HIV/AIDS risk among female sex workers who use crack in Southern Brazil

Monica Malta,Simone Monteiro,Suzana Bauken,Gleisse Cristine Zuim,Francisco Inacio Bastos,Steffanie Anne Strathdee,Merrill Singer,Rosa Maria Jeronymo Lima,Aliamar De Marco

doi:10.1590/s0034-89102008000500007

Abstract

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.

Highlights

In many parts of the world, there is significant overlapping between populations of sex workers and injection drug users (IDU), and, more recently, between crack cocaine smoking and unprotected commercial sex
Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection
Those initiatives might increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections

Summary

Introduction

In many parts of the world, there is significant overlapping between populations of sex workers and injection drug users (IDU), and, more recently, between crack cocaine smoking and unprotected commercial sex. In Brazil, a major aspect is the specific drug scene, where the main drug of abuse is cocaine.[10] Due to specific patterns of cocaine use – constant and repetitive use in a single day – active cocaine users frequently engage in risk behaviors to maintain their patterns of consumption.[11,12] Some studies have reported the transition toward crack cocaine of former cocaine snorters and/or injectors in Brazil.[1,5,8]

Results

Discussion

Conclusion