Prostitution and HIV: what do we know and where might research be targeted in the future?

Abstract

A review of the literature indicates that the association between human immunodeficiency virus (HIV) and prostitution varies by geographic region and can be altered substantially by well-planned public health interventions. In most African countries and in Asian countries such as Thailand, the rate of HIV infection among female prostitutes is substantially higher than the rate in the general population. Relatively few commercial sex workers in South and Central America are HIV-positive; however, their extremely high rates of infection with sexually transmitted diseases indicates the potential for future epidemic spread of HIV. In Europe and North America, HIV infection is most prevalent among drug-injecting or crack-using prostitutes. Neglected has been research on the high incidence of HIV among male transvestite and transsexual prostitutes. The lowest levels of condom use in commercial sex encounters have been recorded in regions in developing countries with the highest HIV prevalence. Also of concern are high condom breakage rates (20-50%) among female prostitutes who use petroleum-based lubricants and male prostitutes who practice anal sex. Valuable would be quantification of the additional HIV risk resulting from sex with a prostitute. Other recommended research areas include estimates of the number of male and female prostitutes working in certain geographic areas, mechanisms for monitoring condom use and substance abuse among prostitutes, the impact of HIV infection on movement into and out of prostitution, the dynamics of prostitute-client condom negotiation, and profiles of the clients of male prostitutes.