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Medical health care for Viennese prostitutes.

In Vienna, legalized prostitution is tightly controlled by the advisory board of the Viennese Public Health Service. Registered prostitutes are routinely screened for all important STDs, such as syphilis, HIV, gonorrhea, chlamydial- and yeast-infections, and Trichomonas vaginalis. Furthermore, cytological smears are obtained from the cervix and chest X-rays are performed at least once a year. In all pathological findings, an appropriate therapy is implemented. Presenting data of 1989, out of the 713 weekly controlled registered prostitutes, Neisseria gonorrhoeae was detected in 0.3% of all examinations (110/35,368). In non-registered prostitutes, the infection rate of N. gonorrhoeae was 6.9% (27/354), and so far, 20 times higher than in registered ones. The infection rate of Chlamydia trachomatis, which has been routinely diagnosed in registered prostitutes for several years, has decreased from 20.4% in 1980 to 2.2% in 1989 compared with 31.4% and 10.9% in non-registered prostitutes. In registered prostitutes, the prevalence of genital infections, such as C. trachomatis, T. vaginalis, and yeasts was shown to be 4.9%. The corresponding data in non-registered prostitutes were much higher (18.8%). Due to examinations for cervical malignancy the incidence of Papanicolaou stain IV and V has decreased from 3.1% in 1988 to 1.6% in 1989. There was no serologic evidence for syphilis and HIV infection in both special risk groups. The data demonstrate, that due to a good health surveillance of STD-risk groups, a good information service, and free treatment, the prevalence of STDs can be reduced in prostitutes.

Austria↗

HTLV-I infection among prostitutes and pregnant women in Kinshasa, Zaïre: how important is high-risk sexual behavior?

High-risk sexual behavior as risk factor for human T-cell lymphotropic virus type I (HTLV-I) infection was assessed in cross-sectional studies with 1,183 prostitutes and 1,166 pregnant women in Kinshasa, Zaire. Eighty six (7.3%) prostitutes were positive for HTLV-I. The seroprevalence among prostitutes from the regions along the equator was 12.7%, whereas among prostitutes from the other regions it ranged between 0 and 4.3%. In the prostitutes from the high-prevalence regions, but not in the prostitutes from the low-prevalence regions, HTLV-I infection was associated with increasing age [odds ratio (OR) = 1.1 per year increment], active syphilis (OR = 2.3), and human immunodeficiency virus (HIV) infection (OR = 2.0). Forty three (3.7%) pregnant women were HTLV-I seropositive. Among the women from low-prevalence regions, there was no significant difference in HTLV-I seroprevalence between prostitutes (4.3%) and pregnant women (3.5%). In a group of 409 prostitutes who were observed for a mean duration of 23 months, the incidence of HTLV-I infection was 0.7 per 100 women-years, whereas the incidence of HIV infection was 9.8 per 100 women-years. We conclude that in Kinshasa prostitution per se was not associated with an increased risk of HTLV-I infection.

Adult↗

Prostitutes and AIDS: a health department priority?

With increasing competition for resources, health departments are faced with the question of whether to target female prostitutes as a high priority component of AIDS prevention strategy. Prostitutes are considered to be a reservoir for transmission of certain sexually transmitted diseases (STDs). However, a variety of studies suggest that human immunodeficiency virus (HIV) infection in prostitutes follows a different pattern than that for STDs: HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity alone does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV. Emerging data from heterosexual groups similarly suggest a low rate of heterosexual transmission, particularly from women to men. Prostitutes who do not use intravenous drugs probably face their highest risk from steady partners who may be infected with HIV and other STDs and with whom barrier protection is generally not used. Nevertheless, there are good reasons for health departments to place high priority on prevention efforts directed to prostitutes: 1) prostitutes often have other risky behaviors such as drug use; and 2) prostitutes are reachable, being a group which is already in the health care system administered by health departments.

Acquired Immunodeficiency Syndrome↗

Effect of health education and condom promotion on behavioral change among low socioeconomic prostitutes in Mae Sot, Tak, Thailand.

A study was conducted to determine the effect of preventive educational efforts among 621 female prostitutes in Mae Sot, Tak Province, in 1989. The intensive health education program at a personal level and free condom distribution to the prostitutes began in March and June 1989, respectively. The proportion of prostitutes' sexual partners using condoms increased from 13.5% in January 1989 to 50.4% by December 1989. The reported increase in condom use was supported by the decline in the incidence rate of gonorrhea among the prostitutes during the same period. Anal intercourse was not commonly practised in these women and decreased from 9.7% in January to 1.8% in December 1989. None of the prostitutes interviewed throughout the year reported using intravenous drugs, nor reported having a steady sexual partner who was an intravenous drug user. None out of 248 prostitutes tested in January 1989 were HIV-1 seropositive. After that throughout the year, 15 of 373 (4.0%) additional prostitutes in this area were found to be seropositive on their first test. Ten out of 405 (2.5%) initially-seronegative prostitutes who were subsequently tested at 3-month intervals became seropositive. The effect of health education and condom promotion among our study prostitutes was modest. Similar studies are needed to evaluate the programs in other settings of Thailand, particularly in areas with high prevalence of HIV-1 infection.

Adolescent↗

Trends in sexual behaviour and the incidence of sexually transmitted diseases and HIV among drug-using prostitutes, Amsterdam 1986-1992.

OBJECTIVE: To determine trends in commercial sexual risk behaviour among drug-using prostitutes in Amsterdam after local and national prevention campaigns began in 1987. DESIGN: A subgroup of 281 drug-using prostitutes was selected from a comprehensive, open cohort study of drug users in Amsterdam. METHODS: Cross-sectional (at intake) and within-person trends in sexual behaviour were evaluated. Person-time analysis was used to determine trends in incidence of sexually transmitted disease (STD). RESULTS: From 1986 to 1992, 'always' use of condoms in the 6 months preceding intake increased from 21 to 58% (P < 0.001) and the number of commercial contacts declined from 84 to 64 per month (P = 0.06). Consequently, the mean number of unprotected commercial contacts declined from 26 to nine per month (P < 0.001). Temporal trends within individual prostitutes from visits 1 to 8 (mean interval between visits, 4 months) showed a somewhat larger risk reduction than the cross-sectional trends. From 1989 to 1992, the STD incidence declined from 61 to 40 episodes per 100 person-years (P = 0.06). Prostitutes residing in Amsterdam for shorter time periods reported more STD and a relatively small core group reported the majority of STD episodes. At intake, when < 10% of all participants knew their HIV serostatus, HIV-positive prostitutes reported significantly lower levels of condom use and more STD than HIV-negatives, while, after learning their serostatus, levels of condom use and the STD-incidence were comparable. Prevalent and incident HIV infections were not observed among non-injecting prostitutes. CONCLUSIONS: Drug-using prostitutes have reduced sexual risk behaviour. There is evidence for the effectiveness of HIV testing and counseling. At present, new infections among clients of drug-using prostitutes are expected to occur, although not on a large scale. Since the incidence of STD continues to be high, it is important to monitor the spread of HIV among heterosexuals, including prostitutes and their clients, closely.

Adult↗

HIV seropositivity among female prostitutes and nonprostitutes: obstetric and perinatal implications.

Serum samples totaling 600 were obtained from female prostitutes (300) resident in different hotels in Lagos, Nigeria and nonprostitutes (300) attending different health centers for routine check-up in Lagos, Nigeria. Sera obtained were screened for the prevalence of HIV seropositivity among prostitutes in comparison with nonprostitutes by the enzyme linked immunosorbent assay (ELISA) using the Abbott test kits as recommended by the manufacturers. Positive sera were subjected to confirmatory testing using the Western Blot test-New Lav Blot I and II. Our results revealed that of the 300 prostitutes and nonprostitutes screened, 50 (16.67%) and 6 (2%) were HIV seropositive, respectively, and the difference was statistically significant (P < 0.01). For antibody to HIV-1, 44 (88%) and 5 (83%) of the positive cases recorded among prostitutes and nonprostitutes were seropositive. Four (8%) and one (16.67%) of the positive cases were HIV-2 seropositive for prostitutes and nonprostitutes, respectively. Only 2 (4%) of the positive samples from prostitutes showed reactivities with HIV-1 and HIV-2 (simultaneous infection or dual reactivity). Incidence of the dual reactivity was not recorded among the nonprostitutes screened. This study is expected to provide baseline data on HIV seropositivities among prostitutes and nonprostitutes in Nigeria. The biomedical application of this study is that it will also serve as strong evidence to indicate the high prevalence of HIV seropositivity among prostitutes in order to attract government intervention to step-up control measures.

Female↗

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Condoms↗

A unique community of family-oriented prostitutes in Nepal uninfected by HIV-1.

In the Mid Western and Far Western regions of Nepal live a unique group of prostitutes which maintains strong bonds resulting from 'untouchable' caste status and family tradition. Known as the Badis (pronounced 'bod ee'), it is estimated that well over 5000 Badi prostitutes are now actively engaged in the sex trade in Nepal. In 1991, a study of some of the social and cultural practices of this unique group was completed. In addition to the provision of counselling and information about STDs and AIDS, over 300 prostitutes were interviewed about their sex practices within the Badi community. Two hundred and twenty-eight Badi prostitutes consented to voluntary confidential testing for VDRL, and 250 consented to anonymous, unlinked serosurveillance for HIV-1. As previous studies have shown moderate to high rates of HIV-1 infection among prostitutes in general, and even higher rates of infection in low class prostitutes, some prevalence of VDRL as well as HIV-1 was expected. However, of the 228 Badi prostitutes tested, 154 (70%) were found to be VDRL positive, while none were found positive for HIV-1. At the same time, many of these prostitutes reported a history of constant and often untreated STDs. The implications for the future prevention of HIV infection in this group are obvious and striking. With immediate and effective STD treatment as well as counselling, the Badis represent one high risk group in which the global AIDS epidemic could be drastically reduced, or even averted.

Adolescent↗

Reproductive failure and antisperm-antibody production among prostitutes.

Reproductive failure and anti-sperm antibody (ASA) production among prostitutes were investigated. A questionnaire including the subject's age, years of prostitution, date of most recent birth, number of children and contraceptive method used at the beginning of prostitution were asked of 109 prostitutes, but only 53 agreed to complete the questionnaire. ASA was detected by ELISA in the prostitutes (n = 109) and in the control group (n = 40) sera. The tests revealed a high ASA rate (43.1%) among the prostitutes. The difference in the incidence of ASA between controls (5%) and the prostitutes (43.1%) was highly significant (p less than 0.01). It was found that ASA positivity incidence in 27 prostitutes who had never use any contraception method and who became infertile within 9.3 years (average) was 61.3%. These results may be explained by repeatedly inoculations with multiple sperm antigens and/or microorganisms.

Adult↗

Chlamydial infection in female prostitutes in Singapore.

Three studies conducted in 1982, 1985 and 1988 investigated chlamydial infections in female prostitutes. In 1982, 115 prostitutes with culture-positive gonorrhoea were studied; 8% were coinfected with Chlamydia trachomatis. In 1985, 86 female prostitutes and in 1988, 100 female prostitutes attending for routine tests were examined. Chlamydia trachomatis was isolated in 12% and 9% of the cases, respectively. Gonorrhoea was detected in 10% and 11% of the cases. In the 1988 study, one (9%) of the 11 women with gonorrhoea had concomitant chlamydial infection. Syphilis was diagnosed in 3% of the female prostitutes investigated in 1988. Our findings indicate that concomitant chlamydial infection occurs in about 8-9% of female prostitutes with gonorrhoea and that 9-12% of the female prostitutes screened harboured Chlamydia trachomatis in their endocervices. A chlamydial control programme in prostitutes is desirable.

Chlamydia Infections↗

Infection by hepatitis B and C virus in non-intravenous drug using female prostitutes in Spain.

We have studied the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) serologic markers in female blood donors and in female prostitutes and the relationship of antibodies to hepatitis B core antigen (anti-HBc) and of antibodies to HCV (anti-HCV) with the presence of treponemal antibodies (FTA-ABS) in non-intravenous drug using female prostitutes. Hepatitis B surface antigen (HBsAg) was found in 1.0% of the female blood donors, anti-HBc in 15.6% and anti-HCV in 0.7%. In the prostitutes, the prevalence of HBsAg was 6.1%, anti-HBc was positive in 29.0% and anti-HCV in 8.8%. No significant statistical association between the prevalence of anti-HBc or anti-HCV and the age of prostitutes (p = 0.9111 and p = 0.8254 respectively) or the length of time as prostitutes (p = 0.3583 and p = 0.5770) was found. FTA-ABS positive prostitutes had a significantly higher prevalence of anti-HCV than FTA-ABS negative prostitutes (p < 0.001). No statistical association was found between anti-HBc antibodies and positive FTA-ABS prostitutes (p = 0.336).

Adolescent↗

Prostitution, AIDS, and preventive health behavior.

Although considerable attention has been placed on the role of prostitutes in the AIDS epidemic, little attention has been directed to features of prostitutes' work lives which are relevant to the control of AIDS. This article reviews several aspects of prostitution in the United States which have implications for control of the epidemic. The article first reviews the epidemiology of human immunodeficiency virus (HIV) infection among prostitutes. The legalized system of prostitution in Nevada serves as a basis for comparison to illegal prostitution. This article examines the effectiveness of mandatory testing of prostitutes for monitoring and controlling the epidemic. And finally, a peer education approach as a means to control HIV infection among prostitutes is explored.

Acquired Immunodeficiency Syndrome↗

Female prostitutes: a risk group for infection with human T-cell lymphotropic virus type III.

In July, 1984 33 female prostitutes in Rwanda and 25 male customers of prostitutes were assessed clinically and for their T-lymphocyte subsets and frequency of antibodies to human T-cell lymphotropic virus type III (HTLV-III). 27 healthy males who denied contact with prostitutes, 33 healthy women who were not prostitutes, and 51 Rwandese prostitutes seen in 1983 served as controls. Only 6 prostitutes were symptom-free (group I), 13 had unexplained generalised lymphadenopathy (LAP) (group II), and 14 had LAP and constitutional symptoms (group III). Mean OKT4/OKT8 ratio in groups II and III was significantly lower than that in group I or in female controls. HTLV-III antibodies were detected in 29 of 33 prostitutes, 4 female controls, 7 male customers, and 2 male controls. In male customers, HTLV-III seropositivity increased according to the number of different sexual partners per year. This study suggests that in Central Africa prostitutes are a high-risk group for HTLV-III infection.

Acquired Immunodeficiency Syndrome↗

Female streetworking prostitution and HIV infection in Glasgow.

OBJECTIVES: To identify the extent of HIV infection and injecting drug use among female streetworking prostitutes in Glasgow; to estimate the size of the female streetworking prostitute population in the city; and to estimate the number of HIV positive women working as prostitutes on the streets in Glasgow. DESIGN: Observation and interviewing of female prostitutes over seven months in red light district; analysis of saliva samples for presence of antibodies to HIV; capture-recapture approach to estimating the size of the female streetworking prostitute population. SETTING: Glasgow. SUBJECTS: 206 female streetworking prostitutes. MAIN OUTCOME MEASURES: Number of women with antibodies to HIV, self reported use of injecting drugs, history of contact with 206 women. RESULTS: Saliva samples were requested from 197 women; 159 (81%) provided samples. Four (2.5%, 95% confidence interval 0.7%-6.3%) of the samples were positive for HIV, all of which had been provided by women who injected drugs. Of the 206 streetworking women contacted 147 (71%) were injecting drug users. About 1150 women are estimated to work on the streets in Glasgow over a 12 month period. CONCLUSIONS: HIV is not as widespread among female prostitutes as many reports in the tabloid press suggest. A greater proportion of female streetworking prostitutes in Glasgow are injecting drugs than has been reported for other British cities.

Female↗

Prostitution, violence, and posttraumatic stress disorder.

One hundred and thirty people working as prostitutes in San Francisco were interviewed regarding the extent of violence in their lives and symptoms of posttraumatic stress disorder (PTSD). Fifty-seven percent reported that they had been sexually assaulted as children and 49% reported that they had been physically assaulted as children. As adults in prostitution, 82% had been physically assaulted; 83% had been threatened with a weapon; 68% had been raped while working as prostitutes; and 84% reported current or past homelessness. We differentiated the types of lifetime violence as childhood sexual assault; childhood physical abuse; rape in prostitution; and other (non-rape) physical assault in prostitution. PTSD severity was significantly associated with the total number of types of lifetime violence (r = .21, p = .02); with childhood physical abuse (t = 2.97, p = .004); rape in adult prostitution (Student's t = 2.77, p = .01); and the total number of times raped in prostitution (Kruskal-Wallace chi square = 13.51, p = .01). Of the 130 people interviewed, 68% met DSM III-R criteria for a diagnosis of PTSD. Eighty-eight percent of these respondents stated that they wanted to leave prostitution, and described what they needed in order to escape.

Adolescent↗

Sociodemographic characteristics and incidence of gonorrhoea in prostitutes working near the Thai-Burmese border.

A study was conducted to determine the sociodemographic characteristics and incidence of gonorrhoea among the prostitutes working in Mae Sot District, Tak in 1988. Of the 238 prostitutes included in the study, 130 were Thai and 108 were Burmese. About 55% of the Thai group and 65% of the Burmese engaged in prostitution before being 19 years old. Most of them experienced sexual intercourse at early age of life. The charge per sex partner ranged from 50-500 baht (US$2-20), with a median of 100 baht (US$4) for both groups. The Thai prostitutes had a significantly higher mean number of clients per day and received more Thai clients than the Burmese. Anal and oral sex were not commonly practised among these prostitutes. Approximately 14% of the prostitutes' clients in both group used condoms. The mean infection rate of gonorrhoea was significantly greater in the Thai prostitute group than the Burmese. Multiple linear regression analysis revealed that the infection rate of both groups was inversely associated with the percentage of client using condoms and the duration of having been prostitutes, and positively associated with the percentage of Thai clients. The program for STD control should be directed towards the increase use of condoms, spermicides, and other barrier methods, and massive health education program on safer sex to this high risk group and the general population.

Adolescent↗

Risk factors of HIV-1 infection among female prostitutes in Khon Kaen, Northeast Thailand.

HIV infection has increased to epidemic proportions in Thailand since 1987. There have been separate epidemics among population groups at high risk of infection and significant increases in different localities. The northeast region of Thailand has been affected by the epidemic since early 1989. The purpose of this study was to identify factors associated with HIV transmission among prostitutes during an early phase of the epidemic in the regional center of Khon Kaen. Three hundred and fifty-six prostitutes known to work in the urban area of Khon Kaen (Ampur Muang) in November 1990 were included in the study. Prostitutes were divided into two groups according to the type of place where they worked: direct prostitutes (in brothels, n = 217) and indirect prostitutes (in massage parlors, n = 139). The prevalence of HIV infection was found to be 12% among direct prostitutes and 2% among indirect prostitutes. Four variables were significantly associated with HIV infection after adjusting for confounders by logistic regression analysis: previous work in an area of high HIV prevalence, working in Khon Kaen less than one month, a low price charged for sex and using injectable contraceptives. Follow-up investigations are currently being carried out to explore in detail the association between the use of injectable contraceptives and HIV infection.

Adult↗

Non-use of condoms by prostitute women.

Ethnographic research among Glasgow female prostitutes working in street, sauna, flat, escort agency and "sugar daddy" sectors investigated prostitutes' accounts of the occasions in which condoms were not used for penetrative sexual encounters. Such occasions were a minority of commercial sex encounters and a majority of private sex encounters. Although prostitutes saw condom use as inappropriate in private sexual relationships this was not, as has been suggested, an aid to relationship interpretation as either private or commercial. Condoms in commercial sex were seen as routine tools of the trade, and hence emerged as emblems of prostitution. These emblematic qualities were found in turn to produce both challenges to condom use from customers and opportunities for prostitutes to manipulate customer relations by judicious suspension of condom application. Both norms of gendered role-play and prostitute status were highlighted as threatening condom use in some situations, while prostitute status could also be used as the basis of rational argument for condom use in others. Relational issues such as familiarity or a desire to communicate trust were at the forefront in explanations of condom non-use. Perceptions of physical power and the authority to permit or withhold sexual service or profit were determining influences crucial in condom use negotiation.

Attitude to Health↗