Brothel-based Female Sex Workers Research Articles

Sexually transmitted infections among at-risk women in Ecuador: implications for global prevalence and testing practices for STIs detected only at the anorectum in female sex workers

ObjectivesAnorectal sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), present treatment challenges, potentially increase antibiotic resistance selection and if undetected may facilitate onward transmission. However,...

Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China.

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects. A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs. A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs. Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

HIV Infection and Potential Predisposing Risk Factors Among Brothel-Based and Non-Brothel-Based Female Sex Workers in Port Harcourt

The study comparatively evaluated the epidemiological distribution of HIV infection among brothel-based and non-brothelbased female sex workers in Port Harcourt. This cross-sectional study design employed venue/facility-based profiling and obtained unequal sample distribution, with more brothel-based, 108 (54%), compared to non-brothel-based, 92 (46%). Recruitment was through a multi-stage sampling with strict adherence to ethical guidelines and diagnostic protocol. The study followed standard clinical laboratory practices for HIV screening using HIV screening kit protocol. The study reported a general prevalence of 29 (14.5%), greater than the venue-specific prevalence among brothel FSWs (13.0%) but less than the prevalence among non-brothel-based FSWs (16.3%). Risk assessment showed no significance with an odd ratio of 1.308 (95% Confidence Interval = 0.595 to 2.877). There was also a relative risk of 1.139 (95% confidence interval = 0.763 to 1.699) and 0.871 (95% confidence interval = 0.590 to 1.284) for brothel-based female sex workers and non-brothel-based female sex workers, respectively. Despite the reported decline in HIV prevalence among FSWs in this study, the prevalence is still higher than the national prevalence in Nigeria. An enhanced expansion of HIV prevention intervention programs is crucial, even as the measure would help to curtail the trend among these high-risk populations.

PREDICTORS OF ADHERENCE TO PRE-EXPOSURE PROPHYAXIS AMONG FEMALE SEX WORKERS IN SOUTH-WESTERN NIGERIA

Introduction: Pre-exposure prophylaxis (PrEP) is an element of biomedical interventions of HIV prevention. The level of protection is strongly correlated to PrEP drug adherence. In Nigeria, the prevalence of HIV among female sex workers (FSW) is 15.5%. The 2020 integrated biological and behavioral surveillance survey did not report on PrEP adherence among FSW. This study therefore assessed the level of adherence to PrEP and its predictors among FSW in South-Western Nigeria. Methodology: The study was cross sectional analytical in design and was conducted in 2021. Study population were brothel-based FSW at Gambari Ogbomoso and Lagos, Nigeria. A total of 156 FSW participated in the study. Data was collected using interviewer-administered semi-structured questionnaire and analyzed using IBM SPSS Version 21. Results: One hundred and forty-nine properly completed questionnaires were analyzed. Ninety-nine respondents (66.4%) have been working for more than 5years as a FSW and 65(43.6%) had initiation of sex work before 18 years of age. Respondents’ sexual behavior showed that 55 (36.9%) of total respondents had consistent use of condom. One hundred and thirty-four respondents (89.9%) had good knowledge of PrEP, 97 (65.1%) had good attitude towards PrEP while 111 (74.5%) had good perception of risk of HIV infection. One hundred and thirty-two (88.6%) reported to be taking PrEP and 119 (79.9%) had good adherence to PrEP. Predictors of adherence to PrEP were educational status, age of commencement of sex work and monthly income. It was found that educated sex workers were 2.67 times more likely to adhere to PrEP (OR=2.67, 95% CI=1.280-5.591, p=0.019). Those who commenced sex work after clocking 18 years of age were 75% times less likely to adhere to PrEP (OR=0.251, 95% CI=0.106-0.597, p=0.001) while those with average monthly income more than #10,000 were 1.65 times more likely to adhere to PrEP (OR=1.65, 95% CI=0.674-4.042, p=0.0275. Discussion and Recommendation: The level of adherence to PrEP is considerably high and underscores a positive effect of the efforts of the Government of Nigeria in controlling HIV as a threat by 2030. Further studies would be useful to understand the behavioral factors associated with low adherence to PrEP among FSW who have spent more than 5 years in sex work.

Prevalence of Hepatitis B Virus Seromarkers in Female Sex Workers in Enugu State, Nigeria

Hepatitis B virus (HBV) is a sexually transmitted virus with a wide range of terminal complications. As such, female sex workers (FSWs) are an important group in the epidemiology of the virus. This study was aimed at evaluating the seroprevalence of HBV markers and the exposure rate of the virus among FSWs in Enugu State, Nigeria. A cross-sectional study was carried out among brothel-based FSWs, involving 200 participants recruited using a consecutive sampling method. Blood specimens were collected and tested for HBV markers using chromatographic immunoassay rapid test kits. Additional information was obtained through the administration of a well-structured pre-tested questionnaire. Data were entered into Statistical Package for Social Sciences (SPSS) version 20.0 and analyzed using the Descriptive Statistics and Chi-Square test in SPSS. Out of the 200 sampled individuals, 82(41%) tested positive for at least one seromarker, with 44(22%) showing evidence of natural infection and 38(19%) indicating a vaccine response. Hepatitis B core antibody (total anti-HBc) was present in 42(21%) of the participants, while 8(4%) had hepatitis B surface antigen (HBsAg), which is indicative of current infection. This study revealed intermediate prevalence, a high exposure rate and a low vaccination rate among the study population. There is a need for more effective intervention strategies among FSWs in the study area.

Factors associated with condom breakage among female sex workers in the Western Region of Ghana.

Condoms have been extensively demonstrated as being effective in reducing Human Immunodeficiency Virus (HIV) infection rates among both men and women. With proper use and production, condom breakage is ideally minimal. However, breakage is reportedly a widespread problem among Female Sex Workers (FSWs), who are classified as a Key Population and warrant special transmission prevention efforts. Nationally, Ghana records an average rate of 5% of condom breakage. This study sought to identify the factors associated with condom breakage among FSWs in the western region of Ghana, a region with an extensive sex worker population and HIV incidence rate of 2.5%, higher than the national average. This study employed a cross-sectional survey among FSW populations in the Western region, Ghana. A sample of 416 participants were proportionately invited between brothel based and roamer communities to participate in the surveys. A total of 403 consented to participate indicating a response rate of 96.9%. Data were analysed for frequencies and prevalence of variables including condom breakage. At the bivariate level, associations with breakage were examined and statistically significant variables were analysed with simple and multiple logistic regression analysis. Of the 403 research participants who consented to participate, 17.4% had experienced breakage over the past week. Brothel-based FSWs were only half as likely to report condom breakage as non-brothel based FSWs (aOR = 0.526; 95% CI, 0.296 - 0.936). Notably, FSWs who consumed alcohol-containing drinks every day were only 65.2% as likely as those who consumed alcohol at least once a week or less than once a week or never to experience condom breakage (aOR = 0.348; 95% CI, 0.164 - 0.740). The study determined that the occurrence of condom breakage among FSWs in the western region was 17.4%. Factors significantly associated with condom breakage were being non-brothel based, frequency of alcohol consumption and parity. Condom use education programmes targeted at non-brothel based FSWs are necessary to reduce breakage and lower the risk of HIV transmission.

Impact of Testing on Sexually Transmitted Infections among Female Brothel Sex Workers in Bangladesh: A Randomized Controlled Trial.

Past studies that have designed interventions to reduce the prevalence of sexually transmitted infections (STIs) have typically provided onsite treatment to sex workers who tested positive, which were expensive and difficult to implement. The purpose of this study was to examine the effect of an intervention which tested for STIs and provided information on the closest treatment facility on reducing the prevalence of STIs among female brothel-based sex workers (BSWs) in Bangladesh. The study adopted a pre-post interventional design as well as a randomized controlled study design. A baseline sample and follow-up urine sample were collected to evaluate the prevalence of STIs among participants in the treatment, but not control group. A baseline survey and interviews were also conducted for both the groups. The study found a nonsignificant reduction from baseline to follow-up in STI prevalence among intervention participants (adjusted odds ratio [aOR]: 0.74; 95% CI: 0.38, 1.45). However, the participants in the intervention group were significantly more likely to have a repeat client (aOR: 1.60; 95% CI: 1.12, 2.29) and nonsignificantly less likely to engage with a client suspected of having an STI (aOR: 0.62; 95% CI: 0.39, 1.00) than participants in the control group. The intervention testing of STIs and providing information to the positive cases about nearest treatment facilities were not effective in reducing the prevalence of STIs among BSWs. Further study of the clinical and behavioral impacts of such efforts to reduce STIs among BSWs is warranted.

Experiences of a 'screen and treat' cervical cancer prevention programme among brothel-based female sex workers in Bangladesh: A qualitative interview study.

Objectives:Little is known about sex workers’ experiences of cervical cryotherapy. We sought to understand sex workers’ perspectives of ‘screen and treat’ programmes and their management of the World Health Organization post-treatment guidance to abstain from sex or use condoms consistently for 4 weeks. We explored contraceptive preferences and use of menstrual regulation services.Methods:We conducted semi-structured interviews with 16 sex workers and six brothel leaders in an urban brothel complex in Bangladesh between October and November 2018. All had undergone cryotherapy. We conducted a thematic analysis using deductive coding, informed by a priori themes, and inductive data-driven coding.Results:Most sex workers could not abstain from sex during the healing period. Consistent condom use was challenging due to economic incentives attached to condomless sex and coercive behaviours of clients. The implications of non-adherence among high-risk groups such as sex workers are not known. Use of short-acting methods of contraception was common, and discontinuation was high due to side effects and other perceived health concerns. The majority of sex workers and brothel leaders had utilized menstrual regulation services. Barriers to accessing timely menstrual regulation and other sexual and reproductive health services included limited mobility, economic costs, and discriminatory attitudes of health care workers.Conclusion:Service innovations are required to enable sex workers to abstain or use condoms consistently in the post-cryotherapy healing phase and to address sex workers’ broader sexual and reproductive health needs. Further research is required to assess the risk of HIV and other sexually transmitted infection transmission following cryotherapy among high-risk groups.

Knowledge, attitude, and utilization of HIV counseling and testing by female sex workers in Lagos State, Nigeria

Objectives: The Human Immunodeficiency Virus (HIV) epidemic continues to expand among female sex workers (FSWs) who have limited access to and utilization of HIV counseling and testing services (HCT). HCT plays a pivotal role in increasing knowledge and awareness to prevent, treat, and control HIV/AIDS. The study objective was to determine the knowledge, attitude, utilization of HCT among brothel-based FSWs (BBFSWs). Method: This was a descriptive cross-sectional study among 300 BBFSWs in Lagos State. The respondents were recruited by snowballing after a multistage sampling method was used in the selection of the brothels. The data was collected using an adapted interviewer-administered questionnaire and analyzed using IBM SPSS Statistics version 23. The level of statistical significance was set at p<0.05. Results: Majority (63.0%) of the respondents were between the ages of 21-30 years and 67.4% had good knowledge of HIV and HCT. About 75.0% had a positive attitude towards HCT and 55.6% of FSWs in this study had utilized an HCT center in the past. The main reason for not taking HIV test was the fear of a positive result (90.6%) while the main reasons given for not visiting any HCT center were lack of confidentiality (13.3%), stigmatization (14.8%), and distance to the HCT center (67.2%). Conclusion: There was a good knowledge of HCT and a positive attitude towards HCT services by the respondents. The main reasons for not taking the HIV test as indicated by respondents were fear of a positive result. HIV-stigma related issues should be adequately addressed.

Socioeconomic and cultural factors driving Human Immunodeficiency Virus epidemic among female sex workers in Akwa-Ibom (South-south) and Benue (North-central) States of Nigeria

This study was aimed at finding out the socioeconomic and cultural factors driving Human Immunodeficiency Virus infection (HIV) epidemics among Female Sex Workers (FSW) in South-south (Akwa-Ibom) and North-central (Benue) States where the infection prevalence is high in Nigeria. A standardized survey instrument was used in multistage cluster sampling approach in Benue and Akwa-Ibom States using sample size of 415 FSW. The study was done on the classified age brackets between 15 and 49 years with Akwa-Ibom having more participants at 20 to 24 years (32.8%) and Benue at 25 to 29 years (33%). Medical Laboratory Scientists equally carried out three (3) stage HIV testing Algorithm among the FSWs under the study. FSWs were subtyped into Brothel-based Female Sex Workers (BBFSW) and Non-Brothel based Female Sex Workers (NBBFSW). Human Immunodeficiency Virus prevalence in Nigeria from the study is 15.5% with Akwa-Ibom having 11.4% while Benue has 20.2% of their population among Female Sex Workers key population typology respectively. Significant differences exist between the two states in the various socioeconomic factors driving the epidemics among Female Sex Workers. For instance, knowledge of HIV status, knowledge of source of HIV Testing Services (HTS) or medication for Acquired Immunodeficiency Syndrome (AIDS), referrals, knowledge of HIV indicators, their risk perception, knowledge and use of Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP), stigma and discrimination and age at sexual debut, stigmatization, knowledge, use of PEP and PrEP, inconsistent use of condom, less risk perception and use of alcohol are some of the key factors driving the increased prevalence of HIV among FSW in Akwa-Ibom and Benue States in Nigeria.

Using Brothel Leadership to Improve Condom Use among Brothel-based Female Sex Workers in Abuja, Nigeria: Results of a Cluster Randomized Pilot Study

Support by brothel leaders and the promotion of a conducive environment for HIV prevention programs within brothel establishments are important to promote a safe working environment for Brothel-Based Female Sex Workers (BB FSWs). This study assesses the effects of a cluster randomized pilot trial examining the use of brothel leaders to improve consistent condom use by FSWs residing in brothels and also assessed the feasibility of implementing a similar intervention on a broader scale. Ten brothels in Abuja, Nigeria were randomized and exposed to the experimental (n=5) and control (n=5) arms of the intervention. The feasibility of the intervention and consistent condom use outcomes by FSWs with different partner types as well as condom negotiation self-efficacy were measured. Condom use outcomes and condom negotiation self-efficacy outcomes were analysed using multi-level mixed regression models. A total of 243 FSWs were recruited into the study (control n=66 and experimental n=177) and 107 of them (44%) were available at 16 weeks follow-up. The intervention demonstrated feasibility and positive outcomes for consistent condom use with boyfriends, casual partners and clients of FSWs were obtained. The interaction effect between condition and time indicated increased consistent condom use with boyfriends in the experimental condition (p=0.02). Adherence to the intervention by the FSWs was moderate with the mean sessions attended at 4.4(SD=2.0). The attrition rate during the intervention was high due to mobility of the FSWs. The intervention showed feasibility and effect outcomes indicate promise in enhancing condom use with steady partners of BB FSWs. The design of HIV prevention interventions may benefit from the inclusion of gatekeepers in the promotion of condom use within the brothel, but an adequately powered phase III trial is needed to inform large-scale implementation of this approach.

Depression and Its Relation with HIV Risk and Social Well-Being among the Brothel-Based Female Sex Workers in Kolkata, India

Depression and Its Relation with HIV Risk and Social Well-Being among the Brothel-Based Female Sex Workers in Kolkata, India

Using brothel leadership to promote condom use among brothel-based female sex workers in Abuja, Nigeria: study protocol for a cluster randomized pilot trial

BackgroundThe HIV prevalence among female populations involved in sex work in Nigeria has heightened interest in HIV prevention programming for this sub-population with brothel-based female sex workers (BB FSWs) having a prevalence of 27.4%, six times higher than the prevalence in the general population.Methods/designThe clusters in the randomized pilot trial will be brothels and female sex workers (FSWs) residing in the brothels will be the participants of the study. The participants will receive free condom distribution as well as HIV prevention messages on condom use and negotiation skills to increase self-efficacy in handling social and gender power plays within their environment. Twelve brothels will be randomized into experimental and control conditions with a minimum total sample size of 200 participants. Recruitment of participants will be carried out from within the brothels. The control condition will receive a standard intervention consisting of a minimum of six interactive sessions with peer educators (PE) engaging their peers through group discussions and one on one interaction using pre-designed HIV prevention messages. The experimental condition will receive the standard intervention as well as interactive sessions with the brothel leadership (chairladies and brothel managers) to facilitate consistent condom use and appropriate condom use policies, conditions, and messaging. Both interventions will be delivered over a maximum period of 16 weeks, and male and female condoms will be distributed during the intervention. Quantitative assessments will be carried out at baseline and at 16 weeks follow-up, and the pilot findings will inform feasibility of and sample size estimation for a phase III trial. The primary outcomes measured are recruitment rate attrition rate and adherence to the intervention. Consistent condom use outcomes by FSWs within the brothel with all partner types and enhanced self-efficacy for condom negotiation with all partner types will be the primary outcomes for the main study, and the feasibility of their measurement will be determined in this pilot trial.DiscussionThe manuscript describes the protocol for a pilot study to determine the feasibility of a behavioral intervention to improve consistent condom use among BB FSWs. The results of this pilot will inform a larger intervention for HIV prevention for this target group in Nigeria.Trial registrationThe Institutional Review Board (IRB) of the Institute of Human Virology, Nigeria; Protocol Number NHREC/10/15/2014a-026.

Implementing quality assurance for laboratory-based and point-of-care HIV testing in Nigeria.

No abstract available.

Health-Seeking Behaviour of Brothel-Based Female Sex Workers in the Management of Sexually Transmitted Infections in Urban Communities of Ogun State, Nigeria

Objective: This study examined the the health-seeking behaviour of female sex workers (FSWs) in the management of STIs. Methods: One hundred and thirty-one FSWs were interviewed using semi-structured questionnaires in Ogun State, South-West Nigeria. Results: Most (87.8%) of respondents interviewed knew condom use as the most effective way STIs including HIV can be prevented. About 24.0% and 94.0% of respondents consistently used condom during each round of sex with their regular/trusted sex partners and clients that ranged from2 to 9 and an average of 5 daily. Low (16.0%) self-perceived risk of STIs/HIV was reported among the FSWs despite their high-risk sexual activity. More than half of the respondents had good knowledge of signs and symptoms of STIs. In contrast, none of them knew that STIs can be asymptomatic. About 23.0% of the respondents have had STIs with 30.0% of these being recurring infections. Good health seeking behaviour was exhibited by respondents as most sought diagnosis (43.3%) and treatment (66.7%) for past STIs from medical doctors although many self-medication before reporting at the hospital for treatment. Moreover, 80.9% of respondents reported that they subject themselves to periodical medical examination. Conclusion: Results suggest the need for more educational interventions targeting this group emphasizing their high susceptibility to STIs/HIV, the significance of correct and consistent use of condoms for the prevention of STIs/HIV and the consequences of self-diagnosis and medication for STIs reported by many of the respondents.

Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment.

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

Symptoms of Reported Sexually Transmitted Infections, Misconceptions about Its Transmission, Treatment Seeking Behaviour-Voices of Brothel-Based Female Sex Workers (FSWs)-A Study among Brothel-Based FSWs of City, Pune, India

Female sex workers (FSWs) report of suffering from symptoms of sexually transmitted infections (STIs), the most common are: lower abdominal pains (LAP), white discharge, genital ulcers and warts. It is important to study the proportion of FSW-reported symptoms of STIs to understand non-use of condoms with clients, their treatment seeking pattern to plan appropriate interventions to control STIs among FSWs. Mixed methods were used. A total of 80 FSWs were selected by two-stage cluster sampling method, followed by selection of 20 FSWs by convenient sampling for in-depth interviews. 55% FSWs reported of suffering from symptoms of STIs in last 6 months. FSWs preferred visiting private doctor for seeking treatment for symptoms of STIs; they had different misconceptions regarding transmission of STIs.

Evidence from epidemic appraisals in Nigeria

Although HIV prevalence has increased in most-at-risk populations (MARPs) across Nigeria, effective programming was difficult because Nigeria lacked information for prevention programmes to target interventions that maximise coverage and cost effectiveness. Epidemic appraisals (EA) were conducted in eight states to provide evidence for the planning, implementation and co-ordination of prevention interventions. Component 1: Mapping determined the size, typology and locations of MARPs. Component 2: Venue profiling identified and profiled venues where general populations engaged in high-risk behaviours. Component 3: Rural appraisals provided insights into risk behaviours and sexual networking in villages. States used mapping results to prioritise areas with a MARP coverage of 70% – 80% and then scale up interventions for non-brothel-based female sex workers (FSWs) instead of focusing on brothel-based FSWs. The eight states prioritisedf unding for the high-coverage areas to ensure a minimum coverage level of 70% – 80% of MARPs was reached. The refocused resources led to cost efficiencies. Applying venue profiling results, six states implemented interventions at bars and night clubs – previously not covered. States also maximised intervention coverage for high-risk general populations; this led to the use of resources for general population interventions in a focused way rather than across an entire state. States focused on condom programmes in rural areas. EA results provided the evidence for focusing interventions for high MARP coverage as well as forhigh-risk general populations. The states applied the results and rapidly refocused their interventions, increasing the likelihood of having an impact on HIV transmission in those states. Nigeria is now implementing EAs in the remaining 29 states to effect national-level impact.

Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru.

This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.

Assessment of the Utilization of HIV Interventions by Sex Workers in Selected Brothels in Bangladesh: An Exploratory Study

In this qualitative study of brothel-based Female Sex Workers (FSWs), the authors explored factors that influence safe sex practices of FSWs within an integrated HIV intervention. Qualitative methods, including focus group discussions (FGDs), in-depth interviews and key informant interviews were applied in four brothels in Bangladesh. Young and elderly FSWs, Sordarnis (Madams who own young FSWs and who may be either active or inactive sex workers themselves), program managers and providers were the participants for this study. Findings showed that condom use was high but not consistent among bonded FSWs (those who are under the control of a Sordarni) who have regular clients. The bonded FSWs reported being maltreated by the Sordarnis for refusing to have sex without a condom, and access to health services was hindered by Sordarnis. Implications of the study are that integrated HIV intervention should provide more encouragement to relevant stakeholders to promote mutual support towards safe sex practices for the FSWs.