Female Sex Workers Population Research Articles

High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors

Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high-risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea. Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods. All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision-making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow-up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases). Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.

P2-S2.20 The association study of job mobility and HIV/STI prevention in female sex workers of Hunan province, China

BackgroundThe job mobility of female sex workers (FSWs) is the working experience that keep low level status and no rising opportunity among all previous jobs before FSWs enter of commercial...

P1-S2.04 Impact of female sex worker turnover on HIV prevalence, incidence and core group intervention impact in Cotonou (Benin)

BackgroundThe influence of turnover of female sex workers (FSW), resulting from different durations spent in sex work or migration patterns remains partly understood but is believed to be an important...

O1-S09.01 Increased condom use and decreased HIV & STI prevalence among female sex workers following a targeted HIV prevention program in Karnataka, South India

BackgroundWe assessed the impact of a large-scale, targeted HIV prevention program among female sex workers (FSWs) in Karnataka state, south India.MethodsIn the context of an HIV prevention program involving 18...

LBP-1.05 Challenges and barriers for conducting STI/HIV prevention projects targeting female sex workers within national programs in Benin and Niger

ContextIn West Africa, HIV/STIs prevention activities targeting female sex workers (FSW) and their partners were developed and supported financially through a bilateral cooperation project. After the end of the project...

O1-S08.06 Variability in the numbers and types of sex partners of female sex workers and its impact on HIV prevalence in southern India

BackgroundHeterogeneity in the structure of sex work within and across female sex worker (FSW) populations may be an important determinant of the spread of HIV. We characterised heterogeneity in sexual...

Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Multiple intravaginal HIV prevention methods, including microbicide gels, barriers, and intravaginal rings, are in clinical development in Africa. Development of intravaginal HIV prevention products requires an understanding of sexual behavior, sexually transmitted infection (STI), and vaginitis prevalences, and sexual and vaginal practices in potential target populations. We assessed these factors in a cohort of Kenyan female sex workers (FSW). Women who reported exchanging sex for money/gifts at least three times in the past month and who were HIV uninfected were enrolled and followed for 6 months. STI prevalence and HIV incidence were analyzed by multivariate logistic regression analysis, controlling for demographic and behavioral factors. Thirty-seven percent (74/200) reported having had anal sex. Frequency of anal sex was higher with regular and casual partners than with primary partners. Women were less likely to use condoms for anal sex than for vaginal sex with regular or casual partners. Vaginal washing was universal (100%). HIV incidence was 5.6 per 100 person-years (95% CI 1.62, 11.67). HIV incidence was not associated with any demographic or risk behavior. The relatively high rate of anal sex and universal vaginal washing may complicate both safety and efficacy evaluation of intravaginal products and should be taken into account in trial design. This FSW population had significant HIV incidence and needs continued HIV prevention interventions.

How many men who have sex with men and female sex workers live in El Salvador? Using respondent-driven sampling and capture–recapture to estimate population sizes

ObjectiveTo estimate the numbers of female sex workers (FSW) and men who have sex with men (MSM) in San Salvador, El Salvador.Design and methodsA capture–recapture exercise was conducted among MSM...

Prevalence, incidence, and persistence of syphilis infection in female sex workers in a Chinese province

The study's objectives were to investigate the prevalence, incidence, persistence, and associated risk factors of syphilis in female sex workers (FSWs) in Kaiyuan City, Yunnan, China. Three serial cross-sectional surveys were conducted and biological specimens were collected and tested for HIV, sexually transmitted infections, and drug use. The logistic Generalized Estimating Equation regression model was used to identify risk factors for prevalent syphilis. The prevalence of syphilis was 7·5%, 8·4% and 8·8%, respectively, in the three survey periods. Estimated syphilis incidence was 1·07 cases/100 person-years, and the persistence of syphilis per person at 6 months was 90·4%. In multivariate analysis, the factors associated with syphilis were age, lower education level, number of clients in a week, inconsistent condom use with clients, herpes simplex virus type 2 (HSV-2), and Chlamydia trachomatis. Persistent syphilis in this population of FSWs is a serious public health concern.

Capture-recapture for estimating the size of the female sex worker population in three cities in Côte d’Ivoire and in Kisumu, western Kenya

To estimate the female sex worker population size in three cities in Côte d'Ivoire and in Kisumu, Kenya. Capture-recapture was used, calculating size estimates by first 'tagging' a number of individuals and, through an independent recapture, calculating the proportion of overlap. The same procedures were used in all four cities. In the first phase, members of the target population were 'captured' and 'marked' by giving them a capture card. Six days later, in the same places and at the same time, a second sample was 'captured', which comprised a certain number of people who were captured in the first round. During the exercise, questions were asked to estimate the coverage of the sex worker clinics. Using capture-recapture, the estimated number of female sex workers was 1160 in Yamoussoukro (95% CI 1053-1287), 1202 in Bouaké (95% CI 1128-1279), 1916 in San Pedro (95% CI 1809-2030) and 1350 in Kisumu (95% CI 1261-1443). The proportion of female sex workers in Côte d'Ivoire who had visited the clinic ranged from 15% in Yamoussoukro to 30% in San Pedro and was 34% in Kisumu. Capture-recapture was successfully applied to estimate the population size of female sex workers. These estimations were urgently needed to help mobilize an increased response to HIV, to assess programme coverage and to estimate potential impact of the targeted intervention.

Human papillomavirus and cervical neoplasia among female sex workers in Madagascar.

Human papillomavirus (HPV) prevalence and type distribution were estimated among 90 female sex workers (FSWs) aged 18 to 58 years in Antananarivo, Madagascar. A total of 90 FSWs aged 18 to 58 years in Antananarivo, Madagascar, were included in this study. Information on sexual and behavioral characteristics was obtained via a questionnaire. Exfoliated cervical cell specimens were collected for conventional cytologic examination and HPV DNA testing by polymerase chain reaction. The prevalence rates of HPV DNA and their corresponding 95% confidence intervals were stratified into the following 3 age groups: younger than 25, 25 to 34, and 35 years or older. To assess the association between HPV DNA positivity and sociodemographic and sexual behavioral factors, age-adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression. The HPV prevalence in exfoliated cervical cell specimens was 36.7%. The most common HPV types found were HPV-52 (11.1%), HPV-31 and -39 (each at 5.6%), and HPV-16 and -83 (each at 3.3%). The prevalence of low-grade squamous intraepithelial lesions was 3.3%, and that of atypical squamous cells of undetermined significance was 18.9%. No high-grade lesion was found. Although associations were imprecise, the HPV prevalence was higher among women who reported younger age at the first intercourse, contraceptive use, a history of cervical lesions, and no history of condom use. The prevalence rates of HPV and cervical lesions among FSWs in Madagascar appear higher than among FSW populations from other African countries with a relatively higher population-based prevalence of human immunodeficiency virus infection.

Combination prevention: a deeper understanding of effective HIV prevention

Evidence-informed and human rights-based combination prevention combines behavioural, biomedical, and structural interventions to address both the immediate risks and underlying causes of vulnerability to HIV infection, and the pathways that link them. Because these are context-specific, no single prescription or standard package will apply universally. Anchored in 'know your epidemic' estimates of where the next 1000 infections will occur and 'know your response' analyses of resource allocation and programming gaps, combination prevention strategies seek to realign programme priorities for maximum effect to reduce epidemic reproductive rates at local, regional, and national levels. Effective prevention means tailoring programmes to local epidemics and ensuring that components are delivered with the intensity, quality, and scale necessary to achieve intended effects. Structural interventions, addressing the social, economic, cultural, and legal constraints that create HIV risk environments and undermine the agency of individuals to protect themselves and others, are also public goods in their own right. Applying the principles of combination prevention systematically and consistently in HIV programme planning, with due attention to context, can increase HIV programme effectiveness. Better outcome and impact measurement using multiple methods and data triangulation can build the evidence base on synergies between the components of combination prevention at individual, group, and societal levels, facilitating iterative knowledge translation within and among programmes.

A study of HIV/AIDS related knowledge, attitude and behaviors among female sex workers in Shanghai China

BackgroundChina is currently facing a rapid and widespread increase in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). The activities of female sex workers (FSWs) have contributed to the mounting epidemic of HIV/AIDS and other sexually transmitted diseases (STDs). Therefore, this study aimed to assess the HIV/AIDS-related knowledge, attitude and risk behaviors among FSWs operating in Shanghai China.MethodsA cross-sectional study was conducted in five districts of Shanghai, including three suburbs and two downtown locales. We adopted a cluster randomized sampling method to obtain ten geographic sites which consisted of one or more communities/villages proximal to a location where FSWs were accessible. A total of 324 FSWs from 109 Xitou Fang, massage parlors and hair salons who explicitly provided sexual services were enrolled in the study. Each participant completed a questionnaire survey and interview aimed to collect information on the individual's knowledge, attitude, and behaviors associated with risk for HIV/AIDs.ResultsThe overall correct answer rate of HIV/AIDS-related knowledge was 60.8%, and the knowledge of FSWs from downtown areas was significantly higher than those from suburban areas (P < 0.05). The percentage of FSWs who reported having experiences in commercial sexual services without the use of condoms was 33.6%. Condom slippage or breakage was reported as having occurred at least once by 51.2% of the FSWs. FSWs from suburban areas were found to more often engage in high-risk behaviors, including oral and anal sex, than those from downtown areas (P < 0.001). Many of the FSWs (65.7%) reported having non-client sexual partners (most were identified as boyfriends or husbands); however, condom usage with these partners were lower (34.3%).ConclusionsBased on the findings from our survey, we advise that promotion of HIV/AIDS-related knowledge be targeted towards FSWs in Shanghai, especially those operating in the suburbs. HIV prevention efforts, such as urging constant condom usage with both clients and steady partners, should be sustained and reinforced among the female sex workers population.

Concentrated and linked epidemics of both HSV-2 and HIV-1/HIV-2 infections in Senegal: public health impacts of the spread of HIV

The objective of this article is to report seroprevalences on HIV and herpes simplex virus 2 (HSV-2) in female sex workers (FSW) and in two sentinel populations of pregnant women living in Senegal. Serosurveys of HIV and HSV-2 were conducted in two unselected sentinel populations from Dakar, Senegal, and its provinces, including in 2003 only pregnant women and 2006 pregnant women and FSW. The population study involved 888 pregnant women and 604 FSW. In pregnant women, HIV and HSV-2 seroprevalences were, respectively, 1.01% and 15.65%. There was no association between HSV-2 and HIV infection, whatever the age. In contrast, the seroprevalence of HIV infection in the group of FSW was high, reaching 22.9% in women over 30 years old. FSW above 20 years of age harboured much higher HSV-2 seroprevalences that those found in pregnant women of similar age groups. In FSW, strong associations between HSV-2 and age, and among HSV-2 and HIV-1 as well HIV-2, were evidenced. In conclusion, HIV epidemic remains concentrated in high-risk groups of the Senegalese population, such as the FSW population in which the seroprevalence of HSV-2 infection is very high. Intervention against STI including HSV-2 is urgently needed to prevent the spreading of HIV epidemic.

Using mathematical modelling to estimate the impact of periodic presumptive treatment on the transmission of sexually transmitted infections and HIV among female sex workers

BackgroundIn settings with poor sexually transmitted infection (STI) control in high-risk groups, periodic presumptive treatment (PPT) can quickly reduce the prevalence of genital ulcers, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis...

Biological Validation of Self-Reported Condom Use Among Sex Workers in Guinea

Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting.

Screening for Chlamydia trachomatis Infection Using Direct Fluorescein Antibody Method in Female Sex Workers Registered in Ankara, Turkey: Pros and Cons

Aim: This study aimed to screen for Chlamydia trachomatis infection by direct fluorescein antibody (DFA) method in a high-risk population, registered female sex workers (FSWs) in Ankara, Turkey, to investigate the advantages and disadvantages of using this method in a routine screening program of the FSW population. Materials and Methods: All registered FSWs (n = 152) in Ankara were enrolled in the study. None of them were showing any genital signs or symptoms of sexually transmitted infections (STIs). Endocervical swabs were collected and examined for C. trachomatis by DFA method (Fluorotect Chlamydia, Omega Diagnostics, UK). Cellular adequacy of the specimens was examined for the presence of at least five columnar epithelial cells per X400 field. A positive diagnosis was made when fixed and stained specimens showed at least 10 chlamydial bodies under the fluorescein microscope. A positive control slide was also stained and examined on each study day. Results: Of the 152 specimens, only 112 (73.7%) were adequate; it was not possible to obtain adequate specimen from the remainder of the women because the cervical os was too tight to insert the swab. Of the 112 adequate specimens, 3.6% (4/112) were positive for C. trachomatis serotype-specific major outer membrane proteins (MOMP), based on DFA method. Conclusions: C. trachomatis infection rate of 3.6% was relatively low in this group of women compared to a priori expectations, yet still remarkable. A significant level of ´´inadequacy´´ in obtaining endocervical specimens (in 26.3% of FSWs) could have limited the external validity of the prevalence rate estimation in this population and the practicality of DFA use for C. trachomatis screening. C. trachomatis screening should be integrated in the STI control program for sex workers in Turkey. However, further research is warranted to optimize the method to be used in screening and/or diagnosis in such high-risk groups.

Impact of an intensive HIV prevention programme for female sex workers on HIV prevalence among antenatal clinic attenders in Karnataka state, south India: an ecological analysis

To examine the impact of an intensive HIV preventive intervention (IPI) among female sex workers (FSW) on community HIV transmission, as represented by HIV prevalence among young antenatal clinic (ANC) attenders in Karnataka state, south India. The IPI was initiated in 18 of the 27 districts in Karnataka in 2003, and was generally at scale by mid-2005, covering over 80% of the urban FSW population. We examined trends over time in HIV prevalence from annual HIV surveillance conducted among ANC attenders in Karnataka under the age of 25 years from 2003 to 2007, comparing the IPI with the other districts. Overall, HIV prevalence among ANC attenders under 25 years of age declined from 1.40% to 0.77%. In a multivariate model, the decline in HIV prevalence in the IPI districts compared to the other districts was statistically significant (P = 0.01), with an adjusted annual odds ratio of 0.88 (95% CI 0.79-0.97). The decline in standardized HIV prevalence in the IPI districts over the period was 56%, compared to 5% in the non-IPI districts. Although this analysis is limited by lack of precise comparative data on intervention coverage and intensity, it supports the notion that scaled-up, intensive, targeted HIV preventive interventions among high-risk groups can have a measurable and relatively rapid impact on HIV transmission in the general population, particularly young sexually active populations as represented by ANC attenders. Such focused intervention programmes should be rapidly taken to scale in all HIV epidemics, and especially in concentrated epidemics such as in India.

Variations in the population size, distribution and client volume among female sex workers in seven cities of Pakistan

To describe the size and distribution of female sex worker (FSW) populations and the distribution of client-FSW encounters in seven major cities of Pakistan. Mapping of FSWs was done using a two-stage process of identifying and validating locations where FSWs solicit and/or meet clients, estimating the size of the FSW population at each location and describing the type of sex work. A sample survey of FSWs was conducted to collect data on sociodemographic and behavioural data. Survey data on client volume were analysed to assess the distributional inequality of client sexual encounters in each of these cities. The overall distributional inequality in client-sex worker encounters across the entire FSW population within a city was assessed by drawing Lorenz curves and computing the Gini coefficient. A total of 34 480 FSWs (40% street-based, 57.5% home-based and 2% brothel-based) were mapped in the seven cities. Of these, 2869 participated in behavioural and biological surveys. The median age of FSWs surveyed was 26 years with sexual debut at 18 years. The contribution of different types of FSWs to the total client volume differed substantially between cities, with the contribution of home-based FSWs ranging from 32% to 75%. The overall distributional inequality in client volume also varied substantially between cities, with the Gini coefficient ranging from 0.22 (low inequality) to 0.50 (high inequality). The relative size and distribution of sex workers and the sex worker-client patterns differs considerably in cities of Pakistan. Programmes should be planned and implemented accordingly.

An evaluation of intravaginal rings as a potential HIV prevention device in urban Kenya: behaviors and attitudes that might influence uptake within a high-risk population.

We sought to assess the potential acceptability of intravaginal rings (IVRs) as an HIV prevention method among at-risk women and men. We conducted a qualitative assessment of initial attitudes toward IVRs, current HIV prevention methods, and common behavioral practices among female sex workers (FSWs) and men who frequent FSWs in Mukuru, an urban slum community in Nairobi, Kenya. Nineteen women and 21 men took part in six focus group discussions. Most participants, both male and female, responded positively to the concept of an IVR as a device for delivering microbicides. Women particularly liked the convenience offered by its slow-release capacity. Some female respondents raised concerns about whether male customers would discover the ring and respond negatively, whereas others thought it unlikely that their clients would feel the ring. Focus groups conducted with male clients of FSWs suggested that many would be enthusiastic about women, and particularly sex workers, using a microbicide ring, but that women's fears about negative responses to covert use were well founded. Overall, this high-risk population of FSWs and male clients in Nairobi was very open to the IVR as a potential HIV prevention device. Themes that emerged from the focus groups highlight the importance of understanding attitudes toward IVRs as well as cultural practices that may impact IVR use in high-risk populations when pursuing clinical development of this potential HIV prevention device.