Prostitutes: a high risk group for HIV infection?

Abstract

Female prostitutes are at increased risk for sexually transmitted diseases and HIV infection. However, the prevalence rate of HIV infection among prostitutes varies geographically, with the highest rates occurring in Africa and in areas with large numbers of HIV infected intravenous drug users (IVDU). In Europe the most important risk factors for HIV infection in prostitutes are intravenous drug use and unprotected intercourse with non-paying partners. Whereas in Europe, there is as yet no evidence that female prostitutes are a source of HIV infection for the heterosexual population, they are playing a major role in the spread of HIV in Africa. Education about safe sex practices should be included in prevention programmes aimed at IVDUs. HIV infection should be monitored in prostitutes, and health education on AIDS prevention should be offered to prostitutes and their clients.

PIP: The importance of female prostitutes to the transmission of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) varies worldwide, with the greatest problem currently existing in Africa. Prevalence rates for STDs are consistently higher among prostitutes than the general population, regardless of region, and up to 40% of prostitutes are positive for syphilis. Non-intravenous-drug- abusing prostitutes in major European and US cities have been found to have relatively low rates of HIV infection (under 8%) ; however, in African countries such as Rwanda and Kenya, 85-88% of prostitutes have antibodies to HIV. The major risk factors for African prostitutes appear to be the number of clients, length of time in prostitution, and a history of other STDs, especially genital ulcers. Although females prostitutes are not at present playing a major role in the transmission of HIV infection among the heterosexual population in the US and Europe, the potential clearly exists. Thus, there is a need in all world regions for health education campaigns aimed at prostitutes and their clients. Condom use and avoidance of intravenous drug abuse are the most effective preventive measures. In Africa, there is a need for operations research on the optimal methods for encouraging condom use among prostitutes. Pilot programs have indicated that the most effective such programs are those that utilize existing networks to train prostitutes as acquired immunodeficiency syndrome (AIDS) educators for both their peers and their clients.