‘An indistinct desire’: Psychogeography in David Copperfield

Introduction Pre-exposure prophylaxis (PrEP) is a key strategy for HIV prevention in Thailand. National PrEP policy (2021) identifies priority populations, however, sex workers are not included, despite meeting established criteria for populations at substantial risk of HIV infection. PrEP uptake coverage among sex workers is very low: >7.5% coverage of all sex workers and especially low among female sex workers. This study investigates key characteristics of PrEP non-users i.e. someone who has never initiated PrEP among female, male and transgender sex workers to inform more inclusive and impactful PrEP policy and programming. Methods A cross-sectional study was conducted from September to December 2023 across seven high HIV burden provinces (Bangkok, Chiang Mai, Chonburi, Kanchanaburi, Phuket, Sakeo and Udonthani). We surveyed 1,511 Thai female, male and transgender women aged ≥18 years, engaged in sex work (venue-based, non-venue based and online) in the past three months, reporting an HIV-negative or unknown HIV status. Structured questionnaires were used and data analyzed in Stata 15.1. Descriptive statistics summarized participant characteristics. Multivariate logistic regression identified factors independently associated with not using PrEP, estimating adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs). Results PrEP uptake was 1.3% among female sex workers (n=621), 13.9% among male sex workers (n=452) and 14.8% among transgender sex workers (n=438). The majority (83.9%) had not used PrEP (n=1,268). PrEP awareness was lowest among female sex workers (25%). Those who had never used PrEP were significantly more likely to report PrEP concerns. Young sex workers (18-24 years) and those who had recently entered sex work reported behaviours putting them at higher risk of HIV exposure. High levels of interest in using PrEP were found among PrEP non-users, which increased further when long-acting injectable PrEP was proposed. Conclusions Tailored interventions to increase sex worker PrEP awareness, expanding options and address key concerns are needed for all sex worker populations. Specific programming is particularly needed for young, female and new entrant sex workers. Expanding PrEP options will increase PrEP demand and uptake among sex workers.

The prevalence of oral sex increased from 27.1% in 1992 to 81.1% in 1997, with a concomitant increase in pharyngeal gonorrhea, among female sex workers in Singapore. The extent of condom use for oral sex among them is unknown. To determine the prevalence of and factors associated with consistent condom use during oral sex. A cross-sectional study of 225 women randomly selected from the surveillance scheme register of female brothel-based sex workers with a history of oral sex documented in their medical records. Slightly more than half (56.9%) consistently used condoms for oral sex compared to 97% for vaginal sex. Condom use was significantly higher among middle than high class sex workers (adjusted rate ratio: 1.52, 95% CI: 1.01-2.29) and those with negotiation skills (adjusted rate ratio: 1.95, 95% CI: 1.32-2.07). Sex workers should be taught skills to negotiate condom use for oral sex.

Sex workers must not be forgotten in the COVID-19 response

Sex workers in Sub-Saharan Africa are vulnerable to a range of factors that dispose them to poor health outcomes. In particular, they are at high risk of violence, injury, rape, discrimination and a spectrum of human rights abuses. Their vulnerability to HIV and other STIs are many fold greater than the non-sex worker population of the same age. Health care systems world-wide, and particularly in Africa, are not adequately responsive to the needs of sex workers. As a result, many sex workers do not receive adequate health services, education or HIV prevention tools. While the literature on female sex work in Africa is fairly robust, troubling research gaps are evident on male and transgender sex work, as well as on the intersections of migration and sex work. Mega-sport events have been associated with increased anxiety about sex work and human trafficking, with few studies tracking the impact of such events on local sex work industries over time. These fears were prominent during the 2010 FIFA Soccer World Cup. This PhD project consisted of three research projects based in South Africa and Kenya. It aimed to evaluate the impact of social and behavioural factors on the health of sex workers. To achieve this objective, it examined the effects of sex worker characteristics, migration status, and their relationships with commercial and non-commercial partners on sexual behaviour and access to services. Such information may assist in designing more effective health policies in addition to providing insights into the structural factors that affect sex work settings and heighten sex worker vulnerability to ill-health. The first research project consisted of face-to-face surveys with 1799 male, female and transgender sex workers in Johannesburg, Rustenburg and Cape Town. The second research project involved telephonic interviews in three waves with 663 female sex workers who advertised online or in newspapers in South Africa. The third component was a prospective cohort of 400 female sex workers in Mombasa, Kenya. The research findings indicate the diversity of the sex industry and the people who work in it. Sex work is an important livelihood strategy that provides an income for sex workers and their extended network of dependents. Migration is a vital component for exploring and understanding how many sex worker lives and work are structured in South Africa. Sex workers are subject to violence from their non-commercial partners as well as from police, while unprotected sex with non-commercial partners emerges as an important risk factor for HIV. The PhD research detected little significant changes in the sex industry due to the 2010 Soccer World Cup, and documents how strategic opportunities were lost to alter some of the structural conditions of sex work during a time of heightened sex work awareness, funding and scrutiny. Moreover, this thesis highlights the shortcomings of health care services in responding to the needs of sex workers. It recommends the rolling-out of specialised, sex work-specific health care services in areas of sex work concentration, and sex work-friendly services in mainstream health care facilities in areas of lower sex work concentration. Non-judgemental and empathetic health workers are a key component of responsive services. Lastly and perhaps most importantly, it underscores the importance of decriminalising sex work in order to safeguard sex worker rights and to protect individual and public health.

This study examined data collected from a sample of female sex workers (FSWs) during the first two years of a brief risk-reduction intervention for vulnerable populations that focused on substance use and HIV risk-related behaviours (2007–2009) as part of a rapid assessment and response evaluation study. In 2007, in collaboration with a local non-governmental organisation (NGO), an initiative was begun to roll out targeted harm reduction strategies for drug-using street based FSWs in Durban, South Africa. Data were collected on demographic characteristics, substance use and HIV risk behaviours to tailor these harm reduction strategies with participants. Over the first two years of the intervention, data were collected from 646 FSWs: 428 who reported being at low risk for HIV and 218 who reported being at high risk for HIV (defined as engaging in unprotected sex with sexual partners in the past 90 days). FSWs who had previously been diagnosed with HIV or a sexually transmitted disease (STD) were significantly less likely to report engaging in unprotected sex. Those who used over-the-counter or prescription (OTC/PRE) drugs reported engaging in unprotected sex significantly more often than FSWs who did not use these substances, while those who used heroin were less likely to report unprotected sex. The findings are encouraging in that those who are aware of their HIV status are less likely to engage in risky sexual behaviour, and therefore HIV testing and counselling is recommended. It indicates the need to identify strategies to encourage the likelihood of all FSWs, particularly those who are HIV-positive, to use condoms. It also encourages further research to investigate specific substances as possible predictors of high risk behaviours in high-risk populations of sex workers.

The Republic of Ireland is a good case study to highlight the problems associated with uncritical appeals to criminal law as the only appropriate tool to tackle demand and protect sex workers from harm. In 2017, the Criminal Law (Sexual Offences) Act came into force in the Republic of Ireland (hereafter Ireland) making it a criminal offence to purchase sex in the jurisdiction. Ireland’s decision to introduce Swedish-style laws followed a protracted public campaign instigated in 2009 by the Irish and radical feminist inspired neo-abolitionist organisation, Turn off the Red Light. In this article, we confront and de-centre the Turn off the Red Light campaign’s hegemonic narrative that the criminal rather than social justice responses provide a more effective vehicle for sex workers’ empowerment. Undertaking our intervention in Irish feminist prostitution politics as a ‘politics of doing’ social justice through our separate and combined research, we extend our analysis by invoking Nancy Fraser and Barbara Hudson’s theoretical work on social and restorative justice. We wish to develop a theoretical framework that can serve as a roadmap for restorative social justice – the process of achieving rights, recognition and redistribution through relational, reflective and discursive interventions in sex work research, policy and practice. We argue that by ‘thinking’ sex workers’ positionality in social relations differently, the ‘doings’ of restorative social justice for sex workers can begin or take place.

Environmental health and safety of Chinese sex workers: A cross-sectional study

Female sex workers (FSWs) in Thailand are at high risk for sexually transmitted diseases (STDs). Although regular attendance at public STD clinics is required, FSWs may frequently use medications obtained in the community for STDs. To determine the frequency of use of medications for STDs from sources other than public STD clinics among FSWs in Thailand and to describe factors associated with such medication use. A cross-sectional survey of FSWs attending the public STD clinic in Chiang Rai, Thailand, was performed. Of the 200 FSWs interviewed, 55% had ever used medications to treat or prevent STDs from a source other than a public STD Clinic, and 36% had done so in the prior year. Most use (79%) was to treat STD symptoms, and medication was most frequently obtained directly from a pharmacy (54%). This use of community medication for STDs was associated with younger age, non-Thai ethnicity, seeking STD treatment during the current clinic visit, and brothel-based sex work. Use of medications from various sources in the community was common among these FSWs. Further research is needed to determine the appropriateness of this treatment. Innovative methods to ensure adequate quality STD care by community providers and to improve the health-care-seeking behaviors of these high-risk women are needed.

ABSTRACTPrevious research shows that interventions aimed at female sex workers (FSWs) can be successful in reducing HIV risk behavior. The current study evaluated a specific HIV prevention intervention for substance-using FSWs in Durban, South Africa by comparing such behaviors before and after the intervention. The intervention was provided by trained outreach workers by an organization that worked with FSWs, and consisted of community-based outreach, HIV and substance use education and information. Safer sex practices were also taught. The sample consisted of 457 substance-using FSWs, with findings indicating a significant decrease in the number of sexual partners (z = −16.05, p < 0.001), number of times they engaged in vaginal sex (z = −8.07, p < 0.001), and a significant decrease in all substances used with the exception of over-the-counter or prescription substances. The intervention therefore seemed to reduce certain risk behaviors among this group of FSWs. Future research should focus on the aspects of the substance use-sex risk intervention that were associated with decreased risk behavior, and include a randomized controlled trial to assess effectiveness of the intervention.

BackgroundFor a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson’s behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries.MethodsSix relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods.FindingsResults from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons – to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities.ConclusionComplex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs.

Introduction Although anecdotal evidence suggests that HIV infections in Mexico were occurring in 1981, the first cases of AIDS in Mexico were documented in 1983. Since then, approximately 50 000 cases of AIDS have been reported nationwide and it is estimated that there are approximately 150 000 HIV-infected persons living in Mexico [1,2]. While it could be argued that there is some underreporting of AIDS in Mexico [2,3], the epidemic is still significantly less intense than that to the north (USA) or south (Central American countries, e.g. Honduras). One possible explanation for this is that, unlike in the countries surrounding it, the epidemic in Mexico has remained 'nuclear', primarily affecting men who have sex with men in urban areas of the country such as Mexico City, Guadalajara, Monterrey and Tijuana [4]. This relative containment of the epidemic is by no means accidental but rather the end result of many prevention efforts conducted by the government as well as by community-based organizations. The national response to AIDS in Mexico was early and strong, beginning shortly after the first cases were reported in 1983. HIV testing began the first year the test was available (1985) and in February of 1986 the National Committee for AIDS Prevention (CONASIDA) was founded. In 1988 a Presidential Decree transformed CONASIDA from a committee to a 'National Council', thus giving it a multisectorial composition that went beyond the scope of individual health sector response. While early national-level attention toward containing the epidemic has benefited the population at large, it is clear that prevention efforts of the Mexican government have been most successful in two areas: in the control of transfusion-transmitted HIV and in preventing infections among female commercial sex workers. Because HIV infection through blood and blood products represents only a small proportion of all cases of HIV/AIDS worldwide it has not received the attention this means of transmission merits [5]. Not only is it the most efficient way in which HIV can be transmitted, but transmission via blood and blood products is also the route most amenable to government control. As a result, devoting attention and resources to insuring the safety of the blood supply represents a unique opportunity and a cost-effective intervention for public health authorities to dramatically change the course of HIV infection in a given country. The changing epidemiology of AIDS in Mexico provides compelling proof of this conclusion. With the exception of patients with hemophilia, transfusion-transmitted HIV in developing countries primarily affects women – specifically women who receive blood for obstetric reasons [6]. Because of this observation, a country with a large proportion of infected women may overestimate the level of 'heterosexual' transmission, overlooking a hidden blood and blood products connection. For example, in 1986 there were 26 cases of AIDS in men for every one in women (26 : 1) in Mexico. Four years later, at the same time that the highest proportion of transfusion-transmitted cases were being reported nationwide, the number of infections among women had climbed so dramatically that the ratio dropped to five cases of AIDS in men for every one in women (5 : 1). Then, in 1999, the first year in which no transfusion-transmitted AIDS cases were reported in Mexico, the trend in male-to-female cases reversed direction ( for the first time ), with six cases of AIDS being reported in men for every one in women (6 : 1). In many countries, infection of the blood supply is chiefly an economic phenomenon. For example, prior to 1987, selling one's blood or plasma was such an attractive source of income for many impoverished Mexicans that commercial blood and plasma donors (who had, by definition, no inducement to know their HIV status prior to donation) formed a significant percentage of total blood suppliers. Thus, the control of transfusion-transmitted HIV in Mexico not only involved mandatory HIV testing but also banning the commercialization of blood and closing of commercial plasmapheresis centers. As noted above, this policy has all but eliminated HIV from the Mexican blood supply. Blood transmission of HIV in other countries continues to be a significant problem. Recent reports from China suggest that paid blood donors may be playing an important role in the spread of HIV there [7]. The impact of commercial sex on HIV transmission is well known and has long been considered a critical vector for the introduction of HIV infection into the general population [8,9]. As a result, interventions to limit the extent of HIV infection among commercial sex workers (CSW) are frequently viewed as a priority in many national prevention campaigns [10]. Perhaps the best-known of the successful interventions with CSW to date is the '100% condom use in brothels' initiative in Thailand [11]. This initiative has lead to a marked decrease in HIV incidence among Thai military recruits as well as to a decrease in the incidence of other sexually transmitted infections in that country. In contrast to Thailand and many other countries though, HIV seroprevalence among female CSW in Mexico has remained low since the beginning of epidemiological investigation, with seroprevalence averaging below 1% in large, repetitive serosurveillance studies. This finding suggests that many of the early interventions targeting CSW in Mexico might have limited the impact of HIV in this group. Yet, it could also be argued that the nuclear epidemiology of HIV in Mexico described above has simply meant that female CSW in Mexico are at less risk of exposure to infection than CSW in other countries. If this observation is so, the low seroprevalence among Mexican CSW may not be credited to public health intervention but rather reflect lack of opportunity to be exposed to HIV. In this article, we will review the major interventions conducted to date in Mexico as part of the National AIDS Prevention and Control Program. We will also review the available data published in journals or presented at the International AIDS Conferences for insights into Mexican HIV prevention successes and failures that may have implications for AIDS programs in other developing countries. The control of HIV transmission through blood and blood products When the AIDS epidemic began in Mexico in the early 1980s there was no coordinated system of blood procurement and a large proportion of the blood available in the country was obtained from paid donors. In addition, an unknown number of commercial plasma collection centers throughout the nation also obtained their products from paid donors. Evidence now suggests that these centers frequently re-used contaminated equipment during blood collection resulting in the introduction of HIV to previously healthy donors. As a result, not only did the centers collect and distribute infected blood products, but they also acted as an efficient means for accelerating that process by transmitting HIV to previously uninfected repeat clients during the plasmapheresis process. Until recently, the impact of transfusion-transmitted HIV on the AIDS epidemic in Mexico had been quite significant. In only 4 years (1984–1988) blood and blood product transfusion associated AIDS in Mexico went from being unheard of to comprising over 10% of all cases. Until 1987, paid blood and plasma donors provided approximately one-third of all blood products in Mexico [12]. Stereotypically, a paid donor would be a young man from a rural area who had migrated to one of the shanty towns that surround large cities like Mexico City, Guadalajara, Monterrey and Tijuana. He would be unemployed/underemployed, disenfranchised, and had no risk factors for HIV infection prior to his migration. After hearing about the opportunity from a friend or family member, he would become a regular customer at one of the local blood banks or plasmapheresis centers, being paid to donate as frequently as the individual center's policy allowed, perhaps as often as every 2 or 3 days. The more times he donated, the higher his risk became for becoming infected with HIV during the blood collection process. If he did become infected, he would almost certainly transmit that infection into the national blood supply – and to other donors at the same center as well – during his subsequent donations. Additionally, he might also transmit HIV to his wife or girlfriend during sex and, through them, to his children. In May of 1986, when HIV testing of all blood donors became mandatory in Mexico, the full extent of the tragedy of HIV among paid donors first began to surface. In two separate but concurrent studies carried out between 1986 and 1987, a prevalence of 7% was found among 9100 paid donors [12] compared to a seroprevalence of only 0.67% among 319 153 persons who donated blood without remuneration [13]. Further evidence of the extreme health risk disparity faced by paid donors in Mexico at that time is evident when their seroprevalence is compared to that of related donors (0.12%) or volunteer donors (0.09%) [12,14]. When the data were analyzed retrospectively, the scope of the risk faced by paid donors became dramatically clear. For example, the prevalence among paid donors at one plasmapheresis center increased in 5 months, from 6% in June 1986 to 9.2% in October of the same year [14]. Furthermore, seroconversion was documented in 22.1% of these subjects during this period. A case–control study of this population revealed that a history of four or more donations per month (odds ratio, 5.4; 95% confidence interval, 1.9–16.3) was associated with HIV infection. As described above, it is believed that donors were iatrogenically infected with HIV during the plasmapheresis process, probably as a result of improper infection control measures. The procedure included recycling of plasmapheresis equipment, reuse of needles or syringes, and even the injection of small amounts of infected plasma or blood. As the number of donations per month was as high as 12, it is feasible that once the infection was introduced into a specific blood or plasma bank, subsequent uninfected donors became infected at the blood or plasma facility at the time of donation. In 1989, the first case of AIDS in a Mexican paid plasmapheresis donor was reported [15] and by 1990 the reporting of this high-risk group became mandatory in Mexico [16]. Thus a new 'risk group' was defined in Mexico and later adopted by the Panamerican Health Organization: the professional blood donor. However, paid donor is not routinely reported as a risk group in many epidemiological reports and thus it may not be recognized as an important contributor to the spread of HIV in a given country (see Fig. 1).Fig. 1.: AIDS cases in Mexico in 1997 by risk group. Mexico versus WHO/UNAIDS.In May of 1987, as a consequence of poor compliance by blood and plasma banks with the 1986 law that mandated HIV screening of blood and blood products, the executive and legislative branches of the government approved a law prohibiting the sale of blood and blood products in Mexico [6,17]. This law was not without controversy and much opposition. Since Mexico lacked a culture of volunteer blood donation, ready sources of HIV testing, and an organized blood collection infrastructure, there was a major fear among public health officials that shutting down the blood and plasma industry would severely compromise the blood supply, prompting the emergence of a black market in blood and blood products. Because of this possibility, a two-pronged response was quickly approved and implemented. Campaigns promoting volunteer blood donations were begun all over the country while, at the same time, the necessary laboratory infrastructure for HIV testing was established. Within 4 months, a network of 70 laboratories capable of screening donors for HIV was set up in the country's 32 states. In addition, blood collection and distribution centers were established in collaboration with the Mexican Red Cross. Table 1 summarizes the steps taken by Mexico for the control of transfusion-transmitted HIV.Table 1: The Prevention of transfusion-transmitted HIV in Mexico. The implementation of the strategies described above has had dramatic consequences for public health in Mexico. Not only is the future health of the general public more assured – the number of transfusion- associated cases peaked within a year of the blood sale ban and no new cases of AIDS secondary to blood transfusion have been reported since 1999 (see Fig. 1) – but so is the future health of blood donors. After paid donors were banned in 1987 the HIV seroprevalence among donors decreased from 2.6% in 1986 to 0.7% in 1988 [6]. In 1989, HIV seroprevalence among blood donors in Mexico further decreased and has remained low (below 0.08% in all years). For example, only 385 out of 1 099 755 blood units tested positive for HIV in 1999 (0.04% prevalence) and 377 out of 1 140 632 were HIV infected in 2000 (0.03% prevalence), (see Figs 2 and 3). As a result of the change in government policy, it is estimated that over 8000 transfusion-transmitted infections have been prevented.Fig. 2.: AIDS cases associated with blood transfusion in Mexico (through July 2000, by date of diagnosis.Fig. 3.: HIV prevalence among blood donors, Mexico 1986–2000. From the National HIV Laboratory Network.This improvement is certainly a cause for relief but the true extent of the widespread damage caused by the paid donor system has yet to be calculated. Close to 400 cases of AIDS among paid donors were reported to the National AIDS Registry before this transmission of HIV was finally contained. This number of cases represents more than twice those reported among hemophiliacs in Mexico [17,18]. Close to 2500 cases of AIDS considered secondary to transfusion of HIV infected blood have been reported, and those account for only the primary infections [2,19,20]. As noted above, many of the paid donors, as well as the recipients of contaminated blood and blood products may have infected their sex partners (and subsequent children). This possibility is a key observation. Before the tragedy was contained, women in Mexico – particularly poor women – were at risk from contaminated blood from not one but two sources. They were at risk directly, via obstetric-related blood transfusions and they were at risk indirectly from sexual partners who were professional donors and who were infected at the time of blood or plasma collection. We believe that it is this 'double jeopardy' that Mexican women faced that led to the rapid transition in male : female ratio of AIDS cases in the mid 1980s and the apparent 'heterosexualization' of the AIDS epidemic. It is reasonable to suppose that without the now present safeguards placed on the blood supply in Mexico, this double jeopardy would have continued and the male : female ratio of infection would have continued to decrease until Mexico achieved a 'pattern 2' (primarily heterosexual) epidemic. Support for this assumption may be inferred by observing the rapid transition of the male : female case ratio in countries that continue to support a paid donor blood collection system. For example, in areas of India and China where epidemic HIV infection in paid donors has been noted, the epidemic has become overwhelmingly 'heterosexual' [21]. Support for this conclusion may also be found more concretely in the results of a study to determine the risk factors for HIV-infection among women in Mexico. Of 454 women who had an HIV test performed in 1992, multivariate analysis revealed that only a history of blood transfusion, low literacy and having sex with an HIV infected partner were associated with being HIV-infected [22]. In summary, the Mexican experience highlights the critical role that mandatory screening of all donors, prohibiting paid donations, and maintaining strict control of the plasma industry can have on the epidemiology of HIV/AIDS. Such simple control measures undoubtedly require resources but, above all, require political will for their implementation. The prevention of HIV infection among female commercial sex workers Commercial sex in Mexico takes place in the 32 federal states of Mexico under one of two legal frameworks: 'abolitionist' or 'reglamentarist' [23]. The abolitionist movement seeks to eliminate prostitution entirely by making its practice a misdemeanor. More commonly though, prostitution is allowed but controlled by legislation. The reglamentarist system restricts prostitutes' activities to certain areas of the city or establishments and requires them to be licensed and have periodic health exams. Most of Mexico (except for the Federal District where Mexico City is located, and the States of Mexico, Puebla and Guanajuato) functions under a reglamentarist system. The public health threat posed by the reglamentarist system – specifically the requirement for periodic health exams – is the potential for corruption (a sex worker might have the opportunity to 'buy' a clean record) and the potential for a false sense of security on the part of CSW clients. This false sense of security, which may lead some clients to request or insist on sex without a condom, is not just a product of political corruption. Unfortunately even periodic health exams are not sufficient to protect clients from recently acquired HIV infection or sexually transmitted infections (STI). There is continuing debate among public health experts about whether the abolitionist or reglamentarist legal framework provides a better system for preventing HIV infection among sex workers. Thailand's experience, however, would seem to suggest that strictly enforced rules and regulations governing both sex workers and their clients (such as 100% condom use in brothels) can be the cornerstone of a successful program of public health safety [11,24]. Commercial sex in Mexico City takes place under an abolitionist system that has been in place since 1940 when the practice of commercial sex was first banned in that city. In Mexico City, any individual who is found practicing commercial sex may be fined and arrested for 24–36 h [25]. Under this legislation the police are also permitted to detain women who are on the street simply because their personal appearance is considered 'offensive to modesty and good custom', even if there is no evidence that the women were actively engaging in prostitution. Nevertheless, patronizing the services of CSW is tolerated and excused, if not condoned. are arrested or This double is In the Mexico City of young health found that 6% of men reported having their first sexual with a CSW The proportion of men who have been clients of CSW during their is undoubtedly Unfortunately this system CSW in a status and them of health services and legal This in the corruption of police and other authorities who routinely from In 1986 an place CSW that, in may have been in the Mexican AIDS epidemic to its nuclear In that female CSW began at National AIDS (CONASIDA) and to request HIV testing and risk In these women provided an opportunity for public health officials to to an population that is and of with the CONASIDA began to to with these women and them into the public health process. Perhaps the most intervention that place during this time was a between the of in Mexico City and the of Health that allowed CONASIDA to a of and interventions with sex workers without the of the local In this way CONASIDA was to with sex workers and their without them to testing of early revealed that HIV incidence among female CSW in Mexico City was below 1% in the 1980s and has remained low since among 1997 women tested for HIV in This finding is in marked contrast to the prevalence of HIV among male CSW in Mexico or to the epidemic among male and female CSW in other countries. the same time interval, for example, the HIV seroprevalence for sex workers in Thailand increased from in 1988 to over in 1990 A of HIV among sex workers has been in India and [21]. on the seroprevalence of HIV found among CSW who are tested in a CONASIDA it is that factors described below may have a low prevalence of HIV among female CSW in Mexico, the that HIV prevalence has remained low to this could also be to increased condom use like other women in Mexico, are to HIV in one or more of four through the transfusion of contaminated blood or blood products during or for obstetric through the use of contaminated needles injection through infection at the time of blood or plasma professional blood plasma or through sex with a who is HIV For the to be – that low HIV prevalence in female CSW is not primarily to increased condom use – it would be necessary to evidence that the of transmission described above in a risk for HIV infection to female the result could that other or means of than transmission from of those In to and evidence be in to the at the of Health and CONASIDA was and was not known about the transmission from contaminated blood or blood products As noted above, transfusion-transmitted HIV primarily affects specifically women who receive blood for obstetric reasons [6]. There was no evidence that female CSW in Mexico were at less risk of blood transfusions than other the low prevalence of HIV among female CSW was probably to a risk from contaminated equipment There was no that HIV may be transmitted via contaminated needles by equipment or during was in was whether the low prevalence of use among female among those CONASIDA and in was sufficient to account for the low prevalence of HIV among them as For other countries with a low prevalence of use among female CSW have the incidence of HIV dramatically in their female CSW the low prevalence of use among female CSW in Mexico undoubtedly the of HIV in this it did not to be more than condom use for the continued low prevalence of HIV. infection at the time of blood or plasma As has been described above professional blood and plasma donors became infected with HIV until this practice was banned in It was thus possible that could also have been professional donors and thus be at risk for HIV infection through this However, of cases of AIDS among professional blood donors have been among which is by the that men were much more to be professional donors. from sex There are at in which sexual in the of may be with a continued low prevalence of HIV among female an HIV seroprevalence in the general population to a significant transmission if the prevalence of HIV is not spread throughout the population and infected clients not female and if the specific sexual in by CSW not HIV In the first the low prevalence of HIV in the general population of Mexico in 1986 six per meant that sex workers as a group faced risk of exposure from their clients The with this explanation was that had found a high prevalence of in many American countries It was that evidence would be before a could be that are less to female CSW than male CSW and that, the risk for infection from this group was than for female In the it was that female CSW did not practice sexual considered to be of high risk with their clients so the or of a For the of transmitting of transmission and evidence would be before a could be that female CSW in Mexico or only in HIV transmitting As a result of the in a major study was in observation, key and to a of commercial sex in the urban area of Mexico City This allowed the of street and where commercial sex From this it was estimated that approximately of the population of Mexico City were women in commercial sex 000 A of these women were to in a study which included sexual as well as testing for and The results of these studies a low prevalence of among female sex workers and the studies which that the HIV prevalence among these women was quite low (see Table A significant was also found between the risk of having an and the of a street have higher of In addition, a level and the number of years practicing commercial sex were associated with being for HIV and prevalence among female commercial sex workers in Mexico. from The results of the were also of major While all women reported having with their reported having sex and reporting having In addition, reported an in condom use since about However, in contrast to their with their reported with their or In multivariate risk factors for sex with clients included a low street no use of a to use clients of and use of services the years subsequent studies conducted in Mexico City as well as in other cities throughout the country have continued to a low prevalence of HIV among female commercial sex workers (see Table 3). As noted above, this finding is in marked contrast to the HIV seroprevalence among sex workers in other developing HIV prevalence studies among female commercial sex workers in Mexico. In an to further sexual and to risk factors for HIV infection among men in Mexico, a of studies have been conducted by group. studies that men at and had a higher seroprevalence of HIV infection than men versus and that reported condom use was quite with only reporting regular condom use As noted above, the practice of has been reported to be among American men in to a of men conducted in this practice to not be as in Mexico City in In that study of men reported that they had sex in their with reporting and The HIV prevalence in this was among men and among men This study also that men might be to the services of male or female CSW when not in a

OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.

Health is a gift that must be acknowledged and maintained throughout life. Health improvement can be achieved by maintaining a proper diet, healthy lifestyle, and positive behavior. Health promotion includes both the prevention and treatment of diseases. One commonly encountered condition is Sexually Transmitted Infections (STIs), which are diseases primarily spread through sexual contact.STIs rank among the top ten causes of discomfort and disease in both men and women. The occurrence of STIs is largely due to the low usage of condoms, particularly among female sex workers. The objective of this study is to examine the effect of condom use socialization on the knowledge and attitudes of female commercial sex workers in the prevention of sexually transmitted infections in Helvetia Subdistrict, Medan, in 2023.This research uses a pre-experimental method with a one-group pre-test and post-test design. The sample was selected using the total sampling technique, meaning the entire population was used as the sample, totaling 30 individuals. The data were analyzed using a One-Group T-Test Experimental method.The results of the study showed a significant impact of condom use socialization on the knowledge of female sex workers in STI prevention, with a T-test result of 0.000. Similarly, the influence on attitudes showed the same result, 0.000, indicating a statistically significant impact.The conclusion of this study is that there is a significant effect of condom use socialization on the knowledge and attitudes of female commercial sex workers in STI prevention in Helvetia Subdistrict, Medan, in 2023. Based on these findings, it is recommended that health workers increase the frequency of educational outreach efforts, particularly focusing on STI prevention among female sex workers through consistent condom use.

In most countries, sex-work is criminalized and frowned upon. This leads to human rights abuses, especially for migrant female sex workers. The burden is heavier on migrant female sex-workers whose gender and foreign citizenship intersect to produce a plethora of adverse health, social, and legal outcomes. This phenomenological study explores the intersectionality of individual factors leading to human rights abuses among migrant Cameroonian female sex workers in N’Djamena, Chad. Ten female sex workers and two key-informants were interviewed, and being a small sample, they gave detailed information about their experiences. The data was later analyzed using thematic analysis. Participants narrated experiences of social exclusion, exposure to diverse abuses, and health risks due to gender, immigrant status, and illegality of sex work. The experiences of female migrant sex workers, within contexts of sex work criminalization, are exacerbated by the intersectionality of these factors. Women endure several vulnerabilities in many African countries, more so when they have to survive on sex work as foreigners in a country where the act is illegal.

Background: The India AIDS Initiative (Avahan) prevention programme funded by the Bill and Melinda Gates Foundation aims to reduce HIV prevalence in high risk groups such as female and male...