Exposure to Treponema pallidum among Female Sex Workers: A Retrospective Study Conducted in the State of Pará, Brazilian Amazon.

BACKGROUND: Syphilis remains a significant global public health issue, and female sex workers (FSWs) are highly vulnerable to the etiological agent of this disease. This study aimed to describe the prevalence of exposure to Treponema pallidum, as well as the vulnerability factors among FSWs in the state of Pará, Brazilian Amazon. METHODS: A cross-sectional, retrospective study involving 360 FSWs from five cities in Pará was conducted from 2005 to 2007. Blood samples were collected for treponemal and non-treponemal testing, and epidemiological information was obtained through interviews. RESULTS: The exposure rate to T. pallidum was 37.7% (136/360), and the majority of FSWs had serological results indicating past exposure (21.1%). Among the FSWs exposed to T. pallidum, most of them were single, aged 23 to 42 years old, had less than 8 years of schooling, and had a family income of between 1 and 3 minimum wages. They reported using condoms during sexual intercourse and had no history of sexually transmitted infection (STI). Furthermore, many of the FSWs exposed to T. pallidum reported having more than 20 sexual partners per month, and had partners from other Brazilian states, but not from other countries. An age over 42 years and a reduced level of education were factors associated with exposure to T. pallidum. Finally, a high rate of exposure to T. pallidum among FSWs in the Brazilian state of Pará (from 2005 to 2007) was detected. In later years, epidemiological studies conducted with FSWs recorded that this rate remained high. Measures to control, treat, and prevent syphilis among FSWs were necessary between 2005 and 2007, and they are still imperative today. Actions related to educational programs and STI control, treatment, and prevention measures contained in Brazilian policies aimed at women's health have not changed the vulnerability scenario of FSWs regarding their exposure to T. pallidum, even after 16 years, and must be reviewed and adapted to the conditions of the Brazilian Amazon.

Substance use, economic vulnerability, and HIV/STI risk among female sex workers in Mexico.

BACKGROUND: Economic hardship (e.g., difficulty to pay for basic needs) has been associated with increased HIV/STI risk among female sex workers (FSW), and may be exacerbated by high levels of substance use. Few studies have assessed the intersection of economic hardship, substance use, and HIV/STI risk among FSW. METHODS: Quantitative data were collected via questionnaires among 469 FSW residing in Tijuana and Ciudad Juarez, Mexico. Using logistic regression, we assessed the role of economic hardship on the association between substance use (past 30-days alcohol use, drug use, or injection drugs use with clients, and past 6-months drug use) and testing positive for an STI (also an indicator of HIV risk). RESULTS: Drug use in the preceding six months was significantly associated with testing positive for an STI (AOR = 1.8, CI: 1.1 = 2.9, p = .02); no difference in this association was found by whether women reported economic hardship. Past 30-day drug use with clients was associated with STI infection, but only among those who did not report economic hardship (AOR = 1.5, 95% CI: 1.1-1.9, p < .01). CONCLUSIONS: Findings suggest that economic hardship influences the association between substance use and increased risk for HIV/STI among FSW; however, these associations may be more complex than previously hypothesized.

Violence Exposure Among Women in the Sex Industry and Their Children in El Alto, Bolivia: A Comparative Cross-Sectional Study.

We conducted a comparative cross-sectional study to compare the prevalence of exposure to workplace violence and intimate partner violence (IPV) in 125 female sex workers (FSWs) and 125 age-matched control women working in other professions (non-FSWs) and their children in El Alto, Bolivia. Violence exposure was assessed using the Demographic Health Survey Domestic Violence Module. To determine associations between work type and violence exposure, we conducted multivariate logistic regression. One-third of working mothers experienced sexual IPV, regardless of their profession. FSWs experienced higher rates of severe physical IPV and workplace violence. Children of FSWs were approximately three times more likely to be exposed to violence in the workplace. In Bolivia, strategies to reduce exposure to violence within the home and in FSW workplaces are paramount to minimizing negative impacts on women and their children. These findings have implications for policies to improve education, living wages, and social interventions to prevent and mitigate violence against women and children.

The preventable burden of mortality from unsafe abortion among female sex workers: a Community Knowledge Approach survey among peer networks in eight countries.

Previous studies have found high levels of unintended pregnancy among female sex workers (FSW), but less attention has been paid to their abortion practices and outcomes. This study is the first to investigate abortion-related mortality among FSW across eight countries: Angola, Brazil, Democratic Republic of Congo (DRC), India, Indonesia, Kenya, Nigeria, and South Africa. The Community Knowledge Approach (CKA) was used to survey a convenience sample of FSW (n = 1280). Participants reported on the deaths of peer FSW in their social networks during group meetings convened by non-governmental organisations (n = 165 groups, conducted across 24 cities in 2019). Details on any peer FSW deaths in the preceding five years were recorded. The circumstances of abortion-related deaths are reported here. Of the 1320 maternal deaths reported, 750 (56.8%) were due to unsafe abortion. The number of abortion-related deaths reported was highest in DRC (304 deaths reported by 270 participants), Kenya (188 deaths reported by 175 participants), and Nigeria (216 deaths reported by 312 participants). Among the abortion-related deaths, mean gestational age was 4.6 months and 75% occurred outside hospital. Unsafe abortion methods varied by country, but consumption of traditional or unknown medicines was most common (37.9% and 29.9%, respectively). The 750 abortion-related deaths led to 1207 children being left motherless. The CKA successfully recorded a stigmatised practice among a marginalised population, identifying very high levels of abortion-related mortality. Urgent action is now needed to deliver comprehensive sexual and reproductive healthcare to this vulnerable population, including contraption, safe abortion, and post-abortion care.

Role of Female Sex Hormones and Immune Response in Salt-Sensitive Hypertension Development: Evidence from Experimental Models.

PURPOSEOF REVIEW: Female sex hormones have systemic effects unrelated to their reproductive function. We describe experiences of different research groups and our own, on aspects related to the importance of female sex hormones on blood pressure (BP) regulation and salt-sensitivity-mediated BP response and salt sensitivity without alterations in BP, as well as renal sodium handling and interactions with the immune system. RECENT FINDINGS: Changes in sodium intake in normotensive premenopausal women cause more BP variations than in men. After menopause, women often develop arterial hypertension (HT) with a profile of sodium sensitivity. Besides, experimental results have shown that in adult rat models resembling the postmenopausal hormonal state induced by ovariectomy, controlling BP is not enough to avoid renal and other tissue infiltration with immune cells, which does not occur when sodium intake is low or normal. Therefore, excess sodium promotes an inflammatory state with the involvement of immune cells. The evidence of activation of adaptive immunity, besides changes in T cell subpopulations, includes changes in sodium transporters and receptors. More studies are needed to evaluate the particular sodium sensitivity of women and its meaning. Changes in lifestyle and sodium intake reduction are the main therapeutic steps. However, to face the actual burden of salt-sensitive HT in postmenopausal women and its associated inflammatory/immune changes, it seems reasonable to work on immune cell activity by considering the peripheral blood mononuclear cell phenotypes of molecules and transport proteins related to sodium handle, both to screen for and treat cell activation.

CETP expression ameliorates endothelial function in female mice through estrogen receptor-α and endothelial nitric oxide synthase pathway.

Endothelial dysfunction is an early manifestation of atherosclerosis. The cholesteryl ester transfer protein (CETP) has been considered proatherogenic by reducing plasma HDL levels. However, CETP may exhibit cell- or tissue-specific effects. We have previously reported that male mice expressing the human CETP gene show impaired endothelium-mediated vascular relaxation associated with oxidative stress. Although sexual dimorphisms on the metabolic role of CETP have been proposed, possible sex differences in the vascular effects of CETP were not previously studied. Thus, here we investigated the endothelial function of female CETP transgenic mice as compared with nontransgenic controls (NTg). Aortas from CETP females presented preserved endothelium-dependent relaxation to acetylcholine and an endothelium-dependent reduction of phenylephrine-induced contraction. eNOS phosphorylation (Ser1177) and calcium-induced NO levels were enhanced, whereas reactive oxygen species (ROS) production and NOX2 and SOD2 expression were reduced in the CETP female aortas. Furthermore, CETP females exhibited increased aortic relaxation to 17ß-estradiol (E2) and upregulation of heat shock protein 90 (HSP90) and caveolin-1, proteins that stabilize estrogen receptor (ER) in the caveolae. Indeed, CETP females showed an increased E2-induced relaxation in a manner sensitive to estrogen receptor-α (ERα) and HSP90 inhibitors methylpiperidinopyrazole (MPP) and geldanamycin, respectively. MPP also impaired the relaxation response to acetylcholine in CETP but not in NTg females. Altogether, the study indicates that CETP expression ameliorates the anticontractile endothelial effect and relaxation to E2 in females. This was associated with less ROS production, and increased eNOS-NO and E2-ERα pathways. These results highlight the need for considering the sex-specific effects of CETP on cardiovascular risk.NEW & NOTEWORTHY Here we demonstrated that CETP expression has a sex-specific impact on the endothelium function. Contrary to what was described for males, CETP-expressing females present preserved endothelium-dependent relaxation to acetylcholine and improved relaxation response to 17ß-estradiol. This was associated with less ROS production, increased eNOS-derived NO, and increased expression of proteins that stabilize estrogen receptor-α (ERα), thus increasing E2-ERα signaling sensitivity. These results highlight the need for considering the sex-specific effects of CETP on cardiovascular risk.

Topiramate treatment during the peripubertal period does not alter aortic endothelial function in female Wistar rats.

AIMS: This study aimed to evaluate the short- and long-term adverse effects of blood pressure (BP), vascular endothelial function, and estrogen receptor (ERα and ERß) modulation on endothelial function in female Wistar rats treated with topiramate (TPM), an antiepileptic drug, during the peripubertal period. MATERIALS AND METHODS: Female Wistar rats were treated with TPM (41 mg/kg) or water (CTR group) by gavage from postnatal day (PND) 28 to 50 (peripubertal phase). At the end of the treatment, the TPM and CTR rats were divided into two groups and evaluated after 24 h or from PND 85 (adulthood). The rats were evaluated for: thoracic aorta reactivity to phenylephrine (Phenyl), acetylcholine (ACh), and sodium nitroprusside (SNP); aortic ring reactivity after ERα and ERß antagonism; and BP. KEY FINDINGS: It was observed that vascular response to Phenyl, ACh, and SNP was similar between TPM and CTR rats in the short- and long-term evaluations. In addition, the ER antagonism did not interfere with aortic contraction or relaxation in either TPM or CTR. SIGNIFICANCE: Taken together, the results show that TPM treatment during the peripubertal period does not alter aortic endothelial function and its estrogen modulation via classic ER in female Wistar rats, suggesting that TPM treatment in this period is safe for the vascular system.

Barriers to Condom Negotiation and Use Among Female Sex Workers in the United States and United States-Mexico Border Cities: A Systematic Review.

Despite the effectiveness of male condoms, many Female Sex Workers (FSWs) report using condoms infrequently with multiple clients during sexual activity. As such, inconsistent condom use by FSWs is a public health concern as it can increase STI and HIV transmission. This systematic review synthesized extant evidence regarding barriers to condom use experienced by FSWs in the U.S and U.S. - Mexico border towns. The search was conducted through PubMed, CINAL, Cochrane, Medline, and PsychInfo. Studies were included if: they were conducted in the U.S. or U.S. - Mexico borders, their target population was FSWs, they examined condom use barriers experienced by FSWs, and they were published in English between 2011 and February 2021. Condom use barriers among FSWs were reported in all the articles including alcohol consumption and drug use before sex, venue stability, socio-economic status vulnerability, violence and gendered power dynamics, trust of regular clients, and age. The review findings indicate the need to develop interventions promoting condom use for both FSWs and their clients, as well as alternative interventions for HIV prevention such as pre-exposure prophylaxis (PrEP).

Trajectories of HIV management among virally suppressed and unsuppressed female sex workers in the Dominican Republic: A comparative qualitative analysis.

PURPOSE: Despite suboptimal HIV outcomes among female sex workers (FSW), limited research has been conducted on factors that impact viral suppression among this population. Examining narratives of HIV management, we examined how experiences of diagnosis, treatment initiation, and ongoing care behaviours shaped viral suppression outcomes over time. METHODS: We conducted 20 in-depth interviews with FSW in Santo Domingo, Dominican Republic. Using narrative and thematic qualitative approaches, we developed analytic summaries and matrices to compare trajectories of managing HIV between suppressed and unsuppressed participants. RESULTS: Regardless of suppression status, participants described similar narratives of overcoming initial challenges to HIV management through personal resilience and social support. Unsuppressed participants identified more delays in initiating antiretroviral therapy and more lapses in adherence due to less active acceptance of their HIV status and more persistent experiences of economic hardship and HIV stigma. CONCLUSIONS: We found that individual, interpersonal and structural factors, including stigma and economic precarity, differentiated trajectories towards viral suppression among FSW indicating the importance of multilevel interventions. Improved access to mental health services and social support could promote greater early acceptance of HIV status and progress towards viral suppression among FSW.

Female sex workers and police violence during the Covid-19 health crisis in 2020-2021: results from the EPIC multi-country community-based research program in Argentina.

BACKGROUND: Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. METHODS: EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020-April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. RESULTS: Among 173 respondents, median age was 34 [IQR 27-42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. CONCLUSIONS: FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.

HIV Voluntary Counseling and Testing (VCT-HIV) effectiveness for sexual risk-reduction among key populations: A systematic review and meta-analysis.

Background: HIV disproportionately affects people who inject drugs, transgender people, sex workers, men who have sex with men, and incarcerated people. Recognized as key populations (KP), these groups face increased impact of HIV infection and reduced access to health assistance. In 1990, the Center for Disease Control and Prevention organized technical guidance on HIV Voluntary Counseling and Testing (VCT-HIV), with subsequent trials comparing intervention methodologies, no longer recommending this strategy. However, KP needs have not been explicitly considered. Methods: We assessed VCT-HIV effectiveness for sexual risk-reduction among KP (PROSPERO 2020 CRD42020088816). We searched Pubmed, EMBASE, Global Health, Scopus, PsycINFO, and Web of Science for peer-reviewed, controlled trials from February, 2020, to April, 2022. We screened the references list and contacted the main authors, extracted data through Covidence, applied the Cochrane Risk-of-Bias tool, and performed the meta-analysis using Review Manager. Findings: We identified 17 eligible trials, including 10,916 participants and evaluated HIV risk behaviors. When compared to baseline, VCT-HIV reduced unsafe sex frequency (Z=5.40; p<0.00001, I²=0%). Interpretation: While our meta-analysis identified VCT-HIV as protective for sexual risk behaviors for among KP, the results are limited to MSM and PWID, demonstrating the paucity of data on the other KP. Also, it highlights the importance of applying a clear VCT-HIV guideline as well as properly training the counselors. Funding: Research funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ/MS-DIAHV N° 24/2019), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Serological Confirmed Syphilis Among Transgender Women in Dominican Republic.

Purpose: Transgender women (TW) in the Dominican Republic (DR) are at high risk for syphillis infection. Although treatable, infection rates remain at epidemic proportions. Methods: In 2016, we conducted a national survey, with serological sampling of TW in the DR (n=255). Results: In our sample, syphillis seropositivity was 47.45%. There was a statistically significant association between age (t=-2.93, df, p<0.01), arrest history (χ 2=8.15, p<0.01), exposure to violence (χ 2=3.73, p<0.05), and syphilis seropositivity. Multivariate analyses show TW arrested in the past 6 months have higher odds of seropositivity (odds ratio=2.05, confidence interval: 1.04-4.06, p<0.05). Conclusions: There is a need for education and public health campaigns focused on TW specifically.

Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil.

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

RESUMEN: Mujeres trabajadoras sexuales (MTS) se ven afectadas de manera desproporcionada por la violencia sexual (VS) y el VIH. Las barreras sociales y estructurales limitan su acceso a la profilaxis posexposición (PEP). Encuesta de muestreo dirigida por encuestados en 12 ciudades brasileñas con 4188 MTS para estimar la prevalencia de VS y los factores asociados al uso de PEP entre MTS que experimentaron VS. La prevalencia de VS fue del 26.3% (1199). De essas, el 7.5% buscó atención médica y usó PEP, el 19% buscó atención médica pero no usó PEP y el 73.5% no buscó atención después del SV. Factores asociados con el uso de PEP: conciencia de PEP; participación en talleres educativos y divulgación del trabajo en los servicios de salud. Aunque Brasil tiene un programa de PEP gratuito, no es de fácil acceso. Es urgente el desarrollo de estrategias efectivas para vincular las MTS con servicios de prevención.

Economic vulnerability, violence, and sexual risk factors for HIV among female sex workers in Tijuana, Mexico.

Economic vulnerability is often reported to underlie involvement in sex work among female sex workers (FSW), but may also create urgency in women's work, limiting women's negotiating power with clients and in turn, increasing their vulnerability for violence and HIV. This study assessed economic vulnerability in relation to violence and sexual risk behaviors for HIV among a sample of FSW in Tijuana, Mexico. FSW at least 18 years of age were recruited through venue-based sampling for a survey (n = 228) and in-depth interviews (n = 50) to investigate HIV risk factors in this region. Using crude and adjusted logistic regression models, we assessed lack of financial support from others as well as reports of financial hardship separately in relation to experiencing sexual violence (e.g. by clients, police, relationship partners, in the past 6 months), physical violence (past 6 months), STI diagnosis, and inconsistent condom use (past 30 days). Qualitative interviews (n = 50), conducted with a subsample of the survey participants, were also examined for related themes. FSW who reported no financial support were more likely to report sexual violence (OR = 2.1; 95% CI:1.1-4.2). FSW who reported financial hardship were more likely to experience sexual violence (OR = 1.9; 95% CI:1.1-3.6) and physical violence (OR = 1.9; 95% CI:1.1-3.6), as well as to report past 30-day inconsistent condom use (OR = 2.4; 95%CI: 1.3-4.6) and to test positive for an STI (OR = 1.9; 95% CI:1.1-3.4). Qualitative data substantiated these findings. Findings suggest that interventions to improve economic well-being may be useful to prevent the intersecting concerns of violence and HIV among FSW.

Psychometric Evaluation of the Personal Feelings Questionnaire-2 (PFQ-2) Shame Subscale Among Spanish-Speaking Female Sex Workers in Mexico.

Shame may increase HIV risk among stigmatized populations. The Personal Feelings Questionnaire-2 (PFQ-2) measures shame, but has not been validated in Spanish-speaking or nonclinical stigmatized populations disproportionately affected by HIV in resource-limited settings. We examined the psychometric properties of the Spanish-translated PFQ-2 shame subscale among female sex workers in two Mexico-U.S. border cities. From 2016 to 2017, 602 HIV-negative female sex workers in Tijuana and Ciudad Juarez participated in an efficacy trial evaluating a behavior change maintenance intervention. Interviewer-administered surveys collected information on shame (10-item PFQ-2 subscale), psychosocial factors, and sociodemographics. Item performance, confirmatory factor analysis, internal consistency, differential item functioning by city, and concurrent validity were assessed. Response options were collapsed to 3-point responses to improve item performance, and one misfit item was removed. The revised 9-item shame subscale supported a single construct and had good internal consistency (Cronbach's α = .86). Notable differential item functioning was found but resulted in a negligible effect on overall scores. Correlations between the revised shame subscale and guilt (r = .79, p < .01), depression (r = .69, p < .01), and emotional support (r = -.28, p < .01) supported concurrent validity. The revised PFQ-2 shame subscale showed good reliability and concurrent validity in our sample, and should be explored in other stigmatized populations.

Acceptability and perceptions of HIV oral self-testing across settings: A comparative qualitative study among Dominican and Tanzanian female sex workers.

Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants' interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW's perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach.

HIV knowledge among cisgender female sex workers of Haitian descent working at the border of Haiti and Dominican Republic.

In this brief report, we aim to assess levels of HIV mis-information among cisgender Haitian female sex workers engaged in sex work at the Haiti and Dominican Republic border. We conducted bivariate analyses on the 2014 Border Study on Sex Workers comparing responses from female sex workers on the Haiti side of the border to those from their peers on the Dominican Republic side (N=212). Prevention of HIV acquisition by correct and consistent condom use with each sex act was correctly endorsed by 90.5% of female sex workers in Haiti but only 57.0% of their peers in Dominican Republic (χ2=32.28, p<0.001); 84.1% of respondents in Haiti correctly identified that HIV can be transmitted through a single unprotected sexual act, compared to 52.3% in Dominican Republic (χ2=25.2, p<0.001). Significantly higher percentages of female sex workers in Dominican Republic correctly responded that HIV can be transmitted in pregnancy, compared to respondents in Haiti (96.5% vs. 71.4%; χ2=21.42, p<0.001). Higher percentages of respondents in Dominican Republic correctly answered that HIV can be transmitted through needle sharing, relative to respondents in Haiti (100.0% vs 89.7%; χ2=9.45, p<0.01). Respondents in Dominican Republic more accurately rejected the possibility of transmission through food or through mosquito bites, compared to respondents in Haiti (95.4% vs. 81.8%, χ2=8.51, p<0.01; 97.7% vs. 86.5%, χ2=7.81, p<0.01, respectively). Findings indicate that if HIV knowledge is examined aggregating responses to individual questions, then elements of misinformation may remain unaddressed. For example, we found significant differences in correct answers ranging from 16.7% to 100.0%.

Treponema pallidum among Female Sex Workers: A Cross-Sectional Study Conducted in Three Major Cities in Northern Brazil.

Female sex workers (FSWs) are an important group of people vulnerable to sexually transmitted infections. Northern Brazil is a rural and socioeconomically underdeveloped region, with lack of epidemiological information on syphilis in key populations. This study investigated the prevalence and factors associated with exposure to Treponema pallidum among FSWs in three major cities in northern Brazil. This cross-sectional study was conducted with a convenience sample of 415 FSWs from the cities of Belém, Macapá, and Rio Branco. Blood samples and personal data were collected from January 2009 to August 2010. Rapid plasma reagin and immunoenzymatic assays were used to detect antibodies against T. pallidum. Logistic regression models were used to determine factors associated with exposure to T. pallidum. In total, 36.1% were exposed to T. pallidum, and 15.7% had active syphilis. Sexual risk behaviors, use of illicit drugs, low education, and reduced monthly income were associated with exposure to T. pallidum. The high rate of exposure to T. pallidum indicates the urgent need for measures to identify, treat, and prevent syphilis and an education program for the valuation, care, and social inclusion of FSWs in northern Brazil.

Overlapping Key Populations and HIV Transmission in Tijuana, Mexico: A Modelling Analysis of Epidemic Drivers.

Tijuana, Mexico, has a concentrated HIV epidemic among overlapping key populations (KPs) including people who inject drugs (PWID), female sex workers (FSW), their male clients, and men who have sex with men (MSM). We developed a dynamic HIV transmission model among these KPs to determine the extent to which their unmet prevention and treatment needs is driving HIV transmission. Over 2020-2029 we estimated the proportion of new infections acquired in each KP, and the proportion due to their unprotected risk behaviours. We estimate that 43.7% and 55.3% of new infections are among MSM and PWID, respectively, with FSW and their clients making-up < 10% of new infections. Projections suggest 93.8% of new infections over 2020-2029 will be due to unprotected sex between MSM or unsafe injecting drug use. Prioritizing interventions addressing sexual and injecting risks among MSM and PWID are critical to controlling HIV in Tijuana.

RESUMEN: Tijuana, México, tiene una epidemia de VIH concentrada en poblaciones claves (PC) superpuestas que incluyen personas que se inyectan drogas (PID), trabajadoras sexuales (MTS), sus clientes hombres, y hombres que tienen sexo con hombres (HSH). Desarrollamos un modelo dinámico de transmisión de VIH en estas PC para determinar hasta dónde sus necesidades no atendidas de prevención y tratamiento dirigen la transmisión del VIH. Para 2020­2029 estimamos la proporción de nuevas infecciones adquiridas en cada PC, y la proporción atribuida a sus comportamientos de riesgo sin protección. Estimamos que 43.7% y 55.3% de nuevas infecciones se dan en HSH y PID, respectivamente, con MTS y clientes conformando < 10% de nuevas infecciones. Las proyecciones sugieren que 93.8% de nuevas infecciones en 2020­2029 se deberán a sexo sin protección en HSH o uso inseguro de drogas inyectables. Dar prioridad a intervenciones que atienden los riesgos sexual y de inyección en HSH y PID es crítico para controlar el VIH en Tijuana.

Prevalence of suicidality, depression, post-traumatic stress disorder, and anxiety among female sex workers: a systematic review and meta-analysis.

The purpose was to assess prevalence of suicidality, depression, post-traumatic stress disorder (PTSD), and anxiety among female sex workers (FSW). A systematic review and meta-analysis was performed. Search strategy was performed in MEDLINE, Scopus, Web of Science, EMBASE, Ovid and Cochrane Central Database from inception until March 2020. Considered for inclusion were cross-sectional studies performed on FSW that assessed prevalence of any of the following: suicide attempt or suicidal ideation, depression, PTSD, or anxiety. Five reviewers, independently and in duplicate, selected all eligible articles in an abstract and full-text screening phase and, moreover, extracted information from each study. A binomial-normal generalized linear mixed model was employed to estimate prevalence of the conditions. From 8035 studies yielded in the search strategy, 55 were included for analysis. The overall prevalence of suicidal ideation and attempt was 27% (95% C.I. 18-39%) and 20% (95% C.I. 13-28%), respectively. Furthermore, overall prevalence of depression and PTSD was 44% (95% C.I. 35-54%) and 29% (95% C.I. 18-44%), respectively. Eleven studies were classified as high quality. Findings indicate that there is an overall high prevalence of suicidality, depression, and PTSD among FSW. Development of accessible large-scale interventions that assess mental health among this population remains critical.