Human immunodeficiency virus seroprevalence and condom use among female sex workers in Italy

BACKGROUND AND OBJECTIVES: In two different studies, we evaluated the human immunodeficiency virus (HIV) seroprevalence rate and the condom use in a group of female sex workers working in Italy. STUDY DESIGN: In the first study we collected data on HIV serologic testing of female sex workers; in the second study, we evaluated the use of condoms and high-risk sexual practices by sex workers with their clients and nonpaying partners. RESULTS: Overall, 131 of 802 (16%) were HIV positive: 36 of 558 (6%) professional sex workers and 95 of 244 (39%) sex workers who used intravenous drugs. There was a significant increase of seroprevalence among professional sex workers between 1988 to 1990 and 1991 to 1995 (2% versus 11%, P < or = 0.001), whereas among the sex workers who used intravenous drugs, the increase was not significant (37% versus 40%, P = 0.70). Similarly, the HIV seroprevalence in the Italian professional sex workers is constant in the two periods of time (2% versus 1%). In the second study, 97 of 102 (95%) sex workers reported regular condom use with clients, whereas 63% of sex workers reported they never used them with nonpaying partners. Fourteen sex workers reported having nonpaying partners who used intravenous drugs and 6 reported having nonpaying bisexual partners; 8 of these 20 partners were HIV positive. CONCLUSION: The results of the first study showed a significant increase of seroprevalence among professional sex workers, whereas the high seroprevalence among sex workers who used intravenous drugs was constant. The results of the second study showed that sex workers may be at higher risk for HIV infection through noncommercial sexual intercourses.     

Clients and brothel managers in Kramat Tunggak, Jakarta, Indonesia: interweaving qualitative with quantitative studies for planning STD/AIDS prevention programs

Clients and brothel managers are often the most powerful decision-makers regarding condom use in brothels, but since publicly promoting condom use is still "culturally" difficult in Indonesia, the most feasible way of reaching clients is through the female commercial sex workers (FCSWs) and their managers. The existence of quasi-official brothel complexes in many major Indonesian cities, however, does make the government a key player in promoting condom use within these complexes. Interweaving qualitative with quantitative studies, this paper, which is part of a larger study, reveals the FCSWs' client/managers-related determinants of condom use. Policies that will promote condom use in brothel complexes are critical to the prevention of the spread of HIV throughout this community, as well as from it to the greater community.     

Facilitating condom use with clients during commercial sex in Nevada's legal brothels

OBJECTIVES: This study examined condom use in legal Nevada brothels. METHODS: Forty female prostitutes in two brothels were interviewed about client resistance to condoms and techniques for facilitating condom use. RESULTS: Of 3290 clients in the previous month, 2.7% (95% confidence interval [CI] = 2.2%,3.4%) were reluctant to use condoms. Of these individuals, 72% ultimately used condoms, while 12% chose nonpenetrative sex without condoms. The remaining 16% left the brothels without services. Condom use rates were markedly lower with nonpaying sex partners (lowers) than with clients. CONCLUSIONS: Brothel prostitutes may be at greater risk for acquiring HIV and other sexually transmitted diseases from lovers than from clients.     

Prostitution and AIDS in the city of Mexico

Since 1987 The National AIDS Council in Mexico (CONASIDA), has conducted research projects among female commercial sex workers (CSW), who are seen at the AIDS Information Centers. Through these studies, we have been able to find out how different issues influence commercial sex work in Mexico City. Since the beginning of our own studies in 1989, HIV prevalence in this particular group has remained low (0.04%-0.2%). Factors found to be associated with condom use were: educational level, not having children, more experience in sex work and younger age. Condom use was reported by 88% of the women; however, qualitative information and high STD prevalence rates suggest a much lower condom use. Mandatory HIV testing is not useful as a preventive measure among sex workers. Persuasive and structural interventions must be implemented in accordance with local and legal situations.     

Changes in attitude, sexual behaviour and the risk of HIV/AIDS transmission in southwest Nigeria

This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.     

A sustainable behavioral intervention to increase condom use and reduce gonorrhea among sex workers in Singapore: 2-year follow-up

BACKGROUND: Prostitution is the most important source of transmission of AIDS and sexually transmitted diseases in Asia. We developed and evaluated the sustainability of an intervention to increase condom use and reduce gonorrhea among brothel-based sex workers in Singapore. The intervention focused on developing sex workers' negotiation skills, educating clients, and mobilizing support from peers and health staff in promoting condom use. METHODS: A pretest-posttest design with one intervention site (n = 124) and another comparable control site (n = 122) was maintained for 5 months followed by a time series design to follow up the intervention group for 2 years. RESULTS: At 5 months, the intervention group improved significantly in negotiation skills and were almost twice as likely as controls to always refuse unprotected sex (adjusted rate ratio 1.90, 95% CI 1.22-2.94). Gonorrhea incidence declined considerably by 77.1% in the intervention group compared with 37.6% in the controls. Consistent refusals of unprotected sex in the intervention group increased from 44.4% at baseline to 65.2% at 5 months, 73.6% at 1 year, and 90.5% at 2 years with a corresponding decline in gonorrhea. CONCLUSION: Sustained condom use with a corresponding decline in gonorrhea was achieved by a behavioral and environmental intervention for sex workers.     

Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda

OBJECTIVE: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa. SETTINGS: Two major urban districts in Uganda. METHODS: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995. RESULTS: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths. CONCLUSIONS: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.     

Current status of the female condom in Africa

The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC     

Discontinuation of treatment with IFN-beta leads to exacerbation of experimental autoimmune encephalomyelitis in Lewis rats. Rapid reversal of the antiproliferative activity of IFN-beta and excessive expansion of autoreactive T cells as disease promoting mechanisms

BACKGROUND: It is important for HIV/AIDS control programmes to determine population knowledge on AIDS in order to develop appropriate Information, Education and Communication (IEC) messages. The objectives of our study were to determine the seroprevalence of HIV and syphilis among pregnant women, female prostitutes and long-distance truck drivers and to evaluate knowledge, attitudes, beliefs, and practice (KABP) with respect to the HIV/AIDS epidemic in these three groups in Burkina Faso. METHODS: We performed three cross-sectional serosurveys including face-to-face interviews on KABP between October 1994 and February 1995 in three population groups. RESULTS: Overall, 1,294 pregnant women, 236 long-distance truck drivers and 426 female prostitutes were recruited. HIV seroprevalence was 8% (95% Confidence Interval (CI): 6.6-9.6) among pregnant women, 18.6% (95% CI: 13.9-24.2) among long-distance truck drivers and 58.2% (95% CI: 53.4-62.9) in female prostitutes. The prevalence of syphilis was 2.5%, 9.3% and 15%, respectively. Most pregnant women (98%), long-distance truck drivers (96%) and female prostitutes (98%) had already heard of AIDS. However, the level of knowledge of HIV transmission routes, of risk factors for HIV transmission and of available preventive measures was very low. Consequently, 41% of pregnant women, 40% of long-distance truck drivers and an alarming 61% of female prostitutes reported that they did not feel themselves at risk for HIV. In each group, high levels of knowledge on AIDS were associated with increased awareness of AIDS risk and the adoption of preventive behaviours. Level of education was associated with knowledge of AIDS and condom use. However, in the 12 months preceding the surveys, condom use was very low among pregnant women (0.1%), long-distance truck drivers (18%) and among female prostitutes (42%). CONCLUSIONS: These results indicate that HIV is widespread in Burkina Faso and that there is an urgent need to develop and evaluate HIV prevention strategies in the general population and among core groups such as female prostitutes and long-distance truck drivers. Interventions must include information campaigns, condom promotion and distribution, and sexually transmitted diseases control.     

Sexually transmitted infections among sex workers in KwaZulu-Natal, South Africa

OBJECTIVE: The purpose of this study was to investigate the prevalence of sexually transmitted infections, including human immunodeficiency virus (HIV), among female sex workers operating at truckstops in the KwaZulu-Natal midlands of South Africa. METHODS: A total of 145 sex workers were recruited from August 1996 to March 1997. A gynecologic examination, including a speculum examination, was performed. Investigations were performed to identify gonorrhea, syphilis, chlamydia (infection), candidiasis, trichomoniasis, bacterial vaginosis, and HIV infection. RESULTS: A total of 50.3% of the sex workers were HIV positive. Infection with Trichomonas vaginalis was present in 41.3% of the women, Candida albicans in 40.6%, Neisseria gonorrheae in 14.3%, and Chlamydia trachomatis in 16.4%. Bacterial vaginosis was present in 71% and active syphilis in 42.1% of the women. CONCLUSION: The high prevalence of sexually transmitted infections, including HIV, clearly highlights the urgent need for interventions. In addition to empowering women with methods they can use and control to reduce their risk of infection, an effective approach to control of sexually transmitted infections also needs to recognize the role of the clients, such as truck drivers, so that they also are targeted for interventions.     

HIV infection among foreign people involved in HIV-related risk activities and attending an HIV reference centre in Rome: the possible role of counselling in reducing risk behaviour

Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.     

Sex bias in psychotherapy: An examination of the effects of client sex, pathology, and therapist sex on treatment planning.

Investigated the effects of therapist sex, client sex, and client pathology on treatment goals formulated by a pool of 32 male and 32 female practicing psychotherapists (psychiatrists, clinical psychologists, psychiatric social workers, and therapists from related disciplines). Each therapist recommended treatment goals for either 2 male or 2 female pseudoclients who differed in their presenting pathology, which was severe and clearly defined. Male therapists chose significantly more feminine treatment goals for all their clients, whereas female therapists chose significantly more masculine goals, regardless of client sex. Therapists responded to the client's pathology, rather than the client's sex, in formulating treatment goals. This suggested either that client sex is not important in determining treatment goals or that client sex may affect therapists' treatment goal choice only when pathology is vague or not severe. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of linear IgA bullous dermatosis with atypical clinical and ultrastructural manifestations

The purpose of this study was to evaluate the effects of a brief intervention programme on STD knowledge, condom use and gonorrhoea incidence among sex workers in Singapore. A controlled before-and-after study design with non-random assignment of sex workers was used, supplemented by multivariate analysis to adjust for baseline differences. Control (n = 221, denoted C1) and experimental (n = 221, denoted E1) groups were interviewed on 2 occasions 3 months apart. Two supplementary groups were interviewed once each at the end of the 3-month period (n = 145 who had received the intervention and n = 151 who had not). Basic knowledge of STD symptoms and HIV transmission was high in all groups. There were misconceptions about casual transmission of HIV which improved dramatically at the second interview for group E1 (from 37-56% correct responses to 82-90%). Overall condom use was high (about 75%) and did not change after the intervention. Gonorrhoea rates were correspondingly low (0.4 episodes/worker/year) and also did not change. This brief intervention improved the STD knowledge of sex workers. However, behaviour as measured by reported condom use and gonorrhoea incidence did not change. Implications for future intervention programmes are discussed.     

Risk profile of female sex workers who participate in a routine penicillin prophylaxis programme in Surabaya, Indonesia

We conducted a sexually transmitted disease (STD) prevalence survey of 1867 female sex workers in Surabaya, Indonesia, some of whom reported participation in a routine penicillin prophylaxis programme. In Surabaya, 34% of female sex workers had received a prophylactic penicillin injection programme from the government within 28 days. Sex workers who had received routine prophylaxis injection were more likely to be less educated, to work in brothel complexes, and to have more customers per week than other sex workers. The prevalence rates of syphilis, gonorrhoea, chlamydia, and trichomoniasis were higher among sex workers who received the routine penicillin treatment than among those who had not received antibiotic treatment in the last 28 days. However, after adjustment for age, education, fee per sex act, number of customers, and condom use in the previous 7 days, only trichomoniasis was still significantly different (adjusted odds ratio of 3.2). High-risk women were more likely to participate in the routine penicillin prophylaxis programme. The lack of a demonstrable individual-level protection from this prophylaxis treatment programme in this cross-sectional study appears due to differential uptake of penicillin prophylaxis by women at higher presumptive risk for STD. Randomized clinical trials and mathematical modelling, together with observational data such as presented here, all can contribute to optimal understanding of a complex intervention like mass chemoprophylaxis for STD among female sex workers.     

Association between human immunodeficiency virus and herpes simplex virus type 2 seropositivity among male factory workers in Zimbabwe

To determine the seroprevalence of herpes simplex virus type 2 (HSV-2), to identify correlates of infection, and to describe the correlation with human immunodeficiency virus (HIV) seropositivity, 224 HIV-negative and 191 HIV-positive male factory workers in Zimbabwe were screened for HSV-2-specific antibodies. HSV-2 seroprevalence was 35.7% among HIV-negative subjects and 82.7% among HIV-positive subjects. The weighted estimate of HSV-2 seroprevalence in this population is 44.6%. The correlation between HIV and HSV-2 remained significant after controlling for multiple sex partners, paying for sex, and history of sexually transmitted disease (adjusted odds ratio, 8.0; 95% confidence interval, 4.8-13.1). If the association between HSV-2 and HIV is causal, then the high seroprevalence of HIV and HSV-2 suggests that suppressive HSV-2 treatment should be considered as a strategy to reduce HIV transmission in this population. HSV-2 seroconversion may be a suitable surrogate end point to evaluate HIV prevention interventions.     

High HIV prevalence, low condom use and gender differences in sexual behaviour among patients with STD-related complaints at a Nairobi primary health care clinic

Of 22,274 patients > or = 12 years old attending a Nairobi primary health care (PHC) clinic, 1076 (4.8%) had STD-related complaints, of whom 980 underwent assessment of risk factors for human immunodeficiency virus (HIV) infection and infrequent condom use. Gonorrhoea, chancroid, syphilis seroactivity, trichomoniasis, or objective signs of STD were found in 78%, and HIV seropositivity in 15% of men and 19% of women. Most women were married, living with a spouse; while most men were single, or married, but living separated from a spouse. Among married men, last sex was with a female sex worker (FSW) or casual partner for 60% not living with a spouse and 26% living with a spouse (P<0.005). Two or more partners during the past year were reported by 82% of men and 25% of women (P <0.001), and 55% of men and 11% of women reported the last partner was high risk. HIV seropositivity among both genders was associated with numbers of partners, and among women, with being widowed or divorced. Only 3% reported use of a condom with the last partner. Among men whose last sex was with a FSW, 74% said the reason for not using a condom was not having one. Thus, infrequent condom use, low condom availability, and gender differences in behaviour necessitate modifying development policies that separate families; and better coordination between family planning, PHC, and AIDS/STD programmes, with improved supply, social marketing and community-based distribution of condoms in high-risk settings for STD/HIV prevention.     

Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection

Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, woman-controlled method of pregnancy and disease protection would be welcomed by these women.     

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.     

Molecular features of primary MDS with cytogenetic changes

This article compares cross-sectional measures of condom use among 2,269 female sex workers in Cameroon randomly assigned to receive one of five different questionnaires measuring condom use. We found that the level of reported condom use varied depending on the type of survey questions used. Measures based on 2-week coital logs or the past 10 acts categorized more women as "100%" or "0%" users than always-to-never scales categorized women as "always" or "never" users. Consistency of use also varied by type of partner. Internal consistency of responses was high. Future studies should assess differences in prospective measures of condom use and the level of association between various measures and infection with sexually transmitted disease.