Sexual and health behaviour of commercial sex workers in Benin City, Edo State, Nigeria

In this paper, examined are the sexual and health behaviours of commercial sex workers in Nigeria, a high-risk group in this era of the acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) epidemic. The aim is to provide in-depth knowledge of their sexual networking and the prevalence rate of sexually transmitted diseases (STDs). This analysis is intended to highlight their implications in the spread and control of AIDS and HIV infection. The results of the study show the extensive sexual networking of these commercial sex workers, the health implications, and the utilisation of nonorthodox health services in diagnosing STDs. The implications of these results are the likely drain on the limited health resources of the Nigerian government and the harmful effects on the women, fetuses, children, and other sexual partners of clients of these commercial sex workers.     

Traditions in transition: young people's risk for HIV in Chiang Mai, Thailand

Thailand is in the midst of a social and sexual transition that is affecting gender roles, sexual behavior, and, hence, risk for HIV. The continuation of past traditions, such as men having sex with commercial sex workers, coupled with an increasing acceptance of noncommercial premarital sex among young people, is fueling the AIDS epidemic. To examine young people's potential risk for HIV, the author investigated their perspectives on sexual behavior and sexual networking, the continued acceptance of premarital sex with commercial sex workers, and perception of risk for HIV in Chiang Mai. This study suggests that a changing social environment and the response to the AIDS epidemic have resulted in new patterns of sexual behavior that might trigger the dissemination of HIV into a broader network.     

Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC).

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.     

Eradicating chancroid

Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is rare in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically vulnerable and occupies a precarious epidemiological niche. Both simple, topical hygiene and male circumcision greatly reduce risk of infection and several classes of antibiotics--some of which can be administered in single-dose treatment regimens--provide rapid cure. H. ducreyi depends on sexual networks with high rates of partner change for its survival, thriving in environments characterized by male mobility and intensive commercial sex activity. Elimination of H. ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community. Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. Social changes--resulting in changing patterns of commercial sex--probably disrupted the conditions needed to sustain chancroid as an endemic disease. Sporadic outbreaks are now easily controlled when effective curative and preventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines. Senegal, and Thailand, a development that may contribute to stabilization of the HIV epidemics in these countries. Eradication of chancroid is a feasible public health objective. Protecting sex workers and their clients from exposure to sexually transmitted diseases (STDs) and improving curative services for STDs are among the proven strategies that could be employed.     

Factors that influence vulnerability to STDs and HIV/AIDS among Hispanic women

Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18-44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =.42, p =.001), although only the latter was related to condom use among single women (r =.29, p =.01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.     

Nonoxynol-9 spermicide contraception use--United States, 1999

Most women in the United States with human immunodeficiency virus (HIV) become infected through sexual transmission, and a woman's choice of contraception can affect her risk for HIV transmission during sexual contact with an infected partner. Most contraceptives do not protect against transmission of HIV and other sexually transmitted diseases (STDs), and the use of some contraceptives containing nonoxynol-9 (N-9) might increase the risk for HIV sexual transmission. Three randomized, controlled trials of the use of N-9 contraceptives by commercial sex workers (CSWs) in Africa failed to demonstrate any protection against HIV infection; one trial showed an increased risk. N-9 contraceptives also failed to protect against infection with Neisseria gonorrhoeae and Chlamydia trachomatis in two randomized trials, one among African CSWs and one among U.S. women recruited from an STD clinic. Because most women in the African studies had frequent sexual activity, had high-level exposure to N-9, and probably were exposed to a population of men with a high prevalence of HIV/STDs, the implications of these studies for U.S. women are uncertain. To determine the extent of N-9 contraceptive use among U.S. women, CDC assessed data provided by U.S. family planning clinics for 1999. This report summarizes the results of that assessment, which indicate that some U.S. women are using N-9 contraceptives. Sexually active women should consider their individual HIV/STD infection risk when choosing a method of contraception. Providers of family planning services should inform women at risk for HIV/STDs that N-9 contraceptives do not protect against these infections.     

Female garment factory workers in Cambodia: migration,sex work and HIV/AIDS

Female garment factory workers in Cambodia are more exposed to HIV/AIDS than previously thought. Although HIV/AIDS epidemics are fast spreading in Cambodia, relatively little is known about the sexual health of women other than those perceived as commercial sex workers or married women of reproductive age. In-depth interviews with 20 unmarried female garment factory workers, who reported to have engaged in multi-partnered sex through direct or discretionary commercial sex occupations, demonstrate that they are exposed to HIV-risk created along the gradients of power. Low socioeconomic status (low education, meager factory wage and high dependency rate at their rural households) and obligations as daughters to provide for the family mainly determine their entry into sex work. At the location of sex work, they are subjected to physical violence, alcohol and drug use, both self-taken and forced, and receive meager wages. In a society where women are expected to be virtuous and obedient to parents and husbands, these workers are motivated to identify male sex partners in paid sex as "sweethearts" rather than "guests." These factors contribute to low consistency of condom use. This paper demonstrates the complex interrelationships between power, cultural definitions of intimacy and economic dependency, which structure sexual relationships and the risk of HIV/AIDS.     

STD-HIV intervention programme: the Sonagachi model

In 1992, a sexually transmitted disease (STD)/HIV Intervention Program was established by India's National AIDS Control Organization in Calcutta's Sonagachi, Rambagan and Sethbagan, Jorabagan, and Rabindra Sarani districts to help modify the sex behavior of commercial sex workers and their clients. The program's conceptual framework emphasized respect for the sex workers, recognition of their profession, and reliance on their understanding. A health service center run by the program provides free syndromic syphilis screening to 35-40 patients a day, primarily sex workers. 65 sex workers have been trained as peer educators to distribute information about HIV/STDs to others. In particular, peer educators encourage other sex workers to attend the health clinic for regular check-ups. The educators also carry condoms with them for free distribution to co-workers. In December 1996, 110,328 condoms were distributed. Cross-sectional surveys revealed that sex workers awareness of HIV/AIDS increased from 30.7% at baseline in 1992 to 96.2% in 1995. The percentage of sex workers who always use condoms increased from 1.1% at baseline to 50.1% in 1995. The program has enhanced the self-respect and professional identity of sex workers. As a result, sex workers are better able to negotiate condom use with clients and to turn away men who refuse.     

静脉吸毒人群中性工作者对HIV/AIDS传播和流行的影响

  目的  了解2014 — 2015年江西省某县嫖客人群的艾滋病知识、商业性行为特征、安全套使用情况及其艾滋病病毒（HIV）、梅毒、性病的检测情况等,为指导在嫖客人群中开展防治艾滋病行为干预提供依据。  方法  于2014 — 2015年在江西省某县对近1年内发生过异性商业性性行为的男性开展横断面调查。  结果  2014 — 2015年共调查662名嫖客,平均年龄为（37.93 ± 12.35）岁,以在婚（占79.3 %,525人）、初中文化（占50.3 %,333人）、本省（占99.1 %,656人）为主;艾滋病知识总知晓率82.8 %,较2014年,2015年调查人群的艾滋病知识知晓有所上升;最近1年在本县区找小姐的次数主要为2～3次,找小姐的地点主要为洗脚屋/发廊;最近1次与小姐发生性行为时,安全套使用率有明显提高（χ² = 6.339,P ＝ 0.012）;最近1年与配偶发生性行为时每次使用安全套的比例较低;较2014年,2015年梅毒抗体阳性检出率有所下降,所有调查对象尿液吗啡、冰毒、K粉检测均为阴性。  结论  江西省某县嫖客人群年龄较小、以本省的在婚男性为主、文化程度较低;艾滋病防治知晓率有所提高;HIV、梅毒呈现低流行水平,嫖客人群感染性病的比例较高;安全套使用率有所提高。     

北京市丰台区114名女性性服务工作者艾滋病相关知识信念行为调查

目的了解女性性服务工作者的艾滋病（AIDS）相关知识信念行为情况，探索在该人群中开展AIDS宣传教育和行为干预的适合模式。方法对经确认的114名女性性服务工作者进行问卷调查。结果114名女性性服务工作者年龄最小的14岁，最大的39岁；51．8％的未婚；83．3％的文化程度为初高中生。调查对象具有一定艾滋病知识，性生活频率高而安全套使用率低，存在吸毒现象。109名女性性服务工作者接受性病艾滋病检测，查出梅毒阳性6人，HIV抗体均阴性。结论女性性服务工作者是艾滋病高危人群而自我防范意识差，应深入其中开展宣传教育和行为干预工作。     

Sexually transmitted diseases,AIDS and prostitution: a case study in Guinea-Conakry

In Africa, many public health interventions related to the fight against HIV/AIDS are aimed at women commercial sex workers. The practices of sexual labour and prostitution are not universal, and considering them within their specific cultural context is vital to understanding these women's needs and the prevention of HIV/AIDS. An exploratory qualitative study inspired by well-rooted theory was conducted with 14 women working within formally renowned prostitution sites in Guinea-Conakry. It aimed at identifying the context and general preoccupations of these women, within which are embedded sanitary concerns. The study showed that their sexual behaviours are mostly influenced by collective, relational and economic aspects which are in turn evaluated by the women within the framework of their continuous and changing life cycle.     

FACTORS THAT INFLUENCE VULNERABILITY TO STDS AND HIV/AIDS AMONG HISPANIC WOMEN

Self-esteem, motivation for sexual health, and sexual risk behaviors as indicated by condom use and number of sex partners was explored in a sample of 140 Hispanic women of childbearing age (18–44 years). The researchers used Cox's Interaction Model of Client Health Behavior (IMCHB) as the conceptual framework for the study. They found that 70% (n = 79) of single women reported condom use with their most recent sexual partner, and 49% (n = 55) of single women reported more than one sexual partner in the last 12 months. Self-esteem and motivation for sexual health were significantly associated (r =. 42, p =.001), although only the latter was related to condom use among single women (r =. 29, p =. 01). Women who reported higher self-esteem were less likely to worry about acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Despite public information about STDs, including HIV/AIDS, a proportion of these women and their partners are vulnerable to these diseases. Health promotion implications are discussed.     

丽江市古城区娱乐场所性工作者HIV、梅毒监测报告

[目的]为了解古城区娱乐场所女性性工作者中性病／艾滋病的分布及其发生频率、现状和流行趋势，为古城区防治性病／艾滋病策略提供依据。[方法]按照全国AIDS／STD检测工作规范要求，对女性性服务人群进行检测。[结果]对483名娱乐场所女性性工作者进行监测，查出艾滋病病毒感染者4例，梅毒4例。[结论]在女性性工作者中检出率较高，应加大对女性高危人群的干预力度，增强其自我保护意识，推广使用安全套，规范性病诊治，加大对古城区预防控制艾滋病／性病传播的有力措施。     

建筑业劳务输出人员性病艾滋病影响因素定性研究

目的了解建筑业劳务输出人员性病艾滋病相关危险行为及其影响因素,为该人群的性病艾滋病防治工作提供依据。方法采用半结构式访谈方法,对劳务输出人员、劳务公司负责人、中介公司老板、南通市对外贸易经济合作局、当地疾病预防控制中心的相关工作人员等26名关键知情人进行访谈。结果商业性行为是建筑劳务输出人员感染性病艾滋病的主要高危行为,其影响因素包括劳务输出地的性服务市场情况、企业管理制度的执行力度、同伴影响、经济收入、艾滋病知识认知不足以及工人的自身素质等。结论应重视劳务输出人员性病艾滋病的防制,并采取适当的干预措施减少高危行为的发生。     

社区女性性工作者性病艾滋病干预效果评估

目的　探讨针对社区女性性工作者 (CFSWs)采用综合性干预措施预防性病 /艾滋病(STD/AIDS)的策略。方法　于 2 0 0 3年在广东省中部某乡镇社区对CFSWs开展以讲课和发放宣传资料为主 ,观看录像、同伴教育为辅的预防STD/AIDS的宣传教育活动 ;在各类娱乐场所内为CFSWs提供免费的安全套 ;在卫生院性病门诊为CFSWs提供免费的规范化的性病检查 ,派发STD/AIDS健康教育处方和开展生殖健康咨询服务工作。干预前后在知情同意情况下用相同调查表对研究对象进行面对面调查。结果　干预前后分别调查 139名和 12 5名CFSWs;研究对象对AIDS知识知晓率从干预前的 33 1%提高到干预后的 6 0 8% (P <0 0 1) ;最近一周的商业性性行为中每次使用安全套的比例由干预前的 86 2 % (81/94 )提高到干预后的 95 0 % (95 /10 0 ) (P <0 0 5 ) ;男用安全套的正确使用率由干预前的 6 0 3% (73/12 1)上升到干预后的 77 0 % (87/113) (P <0 0 1)。结论　对社区CFSWs采取宣传教育等AIDS综合干预措施能有效提高其对防病知识的知晓率和安全套使用率 ,对减缓和阻止HIV通过性乱人群向一般人群传播具有重要作用。     

应用结构方程模型分析女性性工作者HIV检测行为影响因素的研究

目的 通过结构方程模型,阐明女性性工作者HIV检测行为影响因素.方法 在重庆、四川、广西和新疆对1613名女性性工作者进行问卷调查,采用结构方程模型分析其HIV检测行为影响因素.结果 通过结构方程模型发现女性性工作者HIV检测行为影响因素包括社会地位、艾滋病知识、危险自评、安全套使用、性服务频率5个因素.结构方程模型拟合结果:GFI=0.9952,AGFI=0.9898,RMR=0.0115.结论 影响因素模型拟合效果良好.社会地位、艾滋病知识、危险自评、安全套使用、性服务频率均影响女性性工作者的HIV检测行为,应根据干预对象的不同社会地位制定不同的干预机制.     

Who's at Risk? Men's STD Experience and Condom Use in Southwest Nigeria

Many STD/HIV-prevention programs worldwide assume that individuals' risk of acquiring sexually transmitted diseases, including HIV infection, is highest in the context of commercial sex. To address this assumption, research conducted in urban Southwest Nigeria combined qualitative and quantitative methods to examine men's sexual behavior, condom use, and STD experience in different types of sexual relationships (marital, casual, and commercial). Logistic regression analysis of survey data indicates that number of sexual partners and sex with sex workers are positively and significantly related to STD experience. Follow-up in-depth interviews with clients of sex workers indicate, however, that these men are actually more likely to report having contracted an STD from a casual sex partner than from a sex worker. Men are most uncertain about their vulnerability to STDs with casual partners. Men's condom use is highest in commercial sex, inconsistent in casual relationships, and lowest in marriage. STD/HIV-prevention programs need to address the range of sexual relationships and the meanings and behaviors associated with them.     

Difficult Relations: Sex Work, Love and Intimacy

Female sex workers in Western societies report high rates of condom use with clients. However, their continuing low rates of condom use with private partners place some sex workers at increased risk of STDs and HIV. While researchers have focused on the health risks for female sex workers in their private relationships, from the point of view of the women involved, these relationships are a site of more complex struggles. This paper reports findings from a qualitative study of female sex workers and examines the difficulties associated with sustaining a private relationship while engaging in sex work. Sex work practices, in so far as they parody the features of love-making, can profoundly disrupt the special characteristics of intimate sexual relationships. Any intervention designed to promote condom use in the private relationships of female sex workers must engage with the complexity of meanings that are attached to sex work, love and intimacy by these women.