Local Female Sex Workers Research Articles

Causes of mortality among female sex workers: Results of a multi-country study.

SummaryBackgroundThe vast majority of studies on female sex workers (FSW) focus on causes of morbidity while data on causes of mortality are scarce. In low- and middle-income countries, where civil registry and vital statistics data are often incomplete and FSW may not be identified as such in official registries, identifying causes of mortality among FSW has proven challenging.MethodsAs part of a larger investigation on the maternal health of FSW, the current study used the Community Knowledge Approach (CKA) to identify causes of mortality among FSW in LMIC across three global regions in 2019. The CKA, validated to identify maternal, neonatal, and jaundice-associated deaths among women living in a community, was employed to identify deaths of any cause among communities of FSW. Study participants, recruited by in-country partner non-governmental organizations (NGOs) working with local FSW, provided detailed information about FSW deaths in their communities.Findings1280 FSW participated in 165 group meetings through which 2112 FSW deaths were identified. Of these reported deaths, 57·9% occurred in 2019 and 57·2% were among women aged 20-29. Causes of death included abortion (35·5%), other maternal causes (16·6%), suicide (13·6%), murder (12·5%), unclassified causes (11·6%), HIV/AIDS (7·9%), and accidents (3·2%). A total of 3659 children lost their mothers.InterpretationMaternal death comprised the leading cause of FSW mortality in our sample. This methodology can be used by local governments and NGOs to identify unrecognized patterns and clusters of FSW deaths in near-real time and urgently steer targeted preventative strategies.FundingNew Venture Fund.

Trends and associated factors in the uptake of HIV testing among female sex workers in Sino-Vietnam border areas in Guangxi, China: a cross-sectional study

BackgroundHIV testing is a primary prevention strategy against the HIV epidemic and an entry point for HIV/AIDS-related care, prevention and treatment. This study aimed to estimate the uptake of HIV testing among Sino-Vietnam female sex workers (FSWs) in Guangxi, China, from 2016 to 2018, and to identify the factors influencing HIV testing uptake.MethodsA cross-sectional survey was conducted among FSWs in two Sino-Vietnam border cities of Guangxi, China. The survey was conducted through face-to-face interview, the data were collected by a structured questionnaire, and HIV-1 infection was detected simultaneously. Logistic regression analysis was used to determine the factors associated with uptake of HIV testing.ResultsIn total, 4565 Chinese local FSWs (CL-FSWs) and 636 cross-border migrant Vietnamese FSWs (CMV-FSWs) were recruited into this study. HIV-1 prevalence in CL-FSWs and CMV-FSWs was 0.70% and 3.14%, respectively. The rate of self-reported uptake of HIV testing in CL-FSWs and CMV-FSWs was 54.56% and 45.44%, respectively. The rates of self-reported uptake of HIV testing declined in both groups from 2016 to 2018. Logistic regression analysis indicated that a number of factors, including socio-demographic characteristics (age < 35 years, higher education, location in Chongzuo City), behaviour factors (having received free AIDS education, condom distribution services and peer education services, high risk sexual behaviours such as inconsistent condom use, having regular commercial sexual partners, etc.), psychological factors (perception of vulnerability to HIV/STIs, perception of risk for HIV infection) were the factors significantly related to uptake of HIV testing.ConclusionIn recent years, the rate of HIV testing uptake among Sino-Vietnam border FSWs in Guangxi, China was low, which may be an important reason for the high HIV-1 prevalence among FSWs in the region. A number of factors were identified to be associated with HIV-1 testing uptake, suggesting that HIV testing prevention strategies in this region could include accelerating AIDS education training, raising personal awareness of HIV testing, and improving accessibility of HIV testing.

Epidemiology of sexually transmitted infections among female sex workers in Switzerland: a local, exploratory, cross-sectional study.

Female sex workers are often considered highly vulnerable to sexually transmitted infections (STIs). However, data on STI epidemiology in female sex workers are lacking in Switzerland. Our main goal was to evaluate the prevalence of six STIs (human immunodeficiency virus [HIV], hepatitis B, hepatitis C, Chlamydia trachomatis, Neisseria gonorrhoeae and syphilis) among local female sex workers in Lausanne. A local, exploratory, cross-sectional study was conducted on a convenience sample of adult (&ge;18 years) Female sex workers in Lausanne, Switzerland, from 1 April 2015 to 31 December 2016. female sex workers who worked in street sex venues, massage parlours and brothels were approached for recruitment by a local non-governmental organisation. They were then invited to present at the Lausanne University Hospital, where they were offered a free STI screening and hepatitis A and B vaccination. We enrolled 96 female sex workers. They were predominantly undocumented immigrants (60%) from Africa and Eastern Europe with no health insurance; only one participant (1%) was Swiss born. During the study, 15 (16%; 95% confidence interval [CI] 9&ndash;23%) participants were newly confirmed to have an STI: six (6%; 95% CI 1&ndash;11%) had C. trachomatis, five (5%; 95% CI 0.6-9%) latent syphilis and four (4%; 95% CI 0.1&ndash;8%) hepatitis B (three with chronic active infection and one with past exposure). No human immunodeficiency virus (HIV) infections were newly diagnosed among the participants. Nineteen (20%) of the female sex workers were already vaccinated against hepatitis B, and 73 (76%) initiated vaccination against hepatitis A and hepatitis B during the study. Forty-four (46%) of the female sex workers required translation and assistance from social services.

A qualitative study on high risk behaviors and related factors of reported HIV/AIDS cases aged 60 years and above in some areas of Henan province

Objective: To understand the major high risk behaviors and related factors among reported HIV/AIDS cases aged ≥60 years in some areas of Henan province. Methods: In Dengzhou, Xunxian county of Hebi and Xiangcheng county of Xuchang, where the reported number and proportion of HIV/AIDS cases aged ≥60 years were high, a face to face interview was conducted among the cases aged ≥60 years during July-August in 2016. The information about the high risk behaviors before HIV infection confirmation were collected by using a semi-structured questionnaire. Results: A total of 33 HIV/AIDS cases aged ≥60 years were interviewed, including 28 males and 5 females. Their average age was 67.4 years. The infection route was sexual contact. The main findings revealed that the main factor for HIV infection in elder males was commercial heterosexual behavior with local female sex workers. The condom use rate was low. The poor awareness of the knowledge about AIDS prevention could explain why the elderly could not recognize the risk of HIV infection. There were also homosexual and bisexual behaviors in elder male HIV/AIDS patients. Late detection of HIV transmission among couples was the main cause of HIV infection in elder women. Conclusions: The major epidemiological related factors for HIV infection in the elderly in some areas of Henan were unsafe sex behavior and the poor awareness of knowledge about AIDS prevention. A targeted strategy should be taken to control the spread of HIV in the elderly.

The social context of sexual HIV prevention among female sex workers in China

The recent article on scaling up programmes to prevent sexual human immunodeficiency virus (HIV) transmission is timely and addresses a compelling topic.1 However, there are two points that should be emphasized in understanding how to organize an effective response to China’s expanding sexually transmitted HIV epidemic: (i) the heterogeneity within China’s commercial sex industry; and (ii) the unique organizational and social forces that constrain responses. First, China has >6 million female sex workers (FSWs), based on conservative estimates derived from self-reporting in a population-representative sample.2 Public health and social science research from China suggests that there are distinct typologies of FSW, each with distinct workplaces and sexual risks (Table 1).3 Several studies show that low-income FSWs in China have a higher risk of syphilis and other sexually transmitted infections (STIs), including one systematic review of 72 studies that found a 2-fold increased risk of syphilis among low-income FSWs.4 Yet, there have been few interventions focused on low-income FSWs and methodologically rigorous epidemiological studies are limited. Table 1 Chinese FSW typologies and their workplace and approximate sexual risk Second, some sources have described sex work as ‘illegal’ in China, but this does not appreciate the complex relationship between women who sell sex and local authorities. A common Chinese saying is that police have ‘one eye open and one eye closed’ when considering sex work. Male police and other local authorities have many incentives both to curtail and to permit commercial sex.5 A better understanding of these local relationships informed by epidemiology and social sciences could help illuminate strategies for FSW HIV prevention. Given the remarkable heterogeneity in socio-demographics and sexual risk among FSWs in China, simple policy solutions or importing models from Asian successes should be viewed with caution. Policy solutions for preventing heterosexual HIV that resonate with local FSWs and acknowledge the embedded and highly contextual nature of sexual risk have not been piloted in China and are far from scaling up. More research and programmatic efforts to identify and curb high-risk commercial sex are urgently needed.

Sexual health knowledge, sexual relationships and condom use among male trekking guides in Nepal: a qualitative study

People in Nepal generally hold fairly traditional views about sex and sexual health, whilst Western tourists often have a more liberal approach towards sex and relationships. There is evidence that significant sexual interaction occurs between male trekking guides and female travellers and/or local female sex workers in Nepal. This qualitative study explored trekking guides' sexual health knowledge, sexual relationships and condom use with female trekkers and local female sex workers. A total of 21 in-depth interviews were conducted with male trekking guides. Most reported having had sexual relationships with female trekkers and local female sex workers. Explanations for intercourse with female trekkers included: financial support; getting future trekkers through word-of-mouth advertising from the women they have had sex with; and opportunities for emigration. Interestingly, sexual intercourse is reported as more likely to be initiated by female trekkers than by guides, and more so by older women. In contrast, the main reasons for having sex with local female sex workers included: romantic love or sexual excitement and novelty. Awareness regarding sexual health was high among guides, but several factors discouraged the regular use of condoms. Further research with female tourists would help understand the motivations and reasons for their sexual behaviour.

HIV/AIDS-related sexual risks and migratory status among female sex workers in a rural Chinese county

Currently, there are millions of female sex workers (FSWs) in China and these women play a critical role in the escalating HIV epidemic in the country. Existing studies revealed high mobility of this population, but data on the relationship of FSWs’ migratory status and their HIV/AIDS-related sexual risks are limited. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. Sexual risks and current infections of sexually transmitted disease (STD) were compared among local FSWs (i.e. those who were the county residents or from other parts of Guangxi) and those FSWs who migrated from outside Guangxi. Data reveal that local FSWs were younger, less educated and newer to the sex industry, and had more sexual risks and higher rates of STDs compared to migrant FSWs. This relationship remains significant after controlling for potential confounders. A higher level of sexual risks and STDs among local FSWs than migrant FSWs in the rural Chinese county suggests the need to examine the relationship between migratory status and HIV/AIDS-related risks within specific social and cultural contexts. The data also underscore an urgent need for culturally appropriate HIV/AIDS-prevention intervention efforts among FSWs in rural or less developed areas in China.