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Comparison of four survey methods designed to estimate the prevalence of HIV among female prostitutes who inject drugs.

In Glasgow, during the period January 1990 to December 1992, 4 different methods were used to determine HIV prevalence among female prostitutes who inject drugs: the surveillance of prostitutes undergoing voluntary named tests, an unlinked anonymous survey of prostitutes attending a health care drop-in centre, a community-wide voluntary anonymous survey of injecting drug users including female prostitutes, and a voluntary anonymous survey of female prostitutes recruited in Glasgow's red-light area. HIV prevalence varied from 1.2 to 4.7% though overlapping confidence intervals indicated no significant differences. A comparison of each approach leads the authors to suggest that the former 2 methods which are relatively inexpensive should be conducted, if possible, on high risk groups such as prostitutes and injecting drug users on a continuous basis. If these indicate HIV rates which are stable and less than 5%, implementation of more sophisticated voluntary anonymous approaches need only be done every 3 to 4 years. However, if rates are unstable and/or greater than 5% then such surveys should be initiated more frequently, perhaps biannually.

Adult↗

[Changes in condom use among a cohort of prostitutes].

OBJECTIVE: To describe changes in condom use among prostitutes enrolled in a prospective cohort study in Alicante (Spain), and to identify those factors associated with changes in this behaviour. METHODS: Data from this study come from a prospective cohort study of women working at prostitution enrolled in a center for AIDS preventive at Alicante from 1986 to 1996. The proportion of condom use by prostitutes with their clients was recorded during the first visit and the last one, and changes in condom use were estimated as the difference between them. Two logistic regression analyses were done to identify those factors associated with positive or negative changes in condom use. RESULTS: A statistically significant increase in the prevalence of condom use was observed between the first, 69,2%, and the last visit, 83,9% (p < 0,001). Prostitutes working private increased the condom use more than five time than those working in clubs or at the street. The higher the follow-up time the higher the prevalence of condom user, OR > 6 years = 7,6 (95% CI: 2,2-26,0). No variable was associated with a negative change in condom use. CONCLUSION: This study shows an overall increase of condom use in a cohort of prostitutes after 10 years of follow-up. Relapse in risk behavior has been infrequent. In the future, preventive strategies to increase the use of condoms among prostitutes should be adapted to the new forms of sexual commerce.

Adult↗

Prevalence of hepatitis C virus antibodies among intravenous drug abusers and prostitutes in Damascus, Syria.

OBJECTIVE: In studies of risk factors among patients presenting with acute and chronic hepatitis C, a history of intravenous drug use is the most common finding, accounting for 40% or more of subjects. The prevalence of anti-hepatitis C virus antibodies among intravenous drug users is considered one of the highest numbers among high risk groups. Whether hepatitis C virus is transmitted efficiently or at all via sexual contact remains controversial. Therefore, the prevalence of hepatitis C virus antibodies among a group of Syrian intravenous drug users, prostitutes, and blood donors was studied. METHODS: The prevalence of anti-hepatitis C virus in a population of 38 Syrian intravenous drug abusers, 102 Syrian prostitutes, and 2100 blood donors, was carried out in the laboratory of Al-Assad University Hospital, Damascus, Syria. Antibodies of hepatitis C virus were studied by 3rd generation enzyme immunoassay. Hepatitis B surface antigen and antibodies to hepatitis B core were carried out using enzyme immunoassays. Liver enzymes (alanine aminotransferase, aspartate aminotransferase) and total bilirubin were measured using reagents on chemistry autoanalyzer (Hitachi 911). Intravenous drug users group (38) was aged 31 5.6 years, 33 males and 5 females. Prostitutes group (102) were aged 25.1 7 years. Blood donors group (2100) aged were 26.3 10.3 years, 1960 males and 140 females. RESULTS: The prevalence of hepatitis C virus antibodies was 60.5% among intravenous drug abusers, 1.96% among the prostitutes group, and 0.95% among blood donors group. Whereas, the positivity of hepatitis B surface antigen was 5.3% among the intravenous drug abusers, 10.8% among the prostitutes group, and 3.8% among blood donors group. Biochemical parameter results were compared to the results of these parameters that were determined in a group of healthy members (blood donors) during our study. CONCLUSION: The prevalence of hepatitis C virus antibodies among intravenous drug abusers is considered the highest number among high risk groups, however, it is comparable to that reported in other countries. The impact of hepatitis C among drug users is profound, amplifying the spread of hepatits C virus infection and sustaining it in the general population. The prevalence of anti-hepatitis C virus among the prostitutes group was a little higher than that determined among the general population. The transmission of hepatitis C virus via a sexual route is still common and important. The control of the sexual behavior may have a role in minimizing the spread of this pathogen among the general population.

Adult↗

[Infection caused by the human immunodeficiency virus type 1 in prostitutes and risk factors].

BACKGROUND: Women dedicated to prostitution constitute a group at risk of acquiring the human immunodeficiency virus-1 (HIV-1). This study was designed with the aim of knowing the frequency of this infection in prostitutes and the factors associated to the same. METHODS: A descriptive transversal study with analytic components including 444 women who voluntarily attended an AIDS prevention center from 1986-1991 was carried out. The HIV-1 antibody test was performed in 440 of the subjects. All the subjects were interrogated on sociodemographic variables and risk of infection. RESULTS: Of the 440 women studied, 24 had HIV-1 antibodies with a global prevalence (1986-1991) of 5.5% with confidence intervals of 3.4, and 7.6% at 95% (CI 95%). During the study period the prevalence remained stable: 6.8% (1986-87), 5.5% (1988), 4.3% (1989) and 4.3% (1990-91). No positive association was found between HIV-1 infection and education, time in prostitution and the use of condoms. HIV-1 infection was strongly associated to the use of drugs, adjusted odds ratio by logistic regression OR = 26.9 (CI 95%: 8.9; 9/1). Positive associations were also observed with greater number of sexual partners and syphilis but these did not reach statistical significance. The percentage of prostitutes who used condoms with more than 33% of their clients increased from 44.5% in 1986-87 to 85.9% in 1990-91. CONCLUSIONS: In this study no considerable changes were found with respect to the prevalence of infection by the human immunodeficiency virus-1 in prostitutes in Spain. Similarly, this collective has increased its use of preventive measures although they remain insufficient, indicating that more energetic preventive strategies are necessary. These measures should be particularly active with the group of young prostitutes.

Acquired Immunodeficiency Syndrome↗

Inverts, perverts, and Mary-Annes. Male prostitution and the regulation of homosexuality in England in the nineteenth and early twentieth centuries.

The paper examines the relationship between patterns of male prostitution and the changing definitions (and regulation) of homosexual behavior in the late nineteenth and early twentieth centuries. A series of problems is explored. First, an attempt is made to delineate the changing patterns of legal and ideological control in the nineteenth century. This leads to a discussion of the second problem, the ways in which the social and legal context dictated the close relationship between the homosexual subcultures and the cash nexus represented by the prostitution relationship. The third problem concerns the ambivalent nature of the "prostitution," the complex self-concepts that developed, and the factors inhibiting the development of a distinctive subculture of male prostitution. The differences between female and male prostitution are discussed. The paper concludes by underlining the ambivalence of "male prostitution".

England↗

Teenage prostitution--child abuse: a survey of the Ilorin situation.

In the light of civilization that has come to erode some of the sexual constraints in the traditional African society's opennes today toward sexuality and sexual expression, adolescents commence sexual activity at an increasing earlier age and the average marriage come much later. It is therefore not surprising that an increasing proportion of adolescents in Nigeria are engaging in teenage prostitution. This study is an attempt to conduct a general survey into the nature of teenage prostitution in Nigeria and to provide information on the prevalence, factors, trends and characteristics of teenage prostitution. A semi-structured questionnaire was administered to 150 known teenage prostitutes. Among other things the finding suggest that childhood sexual abuse perhaps leads to prostitution. Half of the sample used in the study had their first sexual experience early in life, and about the same number lived with their parents when they began prostituting. Implications of the findings were discussed and suggestions made for further research.

Adolescent↗

[Hepatitis B marker seropositivity in prostitutes using ELISA].

In this study, HBsAg, Anti-HBc and Anti-HBs have been investigated in 172 prostitutes and 50 healthy women with ELISA. Anti-HBc seropositivity was increasing with age in prostitutes. No significant difference was found between Hepatitis-B marker seropositivity and working period of prostitutes. In prostitutes, 6.3% HBsAg, 62.7% Anti-HBc, 50.5% Anti-HBs seropositivity and 69.1% total seropositivity was found. Statistically, except HBsAg seropositivity, seropositivity in prostitutes was higher than the control group. Therefore, prostitutes are an important risk group for Hepatitis-B infection.

Adult↗

Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, São Paulo State, Brazil.

We studied the role of sexual transmission in the epidemiology of HCV by a cross-sectional study comparing prostitutes and HCV seropositive and seronegative sexual clients recruited from the bordellos of the docks of Santos, São Paulo State. The average age in the prostitute group was 27.2 years. The median time spent in prostitution was 3 years. The average number of clients per week was 7. A total of 5.2% of the prostitutes admitted to having used injectable drugs. Nine percent patients said that they had received a blood transfusion and 36.3% claimed to have had a sexually transmissible disease in the past. The prevalence of HCV antibodies was 10.9%. There was a positive and independent relationship between HCV seropositivity and the following variables: use of injectable drugs (OR = 5.2; 95% CI = 2.2 to 12.2), prior blood transfusion (OR = 2.3; 95% CI = 1.08 to 4.9), time spent in prostitution (OR = 2.0; 95% CI = 1.13 to 3.6), and a positive FTA-ABS result (OR = 1.7; 95% CI = 0.95 to 3.0). The risk factors indicating parenteral exposure (use of an injectable drug and prior blood transfusion) presented a stronger relationship with HCV seropositivity. The time spent in prostitution and FTA-ABS positivity, risk factors indicating sexual exposure, also presented a positive relationship with HCV seropositivity, suggesting a significant role for sexual transmission in HCV epidemiology, particularly in groups involved in promiscuous sexual behavior.

Adult↗

[Attendance at a health center by clandestine prostitutes in Djibouti].

The extent of clandestine prostitution in Djibouti is difficult to evaluate. Due to the secrecy of the prostitutes and often their low level of education, the follow-up of these patients is also difficult. A sexually transmitted disease clinic specialized in the treatment of prostitutes and their customers has been established in Djibouti since 1963. We tried to evaluate the available data on the clandestine prostitutes attendance at the center. The population was young with a mean age of 23 years. Fifty percent had children and 60% were divorced or separated. Ninety-one percent were Ethiopian and 73% lived in the same district of the city of Djibouti. Almost half of them were HIV positive. The duration of residence in Djibouti before the first visit to the clinic varied widely with a median of 12 months. However, the total duration of prostitution before the first visit was shorter with a median of 3 months. The complaint at the first visit was most often minor. Among the prostitutes who first came to the center in 1993, half of them came only once. The overall duration of follow-up was 8 months, for an average of 3.7 visits per patient. Alternatively, 20 patients had more than 10 consultations and this represented one third of the consultations given to previous patients. This last group is the only one which tended to respect the monthly visits proposed to each patient at the first consultation. The other patients seemed to come only when they felt ill. The routine statistical activities which separately counted the new and previous patients gave an optimistic but faulty impression: these showed an increase in the total number of patients and also an increase in the percentage of previous patients visiting (from 42 to 69% between 1988 and 1994). It is difficult to evaluate the follow-up of such a mobile population. The few patients known for their fidelity contrasted with the fact that half of the patients had visited the center only once. This low frequency of visitation could be due to either the management of the center or to the lack of proximity of the contacts within the districts.

Adult↗

Sexual behavior patterns of customers of male street prostitutes.

Information about male customers of male prostitutes, including sociodemographic and life-style characteristics, sexual and drug use behaviors, and knowledge about HIV infection were collected from a convenience sample of 211 male street prostitutes and a convenience sample of 15 male customers as part of a feasibility study. Data from these two groups indicate that despite knowledge of HIV infection and its transmission, customers engage in high-risk sexual and drug use behaviors with prostitutes. Because there is a high HIV infection rate within the male prostitute sample (175/1000) and because these customers for the most part describe themselves as bisexual or heterosexual, it is likely that male customers of male prostitutes serve as a vector of transmission of HIV infection to their other partners including the heterosexual population.

Adult↗

Male prostitutes and safe sex: different settings, different risks.

Twenty-seven male prostitutes were interviewed extensively about their work and considerations relating to safe sex with clients. Important differences were found between street prostitutes and those working at home. Street-workers were more likely to be using hard drugs, to have a heterosexual preference, to have no other occupation, to have more clients, but less steady ones, and to have a more negative working attitude. Sexual techniques most often practised were manual and oral contact; however, most prostitutes also practised either insertive or receptive anal intercourse. Homosexual male prostitutes reported more receptive anal intercourse than did their heterosexual male colleagues; but no such differences were found in insertive anal intercourse. Prostitutes were most likely to have had anal intercourse with steady clients, with clients whom they trusted regarding condom use, or with clients they felt sexually attracted to; and also when in dire need of drugs. Of those who had practised anal intercourse in the previous year, a minority had not consistently used condoms. The same factors that encourage anal intercourse also appear conducive to unprotected intercourse.

Adolescent↗

Changes in prostitution and the AIDS epidemic in Thailand.

The HIV/AIDS epidemic which broke out in Thailand 1988 was mainly caused by the widespread patronage of prostitutes. The Thai authorities responded with programmes which encouraged the use of condoms in commercial sex. These programmes were highly successful. However, prostitution has changed since the beginning of the epidemic, partly for economic and demographic reasons, but mainly because of the fear of AIDS. Fewer women practise prostitution, men patronize it less, and the price of commercial sex has risen. Prostitution is less likely to be practised in brothels and more likely to be practised in establishments like restaurants and bars. Moreover, as fewer native Thai women are willing to practise prostitution, foreign women are taking their place. In order to continue to control the epidemic, the authorities will have to adapt their programmes to the changing structure of commercial sex.

Acquired Immunodeficiency Syndrome↗

Prostitution, condom use, and invasive squamous cell cervical cancer in Thailand.

Cervical cancer is probably caused by a sexually transmitted agent. A case-control study was conducted in three hospitals in Thailand to investigate further the role of male sexual behavior, particularly regarding sexual contacts with prostitutes, in the development of this disease. Data were obtained from interviews with 225 married women with invasive squamous cell cervical carcinoma and 791 hospitalized controls, all of whom reported having only one sexual partner, and from interviews with their husbands. Risk of cervical cancer was strongly related to the women's husbands having visited prostitutes without using a condom when the husbands were less than 30 years old. A strong increasing trend in risk in relation to decreasing frequency of the husbands' condom use with prostitutes was observed, and a weaker increasing trend in risk with husbands' estimated lifetime total number of visits to prostitutes was found. The average latent period between the women's likely initial exposure to a sexually transmitted oncogenic agent and her diagnosis of invasive cervical cancer was about a quarter of a century. Regular use of condoms by customers of prostitutes could reduce the number of invasive cervical cancer cases in the general population of Thailand by at least one fourth.

Adult↗

HIV infection and STD in drug addicted prostitutes in Amsterdam: potential for heterosexual HIV transmission.

To assess the potential role of drug using prostitutes in the heterosexual transmission of human immunodeficiency virus (HIV), 117 prostitutes, recruited from December 1985 to November 1987 at a weekly evening sexually transmitted diseases (STD) clinic for drug using prostitutes only, were studied for the prevalence of HIV and STD. Intravenous drug use was reported by 96 (82%) of the women. Antibody to HIV was found in 35/117 (30%) women, all but one of whom had been using drugs intravenously. Most (73, 62%) of the prostitutes reported having had more than 2000 clients each in the preceding five years. In the six months preceding enrollment to the study they had practised mainly vaginal (106/117) and orogenital (82/117) intercourse; 90% (105/117) reported frequent use of condoms in vaginal intercourse and 65% (68/105) in orogenital intercourse. Despite frequent condom use, 81% (84/104) contracted one or more STD in this period. Considering the high incidence of HIV and STD and the finding by others that the presence of STD may facilitate transmission of HIV, we conclude that the potential for HIV transmission from these prostitutes to their clients (and vice versa) was clearly present.

Acquired Immunodeficiency Syndrome↗

Syphilis and human immunodeficiency virus seroconversion during a 6-month follow-up of female prostitutes in Mogadishu, Somalia.

A total of 155 prostitutes inhabiting 4 different districts in Mogadishu, Somalia, were enrolled in a 6 month prospective study of syphilis and HIV infection. Blood samples were taken on entry, at 3 months and at 6 months. Differences were seen between the prostitutes in the 4 districts regarding possible risk factors for the acquisition of STDs. Initially 107 (69%) were found to have syphilis serum markers and 47% had active syphilis as judged by positivity in both Treponema Pallidum Haemagglutination (TPHA) test and non-treponemal (VDRL and RPR) tests. TPHA positivity was correlated to the number of sexual partners. Sixty-nine prostitutes were followed for 6 months. Two of the 16 initially TPHA negative women seroconverted for syphilis during the follow-up. HIV antibodies were detected in one (0.6%) of the 155 prostitutes at the start of the study and one out of 68 seroconverted during the 6 months follow-up. To control the spread of HIV infection health education targeting the risk groups like prostitutes must be given a high priority.

Adolescent↗

Human immunodeficiency virus type 1 (HIV-1) infection among female prostitutes in Borno State of Nigeria: one year follow-up.

Serological investigations on female prostitutes resident in Borno State in northeastern Nigeria have shown that the seroprevalence of HIV-1 infection has increased 9.81%--fold in one year. The highest sero-prevalence rates were found amongst prostitutes who had not benefited from previous health education campaigns. Prostitution appears to be on the increase in spite of AIDS probably because of the difficulty in finding alternative means of making a living. Attempts to halt the spread of HIV infection are hampered by the fact that most prostitutes are indifferent to the use of condoms and do not appreciate the importance of protecting themselves from the risks of HIV infection. Their frequent mobility also poses a problem as it makes it difficult for them to benefit from health education campaigns. The prevalence of HIV-1 infection among female prostitutes in Borno State (as indeed in other States in Nigeria) is likely to rise sharply in the next few years unless serious efforts are made to intensify health education campaigns targeted at the high risk groups.

Acquired Immunodeficiency Syndrome↗

Prevalence and risk factor analysis of TTV infection in prostitutes.

TTV, a DNA virus, has been isolated from patients with non-A to non-E post-transfusion hepatitis. In the past it was assumed that TTV was transmitted parenterally. It is unclear whether sexual contact leads to transmission of this virus. In this study, two sets of TTV-specific polymerase chain reaction primers were used to detect serum TTV DNA in 140 prostitutes and 136 controls. The prevalence of TTV DNA in prostitutes was significantly higher than in the control group (46/140 [32.9%] vs. 29/136 [21.3%]; P = 0.043). There was no significant difference in the prevalence of positive antibody to hepatitis A virus (anti-HAV) in either group (87.8% for prostitutes, 85.3% for controls). No particular risk factor was significantly associated with positive TTV DNA in prostitutes. In summary, TTV is highly prevalent in prostitutes. Transmission of TTV via sexual contact is not as efficient as transmission of hepatitis C and D viruses and GB virus-C hepatitis G virus. The high prevalence of TTV in controls indicates that there are diverse routes of transmission of this virus.

Adult↗

Early sexual experience as a factor in prostitution.

Using the literature of the early sexual histories of "normal" women and two recent studies on the sexual histories of prostitutes, this article examines the pattern of early sexual experience among prostitutes and how it differs from that common to nonprostitute women. Some significant differences found between the samples of prostitutes and the samples of "normal" women were that the prostitute samples, on the whole, learned less about sex from parents and more from personal experiences, as children experienced more sexual advances by elders, were more victimized by incest, generally initiated sexual activity at a younger age, more often had no further relationship with their first coital partner, and experienced a higher incidence of rape. The analysis of these data on early sexual history concentrates on abusive sexual experiences such as incest and rape. The authors believe that an abusive sexual self-identity relates to the development of an adult female pattern of occupational deviance such as prostitution.

Adolescent↗