Drug use, sexual behaviour and HIV risk of the homeless in Port-of-Spain, Trinidad

Data were collected from 88 homeless persons in Port-of-Spain, Trinidad to assess HIV risk. 68 percent of the sample were engaging in unprotected sex with multiple partners, 25 percent were exchanging sex for money, and 29.5 percent were regularly smoking crack cocaine. Many had two or more of these behaviours that put them at high risk of HIV infection. Females were significantly more likely to be sex traders, to engage in bisexual behaviour and to have a history of psychiatric illness. The relationship between psychiatric illness and HIV risk behaviours among homeless female persons is explored. Educational interventions are suggested to reduce the public health risks in this population.(AU)

Drug use and syphilis: co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street-and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88 percent) reported regular alcohol consumption while looking for clients, 27 (22 percent) said they smoked cocaine and 51 (42 percent) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72 percent reported that they never used condoms with regular sex partners and 35 percent reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46 percent (54/118) tested HIV positive and 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95 percent CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95 percent CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95 percent CI = 1.65-16.74; p = 0.04; and a history of receiving treatment for salpingitis (OR = 2.31; 95 percent CI = 0.93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population (AU)

HIV seropositivity and associated factors among female commercial sex workers in Guyana

To determine the prevalence of, and risk factors for, HIV infection among female commercial sex workers in Guyana a cross sectional survey was done among 124 streetwalkers and brothel based female sex workers in Georgetown during January and February, 1997. The mean age was 30.6 years (range = 17 to 52; sd = 7.24). Sixty-one percent said they had worked in the sex industry for 1 to 4 years while 30 percent indicated they had worked for >4 years. Forty-six percent (54/118) tested HIV positive while 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7 - 21.97, p<0.01), a history of cocaine use (OR = 2.57, 95 percent CI = 0.95 - 7.11, p = 0.039), having > 4 clients per night (OR = 5.14, 95 percent CI = 1.65 - 16.74, p = 0.04), a history of having received treatment for syphilis (OR = 2.93, 95 percent CI = 1.12 - 7.8, p = 0.0035) and a history of receiving treatment for salpingitis (OR = 2.31, 95 percent CI = 0.93. 95 percent CI = 1.12 - 7.8, p = 0.0035) and a history of receiving treatment for salpingitis (OR = 2.31, 95 percent CI = 0.93 - 5.75, p = 0.0035). These results show a high prevalence of HIV infection and inconsistent condom use among the participants of the study. Exposure to syphilis seems to be a major risk factor for HIV. There is an urgent need for an integrated and innovative internvention targeting this high risk population. (AU)

Percepcion del riesgo, comportamientos riesgosos y seroprevalencia del VIH en trabajadoras sexuales de Georgetown, Guyana / HIV risk perception, risk behavior, and seroprevalence among female commercial sex workers in Georgetown, Guyana

A study of 108 female sex workers engaged in prostitution in Georgetown, Guyana, was made in April 1993. Based on interviews and procurement of blood samples, the study investigated relationships between HIV seroprevalences and AIDS knowledge, risk behaviors, client characteristics, and condom use. Street-walkers-as distinct from sex workers in bars, hotels and Port Georgetown-tended to charge less, be worse off socioeconomically, and have clients who were similiarly disadvantaged; they were therefore classified as belonging to a "lower" socioeconomic stratum, while the other workers were classified as belonging to a "higher" stratum. The overall HIV seroprevalence found among the sex workers was 25 percent (95 percent CI: 17-33 percent). But the 50 subjects in the lower stratum had a relatively high seroprevalence (42 percent, as compared to 10 percent among those in the higher stratum), accounting for 21 of the 27 HIV-seropositive subjects. Reported patterns of client origins (Guyanese or foreign), worker willingness to have sex without a condom, and condom use by clients differed by stratum. Participants in the higher stratum were more disposed to having sex without a condom. The workers' knowledge of what causes AIDS and how HIV is transmitted was low in both strata; substantial numbers of workers said they had contracted a sexually transmitted disease within the past two years or were users of illicit drugs. Condom use is reportedly less common among among Guyanese than foreign clients, suggesting a greater risk of contracting HIV from Guyanese clients or infecting Guyanese clients with it. The HIV seroprevalence among those reporting more than five clients per week was statistically greater among those reporting fewer. HIV seropsitivity was relatively high among the 12 workers whosaid they used cocaine. Overall, the findings supported the view that interventions targeted at female sex workers and their clients should be strengthened-more specifically, that concerted efforts should be made to intensify condom promotion, distribution, and social marketing; to improve STD services that provide treatment and counseling for female sex workers; and to increase educational activities among the workers' Guyanese clients (AU)

Genital Chalmydia trachomatis (serotypes D-K) infection in Jamaican commercial street sex workers

OBJECTIVE: To determine in the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmuofluorescence (MIF) test. RESULTS: The DFA detect C trachomatis in 16 percent (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24 percent (31/129) and 25 percent (33/129) respectively. The overall prevalence of current chalmydial infection detected by the isolation techniques used was 25 percent (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95 percent, 61/64) was found in CSSW compared with blood donors (53 percent, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9 percent) and Candida albicans (7 percent) were found in comparatively low frequencies, while Trichomonas vaginalis (0 percent) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequeles of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.(AU)

HIV risk perception, risk behavior, and seroprevalence among female commercial sex workers in Georgetown, Guyana

A study of 108 female sex workers engaged in prostitution in Georgetown, Guyana, was made in April 1993. Based on interviews and procurement of blood samples, the study investigated relationships between HIV seroprevalences and AIDS knowledge, risk behaviors, client characteristics, and condom use. Street-walkers-as distinct from sex workers in bars, hotels, and Port Georgetown-tended to charge less, be worse off socioeconomically, and have clients who were similiarly disadvantaged; they were therefore classified as belonging to a "lower" socioeconomic stratum, while the other workers were classified as belonging to a "higher" stratum. The overall HIV seroprevalence found among the sex workers was 25 percent (95 percent CI: 17 percent-33 percent). But the 50 subjects in the lower stratum had a relatively high seroprevalence (42 percent, as compared to 10 percent among those in higher stratum), accounting for 21 of the 27 HIV-seropositive subjects. Reported patterns of client origins (Guyanese or foreign), worker willingness to have sex without a condom, and condom use by clients differed by stratum. Participants in the higher stratum were more disposed to having sex without a condom. The workers' knowledge of what causes AIDS and how HIV is transmitted was low in both strata; substantial numbers of workers of workers said they had contracted a sexually transmitted disease within the past two years or were users of illicit drugs. Condom use is reportedly less common among Guyanese than foreign clients, suggesting a greater risk of contracting HIV from Guyanese clients or infecting Guyanese clients with it. The HIV seroprevalence among workers who said they had only Guyanese clients was statistically greater than the rate among those who said they had only foreign clients. The HIV seroprevalence among those reporting more than five clients per week was statistically greater than among those reporting fewer. HIV seropisitivity was relatively high among the 12 workers who said they used cocaine. Overall, the findings supported the view that interventions targeted at female sex workers and their clients should be strengthened-more specifically, that concerted efforts should be made to intensify condom promotion, distribution, and social marketing; to improve STD services that provide treatment and counseling for female sex workers; and to increase educational activities among the workers' Guyanese clients (AU)

Risk factors associated with STD/HIV seropositivity among female commercial sex workers (FCSWs)-implications for an integrated intervention strategy - abstract

HIV seropositivity is still relatively low in the general population in Jamaica. An initial study in Kingston identified an HIV prevalence of 12 percentage among female commercial sex workers (FCSWs). This study among Montego Bay FCSWs was to determine the prevalence of HIV/STD and identify risk factors associated with HIV seropositivity at initial presentation to a screening service [Women Health Interventions (WHI), ACOSTRAD project]. From August 1994 to October 1995, a detailed sexual history, a full physical examination, voluntary laboratory examination for syphilis and HIV infection were conducted on 143 FCSWs and a questionnaire administered. 25 percent of the FCSWs were seropositive for HIV infection (CI=17.6, 33.0) and 34 percent had a positive serological test for syphilis (CI=26.1, 42.3). Significant associations were found between HIV seropositivity and duration of time in prostitution greater than or equal to 5 years (OR=2.60 CI=1.10, 6.15); living alone with no regular partner (OR=3.90 CI=1.36, 11.21); number of different sex partners (paying and nonpaying) during this last week > two (OR=2.86 CI=1.25, 6.54), number of paying customers this last week> five (OR=2.57 CI=1.10, 5.99). Partners' cocaine use (p=0.003), "ever had syphilis" (p=0.009),"ever had sores on genitals" (0.013), were also significantly correlated with HIV seropositivity. No significant associations were noted with condom use during last sex act, sexual practices, self reported drug use and past history of other common STDs. The seroprevalence of HIV among FCSWs in Montego Bay is high. Strategies to decrease the prevalence of prostitution and create other opportunities for FCSWs are urgently needed (AU)

Early socialization, current sexual practices and risk of sexually transmitted diseases of female workers in three districts in Belize

The study was designed to investigate the prevalence of a defined set of demographic and lifestyle variables and their relationship to the the transmission of STD/HIV in two groups of sex workers. It was carried out in three districts in Belize during a two week period. A sample of 80 female sex workers (45 brothel and 35 freelance workers) was selected by a multistage sampling method. The instrument used was an interview administered questionnaire. Brothel sex workers were, for the most part, non-nationals. They tended to be younger, p<0.008 and were more likely to use condoms (p<0.00) than freelance workers. The only HIV positive sex worker was a freelance sex worker. The majority of the respondents had 365 - 1460 'work' sexual contacts per annum. Both groups reported a high incidence of childhood sexual abuse (67.5 percent). In addition, two 15 year old girls were found in the sample. Combating STD transmission and its complications in this population offers a challenge to the social services and public health officials in Belize. Issues, such as, child sexual abuse, women's health, migration and socioeconomic conditions of women must also be taken into consideration. It can be appreciated then that there is a need for community based interventions to be implemented as quickly as possibly to ensure safer sex practices as other factors influencing prostitution need more long term solutions (AU)

Prostitution and the military: planning AIDS intervention in Belize

First world militaries based in "third world" countries offer an appropriate context for developing AIDS intervention models that are keyed to large-scale population movements and regional differences in HIV infection. In this work, the ethnographic concept of "social interface" replaces the epidemiological concept of "risk group" to allow for a more dynamic analysis of the particular forms of interactions between groups that may be linked to the sexual transmission of HIV. The social interface between military and sex workers in Belize displays two distinct forms of organization: (1) "recognized prostitution" in health-regulated brothels, and (2) "quasi-prostitution" in non-health regulated public sites such as bars and hotels. These two forms are also distinguished by the ethnicity, national origin, and professional identify of sex workers. Based on survey-form participant-observation in Belize and cross-cultural data on condoms use, the social identify of sex workers emerges as a factor crucial to understanding how public health information is incorporated by heterosexuals who put themselves at risk for HIV in different social contexts. The scope of analysis shifts between the personal and transnational; discussion of the possibilties for inter-governmental negotiations regarding AIDS policy issues is included.(AU)

HIV study of cocaine-dependent persons - abstract

In Trinidad and Tobago, the crude incidence rate for AIDS rose ten-fold from 0.7 in 1983 to 7.1 in 1987. Cocaine use is epidemic and female addicts commonly support their habit by prostitution, thus creating a behavioural pattern likely to enhance transmission of the virus between groups with different sexual behaviours. It was postulated that, despite the absence of IV drug use in Trinidad and Tobago, drug users may be significant in the transmission of the HIV virus to and within the heterosexual population. In this preliminary investigation conducted in 1988, cocaine individuals were tested for exposure to the HIV. Subjects satisfied the DSM IIIR criteria for cocaine dependence and were relatively heavy users. ELISA HIV-positive blood was confirmed by Western blot analysis. Nine (3.3 percent) of the 276 male addicts and 6 (14.3 percent) of the 42 women tested were HIV-positive. HIV-positive subjects reported having > 10 sexual partners over the past year more often than those who were HIV negative. Prostitution was significant among the female addict population (14/42 or 33 percent). Two-thirds of female addicts who were HIV-positive were prostitutes as compared to 28 percent (10/36) of those who were HIV-negative. It was concluded that cocaine addicts, especially females, are at increased risk for HIV infection through sexual behaviour which involved multiple partners and included prostitution. Further research is recommended to confirm these findings and to develop appropriate intervention strategies (AU)