), but lower for DFSWs with sweethearts (OR, 0.68) and who reported abnormal vaginal discharge (OR, 0.52). For IDFSWs, in the adjusted models, reported condom use with clients was higher in later years (OR, 1.77) and for those reporting abnormal vaginal discharge (OR, 1.34) and HIV testing (OR, 1.46), and lower for those with sweethearts (OR, 0.49). CONCLUSIONS: From 1997 to 2003, Cambodian direct and indirect sex workers increased their use of condoms each year with commercial as well as noncommercial partners, contributing to the evidence that HIV prevention programs can produce significant changes in risk behaviors.     

Prevalence and genotype distribution of human papillomavirus infection among female sex workers in Guangxi, China: implications for interventions

Human papillomavirus (HPV) infection is a major public health concern in women, but information on HPV among female sex workers in China is limited. The aim of the study was to estimate the prevalence and genotype distribution of HPV infection among female sex workers in two cities in Guangxi, China. A total of 811 female sex workers were recruited from venues between July and September of 2009. Data on socio-demographic and behavior characteristics were collected, and cervical swabs were collected to determine HPV infection and genotype distribution. The overall prevalence of infection with any HPV type was 38.9%. HPV type 52 was the most prevalent type with prevalence of 11%, followed by HPV types 16, 58, 53, and CP8304, with prevalences of 6.5%, 5.7%, 5.6%, and 4.8%, respectively. HPV 16 or 18 accounted for 23.2% of all HPV positive cases. Age group <20 years was significantly associated with infection of the high-risk and multiple types of HPV infection. A higher prevalence of multiple HPV infection was observed among female sex workers from the outdoor venues (14.0%; 95%CI, 10.6%-17.3%). These findings have important implications for developing HPV prevention programs including HPV vaccination in female sex workers.     

Trafficked female sex workers awaiting deportation: comparison with brothel workers

Summary In 2002, we researched the psychosocial characteristics of 55 women working in the commercial brothel-based sex industry in three Israeli cities. This previous social epidemiological study focused exclusively on women working in brothels and the brothel owners consented to their interviews, suggesting that this might be a sample of the most organized brothels with the best social conditions. We therefore decided to study a second sample obtained by different referral methods. The sample consisted of 49 women in a detention center who are awaiting judicial hearings for deportation. This prison sample of sex workers is strikingly similar to the previously studied sample of sex workers working in brothels in terms of demographic features and working conditions. A higher percentage of the prison sample reported depression and somatic symptoms. However, this finding is consistent with a reaction to being arrested and awaiting deportation. Guided by a life course perspective, in the combined sample, we examined whether early exposure to trauma, motherhood and early entry into sex work affected current health and mental health. Those who were mothers were likely to have entered sex work at a later age but no other aspect of their working conditions differed from the non-mothers suggesting that motherhood per se did not appreciably change the experience of these mostly trafficked women sex workers. Early exposure to trauma increased the likelihood for work-related trauma, poor health and mental health outcomes.     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.     

Sexually transmitted infection service use and risk factors for HIV infection among female sex workers in Georgetown, Guyana

OBJECTIVES: To identify risk factors for HIV and sexually transmitted infection (STI) service use patterns among female sex workers in Georgetown, Guyana. DESIGN: A cross-sectional study was conducted among 299 female commercial sex workers. METHODS: HIV prevalence was assessed using an oral fluid test, and sociodemographic and behavioral data by interview administered by sex workers and women's group members. RESULTS: HIV prevalence was 30.6% [95% confidence interval (CI) 24.9-36.3]. Multivariate logistic regression found a significant association between HIV infection and having a vaginal ulcer in the last 12 months [odds ratio (OR) 4.0, CI 1.4-12.0]. Having had a vaginal ulcer was associated with use of cocaine. Multivariate logistic regression on STI service use variables found significant associations between HIV infection and getting condoms from public sector STI services (OR 3.1, CI 1.6-5.8), not going back for HIV test results (OR 3.4, CI 1.1-10.1), and last getting tested for HIV more than 6 months ago (OR 2.8, CI 1.3-6.2). CONCLUSIONS: An active program of screening and treatment of ulcerative STIs should be combined with substance abuse services for sex workers (SW). Condom promotion services are reaching SW at high risk, but HIV stigma may prevent SW at high risk from accessing HIV test results.     

Suppressed cellular alloimmune responses in HIV-exposed seronegative female sex workers

Particular human leucocyte antigen (HLA) polymorphisms have been associated with a reduced risk of HIV transmission. However, protective alloimmune responses expected to result from such a genetic predisposition have not been demonstrated. To this end, we analysed and compared cellular and humoral alloimmune responses in a cohort of female sex workers who remained human immunodeficiency virus (HIV)‐seronegative despite more than 3 years of high‐risk sexual activity (ESN FSWs) with those of low‐risk HIV‐seronegative female blood donors in Abidjan, Côte d’Ivoire. ESN FSWs showed significantly lower allostimulated CD69 expression and secretion of interferon‐γ, macrophage inflammatory protein (MIP)‐1β and RANTES (regulated upon activation, normal T‐cell expressed and secreted) by lymphocytes than controls. In contrast, ESN FSWs showed significantly higher mitogen‐stimulated CD69 expression and secretion of tumour necrosis factor‐α and MIP‐1β than controls. Suppression of cellular alloimmune responses among ESN FSWs was associated with a higher self‐reported frequency of unprotected sex. Levels of anti‐HLA class I alloantibodies in plasma were not significantly different between ESN FSWs and controls. These findings indicate that frequent sexual exposure to multiple partners results in suppression rather than activation of cellular alloimmune responses. Our data support the hypothesis that suppressed cellular alloimmune responses may play a role in protection against HIV infection.     

Mental health status among female sex workers in Tabriz,Iran

Female sex workers are a deprived part of Islamic communities. It is necessary for public health policy makers to have knowledge about their mental health status. This study aims to have an evaluation of mental health among female sex workers in Tabriz for the first time in northwest of Iran. In this cross-sectional study, 48 female sex workers who had accepted to be evaluated were included. Sociodemographic and general mental health statuses, using General Health Questionnaire (GHQ-28), were recorded. Those with GHQ-28 score more than 23/24 in the first session were thoroughly interviewed in a second session in order to find out their specific mental disorder, using Structured Clinical Interview for DSM-IV axis 1 and 2 Disorders (SCID 1 and 2). This study suggests that 62.5% of female sex workers suffer from a mental health problem which is in accordance with previous studies. Mood and anxiety disorder were two of the most common, and there were also records of personality disorders among participants of this survey. There were also high rates of addiction in female sex workers of this study. Based on findings of this study, high rates of mental disorders such as personality disorders, anxiety disorder, and mood disorder were detected among female sex workers in the northwest of Iran. Financial incentive was reported to be the primary motivation for choosing sex work as a source of income.

     

HIV infection and risk characteristics among female sex workers in Hanoi, Vietnam

The prevalence of HIV/sexually transmitted diseases (STDs) was determined, the risk characteristics examined, and factors associated with HIV infection identified among noninstitutionalized female sex workers (FSWs), using a cross-sectional survey with 2-stage cluster sampling. Four hundred FSWs were interviewed face to face using a structured questionnaire and tested for HIV, syphilis, Chlamydia infection, and gonorrhea. HIV seroprevalence was 12%, syphilis 17% (using the treponemal pallidum hemagglutination assay), Chlamydia infection 3.8% (using polymerase chain reaction [PCR]), and gonorrhea 6.3% (PCR). Lower-class FSWs averaged 2 clients per day, and middle-class FSWs about 1.2. Median duration in sex work was 2.3 years. Consistent condom use was 63% with irregular clients, 41% with regular clients, and only 4.8% with "love mates." Fifty-five percent had had sex with a drug user(s). Thirty-eight percent used drugs, of whom 83% injected. Factors associated with HIV included being young, having a low level of education, longer residence in Hanoi, being a lower-class FSW, having higher income compared with peers, perception of self being at low risk for HIV, poor knowledge of HIV, and sharing injecting equipment. Intervention strategies should include reduction of both stigmatization and sharing of drug paraphernalia, promotion of nonstigmatizing voluntary testing and counseling, and aggressive marketing and promotion of condoms.     

PEPFAR's evolving HIV prevention approaches for key populations--people who inject drugs, men who have sex with men, and sex workers: progress, challenges, and opportunities

In most countries, the burden of HIV among people who inject drugs, men who have sex with men, and sex workers is disproportionately high compared with that in the general population. Meanwhile, coverage rates of effective interventions among those key populations (KPs) are extremely low, despite a strong evidence base about the effectiveness of currently available interventions. In its first decade, President's Emergency Plan for AIDS Relief (PEPFAR) is making progress in responding to HIV/AIDS, its risk factors, and the needs of KPs. Recent surveillance, surveys, and size estimation activities are helping PEPFAR country programs better estimate the HIV disease burden, understand risk behavior trends, and determine coverage and resources required for appropriate scale-up of services for KPs. To expand country planning of programs to further reduce HIV burden and increase coverage among KPs, PEPFAR has developed a strategy consisting of technical documents on the prevention of HIV among people who inject drugs (July 2010) and prevention of HIV among men who have sex with men (May 2011), linked with regional meetings and assistance visits to guide the adoption and scale-up of comprehensive packages of evidence-based prevention services for KPs. The implementation and scaling up of available and targeted interventions adapted for KPs are important steps in gaining better control over the spread and impact of HIV/AIDS among these populations.     

HIV infection and sexually transmitted diseases in female commercial sex workers in China

A cross-sectional survey was conducted among female commercial sex workers (FSWs) in Zhengzhou, China, to estimate rates of HIV infection and sexually transmitted diseases (STDs) and to document their sexual behavior patterns from October 2000 to January 2001. FSWs were recruited by the snowball sampling technique and were interviewed at their working environments anonymously. This strategy resulted in high rates of response (92%) and concordance (98%) to sensitive questions. A total of 621 FSWs were enrolled. One direct FSW and 1 indirect FSW were positive for antibodies to HIV in oral fluids (prevalence of HIV infection, 1.4% and 0.2%, respectively). A history of STDs was reported by 49% of the FSWs. Most FSWs (87%) reported inconsistent condom use. Ten percent of FSWs recognized their clients as drug users. A few FSWs (2.2%) were injecting drug users, of whom 2 reported incidents of sharing needles/syringes with other injecting drug users. Direct FSWs had more risk characteristics and were more vulnerable to HIV infection and STDs than indirect FSWs. Inconsistent use of condoms and a high level of STDs underscore the urgent need to implement intervention strategies and condom promotion, particularly among direct sex workers in China.     

Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.     

Psychotherapeutic interventions for female sexual dysfunction

This paper summarizes basic elements of psychotherapeutic interventions in women with female sexual dysfunction. Many women can be helped simply by being allowed to talk about their concerns in a safe and sympathetic environment or by being provided with basic information about female physiology and the sexual response. For other women, biomedical treatment (e.g. sex hormone therapy) may be appropriate. For those women who require more intensive or sustained psychotherapy, a variety of different approaches can be combined in a treatment program.     

Knowledge,attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

Background

There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers).

Objective

To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda

Methods

Structured questionnaires were administered to explore FSWs'' and truckers'' knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed.

Results

Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, “using condoms properly and consistently reduces risk of HIV infection”. Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, “condom use is the best method of HIV prevention”. Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms ‘kill the mood for sex’ remain key barriers to consistent condom use.

Conclusions

Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.     

A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men

This meta-analysis examines the efficacy of international HIV prevention interventions designed to reduce sexual risk behavior of men who have sex with men (MSM). We performed a comprehensive search of published and unpublished English-language reports of HIV prevention interventions that focus on MSM and evaluated changes in risky sexual behavior or biologic outcomes related to sexual risk. Data from 33 studies described in 65 reports were available as of July 2003. Studies with insufficient data to calculate effect sizes were excluded from the meta-analysis. Interventions were associated with a significant decrease in unprotected anal intercourse (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.65-0.92) and number of sexual partners (OR = 0.85, 95% CI: 0.61-0.94) and with a significant increase in condom use during anal intercourse (OR = 1.61, 95% CI: 1.16-2.22). Interventions successful in reducing risky sexual behavior were based on theoretic models, included interpersonal skills training, incorporated several delivery methods, and were delivered over multiple sessions spanning a minimum of 3 weeks. Behavioral interventions provide an efficacious means of HIV prevention for MSM. To the extent that proven HIV prevention interventions for MSM can be successfully replicated in community settings and adapted and tailored to different situations, the effectiveness of current HIV prevention efforts can be increased.     

Adherence to oral HIV pre-exposure prophylaxis among female sex workers in Kampala,Uganda

IntroductionIn Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence.MethodsThis cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were interviewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done.ResultsUsing long-term contraception methods (OR 0.06, 95% CI: 0.04–0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01–0.42) were negatively associated with high PrEP adherence.ConclusionBarriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks.     

Etiology of sexually transmitted infections among street-based female sex workers in Dhaka, Bangladesh

An etiological study of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Dhaka, Bangladesh. Endocervical swab and blood samples from 269 street-based FSWs were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis as well as for antibodies to Treponema pallidum and herpes simplex virus 2 (HSV-2). Sociodemographic data and data regarding behavior were also collected. A total of 226 of the 269 FSWs (84%) were positive for the STI pathogens studied. Among the 269 FSWs, 35.5% were positive for N. gonorrhoeae, 25% were positive for C. trachomatis, 45.5% were positive for T. vaginalis, 32.6% were seropositive for T. pallidum, 62.5% were seropositive for HSV-2, and 51% had infections with two or more pathogens.