HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site.

INTRODUCTION: Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS: Cross-sectional study on 400 WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS: WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively and higher in women who exercised on the street or highway, 5.6%, 1.9% and 1.2%, respectively. CONCLUSION: The information generated in this study will be useful for the design specific preventive interventions aimed at this group.

HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site. / Vulnerabilidad frente al VIH, clamidia y gonococia según el lugar donde se ejerce el trabajo sexual.

INTRODUCTION: Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, Chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS: Cross-sectional study on 400WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS: WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, Chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively, and higher in women who exercised on the street or highway: 5.6%, 1.9% and 1.2%, respectively. CONCLUSION: The information generated in this study will be useful for the design specific preventive interventions aimed at this group.

[Social characteristics, risk behaviours and differences in the prevalence of HIV/sexually transmitted infections between Spanish and immigrant female sex workers in Catalonia, Spain]. / Diferencias en las características sociales, conductas de riesgo y prevalencia de infección por el virus de la inmunodeficiencia humana e infecciones de transmisión sexual entre trabajadoras del sexo españolas e inmigrantes en Cataluña.

BACKGROUND AND OBJECTIVE: To describe and compare the social characteristics, human immunodeficiency virus (HIV), Chlamydia trachomatis and Neisseria gonorrhoae prevalences, and risk behaviours among immigrant female sex workers (FSW) according to their geographical area of origin. MATERIAL AND METHOD: Cross-sectional study in an opportunistic sample of FSW in Catalonia in 2005 using an anonymous questionnaire. Oral fluid and urine samples were collected to determine the prevalence of HIV and C. trachomatis/N. gonorrhoeae, respectively. RESULTS: Four hundred women participated in the study; 10.8% from Spain, 32.5% from Eastern Europe, 30.7% from Latin America, and 26% from Africa. The majority of them (95.5%) always used condoms during vaginal intercourse with clients, but only 12.4% with steady partners. Overall HIV, C. trachomatis and N. gonorrhoeae prevalences were 1.8%, 5.5% and 0.6%, respectively. Spanish women injected drugs more frequently (9.3%), and used condoms less commonly (85.7% used condoms consistently) (p < 0.05). We observed differences in HIV prevalence only (9.3% among Spanish FSW; p < 0.01). CONCLUSIONS: To insist on consistent condom use with clients and steady partners has to become a prevention strategy. Spanish FSW need special attention because they reported less use of condoms and highest HIV prevalences.

Condom use among female sex workers in Catalonia: why do they use a condom, why don't they use it?

The present study, based on social representation theory (Moscovici, 1961), aimed to identify the social representation of condom use (CU) in a collective of female sex workers (FSW) in Catalonia, considering both their work and private life. It involved 124 FSW and combined both qualitative and quantitative methodologies. Results suggest that both CU and non-CU represent strategies that FSW use mainly when confronted by threats to things they consider important. In work life, where CU is widespread, the most important thing is health protection, and the threat is represented by sexually transmitted infections. In private life, where non-CU is widespread, the most important thing is that their relationships adhere to an idealized relationship model, based on love, trust, and sexual gratification; this model lies in contrast to the status of the women as FSW. The threats are represented by both partner infidelity and their FSW status (symbolic threats).

[Trends in HIV prevalence and associated risk behaviors in female sex workers in Catalonia (Spain)]. / Tendencias de la prevalencia del VIH y de las conductas de riesgo asociadas en mujeres trabajadoras del sexo en Cataluña.

OBJECTIVES: To describe trends in HIV prevalence, sexual risk behaviors and other sexual health indicators in female sex workers (SW) from 2005 to 2011. METHODS: Cross-sectional studies were conducted biennially among SW recruited in Catalonia (Spain) in the street, flats and clubs (n = 400). In addition to an anonymous questionnaire, oral fluid samples were collected to estimate HIV prevalence. Linear trends in proportions were assessed by the Mantel test. RESULTS: The percentage of SW who used condoms inconsistently with clients (past 6 months) increased from 5.1% in 2005 to 9.9% in 2011 (p = 0.005); this percentage also increased with steady partners (86.2% in 2005 to 94.4% in 2011, p = 0.002). The prevalence of self-reported sexually transmitted infections (STI) increased from 14% in 2005 to 20.6% in 2011 (p = 0.001). The prevalence of HIV held constant over the years (about 2%), being higher in Spanish women (14.7% in 2011). DISCUSSION: The prevalence of HIV in SW remained stable over the years, being higher in Spanish SW. The increase in unprotected sex and in the prevalence of self-reported STI among SW from 2005 to 2011 highlights a possible relaxation in preventive behaviors in this group. Interventions to reduce the transmission of these infections, as well as unwanted pregnancies, should continue in Catalonia in SW.

Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain.

OBJECTIVES: To determine the prevalence of human immunodeficiency virus (HIV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among immigrant female sex workers (FSW) according to their geographic area of origin and identify possible risk factors independently associated with current infection with CT and/or NG. STUDY DESIGN: Cross-sectional study of 357 FSW in Catalonia in 2005. Information on sociodemographic and sex work characteristics, use of alcohol and drugs, sexual practices, and the use of social and health care services was collected. Oral fluid and urine samples were collected to determine the prevalence of HIV and CT/NG, respectively. Factors independently associated with CT/NG were assessed using multivariate logistic regression models. RESULTS: A total of 36.4% of women were from Eastern Europe, 34.5% from Latin America, and 29.1% from Africa. Overall CT and NG prevalence were 5.9% [95% confidence interval (CI): 3.7-8.9] and 0.6% (95% CI: 0.1-2.0), respectively. No differences were observed by geographic origin. Three African women were HIV positive (overall HIV prevalence was 0.8%, 95% CI: 0.2-2.4). In multivariate analysis, younger age and unprotected sex with clients were associated with the presence of CT/NG. CONCLUSIONS: The prevalence of sexually transmitted infections among FSW in Catalonia was lower than in other European countries. Even though the prevalence of HIV was only 0.8%, it could increase in the future given the high vulnerability of these women and their wide geographic mobility. It is necessary to continue with the work carried out by nongovernmental organizations (harm reduction programs, outreach programs, and safe sex workshops) as well as to facilitate the access to health centers, especially for the youngest women.