Prostitution and risk of HIV: female prostitutes in London

Abstract

Objective: To measure the prevalence of HIV and to describe established risk factors in female prostitutes.

Design: A cross sectional survey.

Setting: A genitourinary medicine clinic, streets, and magistrates' courts in London.

Subjects: 280 female prostitutes recruited between April 1989 and August 1991.

Main outcome measures: Infection with HIV-1, reported risk behaviours, and prevalence of sexually transmitted infections.

Results: 228 of the women had HIV tests, and two (0.9% (95% confidence interval 0% to 2.1%)) were infected with HIV-1. Reported use of condoms was high for commercial clients and low for non-paying partners: 98% (251/255) of women used condoms with all clients and 12% (25/207) with non-paying partners for vaginal intercourse. Twenty two women were current or past injecting drug users. Of the 193 women examined for sexually transmitted infections, 27 had an acute infection (gonorrhoea, chlamydia, trichomonas, or primary genital herpes) at the time of interview. Infection was associated with younger age and increasing numbers of non-paying sexual partners, but not with duration of prostitution, numbers of clients, or reports of condom failures. When age and numbers of non-paying partners were analysed by logistic regression they remained significantly associated with sexually transmitted infections.

Conclusions: A large and diverse sample of prostitutes had a low prevalence of infection with HIV and high levels of use of condoms in commercial sex. There was a significant risk of other sexually transmitted infections associated with prostitutes' non-commercial sexual relationships, in which unprotected sex is common. Interventions to reduce the risk of sexually transmitted infections in prostitutes should address both commercial and non-commercial sexual partnerships.

PIP: In a cross sectional survey, 280 female prostitutes were recruited between April 1989 and August 1991 by referral from health workers in the genitourinary medicine clinic at St. Mary;s Hospital, London, England, and referral from friends and colleagues of prostitutes, fieldwork (visiting streets, magistrates' courts, flats, agencies, and saunas), and telephone contacts. The objective was to measure the prevalence of HIV and to describe established risk factors in female prostitutes. 228 of the women had HIV tests, and 2 (09%) were infected with HIV-1. A high 98% (251/255) of women used condoms with all clients, while 12% (25/207) did with nonpaying partners for vaginal intercourse, 22 of the women had a history of blood transfusion; 22 women were current or past iv drug users; 53 reported use of injected drugs either by themselves or by their sexual partners; and 58 reported having sex with bisexual men and 4 with men known to be infected with HIV. Women recruited through fieldwork were more likely to report use of injected drugs than those interviewed at the clinic (11/87 (13%) vs. 11/193 (6%). 193 women were examined for sexually transmitted infections (STDs) on the day of their interview or within a week later, and 27 had one or more current, acute infections; 9 had gonorrhoea, 12 chlamydia, 7 trichomonas, and 4 primary genital herpes. Infection was related to younger age and increasing numbers of nonpaying sexual partners but not to duration of prostitution, numbers of clients, or reports of condom failures. The age and numbers of nonpaying partners remained significantly associated with STDs when analyzed by logistic regression. There was a significant risk of other sexually transmitted infections associated with the prostitutes frequently unprotected, noncommercial sexual relationships. Interventions should consider both commercial and noncommercial sexual partnerships in order to reduce the risk of sexually transmitted infections in prostitutes.