HIV Infection, Syphilis, and Behavioral Risks in Brazilian Male Sex Workers

To describe the epidemiology of HIV and syphilis infection and sexual practices among male sex workers, we studied 434 transvestites and 96 hustlers recruited by peers in the metropolitan area of São Paulo, Brazil, from 1992 to 1998. Participants were young adults with low education levels who had recently immigrated to São Paulo and supported themselves primarily through sex work. The prevalence of HIV infection among transvestites and hustlers was 40% and 22% respectively, and the prevalence of current or past syphilis was 43% and 27%, respectively. Infection was associated more with gender performance and duration of sex work than to recent unsafe sexual practices or recent condom use. As opposed to hustlers, whose clients came primarily from São Paulo and were homosexual, transvestites were more likely to have foreign and heterosexual clients. HIV and syphilis among sex workers are urgent public health problems that require continuous prevention programs for male sex workers and their clients.