Feminicídios de prostitutas no município de Porto Alegre, RS, Brasil / Femicidio de prostitutas en el municipio Porto Alegre, RS, Brasil / Femicides of prostitutes in Porto Alegre, RS, Brasil

Este artigo analisa inquéritos policiais referentes a feminicídios de trabalhadoras sexuais ocorridos no município de Porto Alegre entre 2006 e 2010. Trata-se de um estudo de caso que investigou 12 relatos de feminicídios ocorridos com prostitutas e identificados em 94 inquéritos policiais referentes a assassinatos de mulheres, disponibilizados pela Delegacia de Homicídios do município. Os feminicídios foram classificados segundo três categorias: crimes da miséria, pois todas as mulheres mortas eram muito pobres; crimes de ódio, nos quais houve estupro, mutilações, tortura e uso extremado de instrumentos letais; e crimes sexuais, nos quais houve violência sexual. No período estudado, os feminicídios de trabalhadoras sexuais apresentaram frequência elevada em relação a outras mulheres. Essas mortes expressam o descaso e a misoginia da sociedade patriarcal e a pouca valia dessas vidas humanas. (AU)

Este artículo analiza investigaciones de la policía relativas a feminicidios de trabajadoras sexuales habidos en el municipio de Porto Alegre entre 2006 y 2010. Se trata de un estudio de caso que investigó 12 relatos de feminicidios ocurrido con prostitutas e identificados en 94 investigaciones de la policía referentes a asesinatos de mujeres, puestos a disposición por la Comisaría de Homicidios del municipio. Los feminicidios se clasificaron en tres categorías: crímenes de la miseria, puesto que todas las mujeres muertas eran muy pobres; crímenes de odio, en los cuales hubo violación, mutilaciones, tortura y uso extremado de instrumentos letales; y crímenes sexuales, en los que hubo violencia sexual. En el período estudiado, los feminicidios de trabajadoras sexuales presentaron una frecuencia elevada con relación a otras mujeres. Esas muertes expresan el poco caso y la misoginia de la sociedad patriarcal y el poco valor dado a esas vidas humanas. (AU)

This article presents the feminicides among sex workers in the city of Porto Alegre, in the years 2006-2010. A case study analyses 12 feminicides that occurred in prostitutes and were identified in 94 police inquiries, referring to the women murders available by the Police State Department of the city. Feminicides were characterized into three categories: crimes of misery, because all the women were very poor; hate crimes, in which were rape, mutilations, torture and extreme use of lethal instruments; and sexual crimes in which were sexual violence. During the period studied, feminicides by sexual workers were highly frequent in relation to other women. These deaths express the neglect and the misogyny of patriarchal society and the little value of these human lives. (AU)

Induced abortion among Brazilian female sex workers: a qualitative study / Aborto induzido entre prostitutas brasileiras: um estudo qualitativo

Prostitutes are vulnerable to unplanned pregnancies and abortions. In Brazil, abortion is a crime and there is no data about unsafe abortions for this population. The study describes how prostitutes perform illegal abortions and the health consequences thereof. Semi-structured interviews with 39 prostitutes from three cities in Brazil with previous induced abortion experience were conducted. Sixty-six abortions, with between one and eight occurrences per woman, were recorded. The majority of the cases resulted from sexual activity with clients. The inconsistent use of condoms with regular clients and the consumption of alcohol during work were indicated as the main causes of unplanned pregnancies. The main method to perform abortion was the intravaginal and oral use of misoprostol, acquired in pharmacies or on the black market. Invasive measures were less frequently reported, however with more serious health complications. The fear of complaint to the police meant that most women do not inform the health team regarding induced abortion. The majority of prostitutes aborted with the use of illegally-acquired misoprostol, ending abortion in a public hospital with infection and hemorrhagic complications. The data indicate the need for a public policy focusing on the reproductive health of prostitutes.

As prostitutas estão vulneráveis à gravidez não planejada e ao aborto. No Brasil, essa prática é crime e não há dados sobre aborto inseguro entre essa população. O estudo descreve como prostitutas abortam ilegalmente e o impacto à saúde. Foram realizadas entrevistas semiestruturadas com 39 prostitutas de três cidades do Brasil com experiência prévia em aborto induzido. Foram realizados 66 abortos, entre 1 e 8 ocorrências por mulher. A maioria dos casos resultaram de atividades sexuais com os clientes. O uso inconsistente dos condoms e o consumo de álcool na prostituição foram indicadas como as principais causas de gravidez não planejada. O principal método para abortar foi uso intravaginal e oral de misoprostol, adquirido em farmácias ou no mercado clandestino. Métodos invasivos foram menos frequentes, apesar de com mais sérias implicações à saúde. O medo de denúncia à polícia fez com que a maioria das mulheres não informasse à equipe de saúde sobre a indução do aborto. A maioria das prostitutas abortou com uso de misoprostol adquirido ilegalmente, finalizando o aborto em hospital público com quadros de infecção e complicações hemorrágicas. Os dados indicam a necessidade de uma política pública voltada à saúde reprodutiva das prostitutas.

Educação Popular em Saúde e participação de prostitutas: contribuições para a gestão participativa do SUS / Popular Education in Health and participation of prostitutes: contributions to participatory management of SUS

O Sistema Único de Saúde ancora-se em princípios como a universalidade, a equidade, a integralidade e a participação da sociedade na formulação e controle das políticas públicas de saúde. A Educação Popular em Saúde potencializa a participação popular de diferentes segmentos sociais e o desenvolvimento de mecanismos de escuta para apreender demandas e opiniões da população acerca dos serviços de saúde. Este artigo apresenta diferentes formas de participação popular protagonizadas pelo movimento social de prostitutas e seu engajamento na luta pelo direito à saúde, com intuito de descortinar contribuições que esse grupo social acrescenta à reflexão acerca das potencialidades e dificuldades de implementação de uma gestão participativa no SUS...

El Sistema Público de Salud Brasileño se basa en los principios de universalidad, equidad, integralidad y participación de la sociedad en la formulación y control de políticas de salud. La Educación Popular en Salud amplía la participación popular de los diferentes grupos sociales y lo desarrollo de mecanismos de escucha para captar sus demandas y opiniones acerca de los servicios de salud. Este artículo presenta diferentes formas de participación popular de lo movimiento social de prostitutas y su lucha por el derecho a la salud, a fin de descubrir sus contribuciones a la reflexión sobre las posibilidades y dificultades de implementación de una gestión participativa en el SUS...

The SUS – Brazilian public health system – is anchored in the principles of universality, equity, integrality and participation of society in the formulation and control of public health policies. The Popular Education and Health favors popular participation of different social groups and development of mechanisms for listening to apprehend their demands and opinions about the health services. This paper present different forms of popular participation by social movement of prostitutes and their engagement in the struggle for the right to health, in order to uncover contributions that social group adds to the reflection on the strengths and difficulties of develop a participatory management in the SUS...

Risk factors for herpes simplex virus type 2 infection among female commercial sex workers in Mexico City.

A scarce number of studies have been carried out to determine the epidemiology of herpes simplex virus type 2 (HSV-2) infection in female sex workers (FSWs). The objective of this study was to examine the correlates of infection for HSV-2 with socioeconomic and demographic characteristics, sexual behaviour and history of sexually transmitted diseases (STDs) among FSWs in Mexico City. A sample frame of commercial sex work sites was constructed during the fall of 1992. Sites identified were streets, bars and massage parlours. During 1993 we surveyed 757 FSWs aged 18-76 years, from a random sample of sites. Participating women provided a blood sample and answered a standardized questionnaire. HSV-2 antibodies were identified based on a Western blot assay, using type-specific recombinant glycoprotein gG2. In a multivariate analysis, the presence of HSV-2 antibodies was correlated (P < 0.005) with increasing age and time working as prostitutes, low education, street working site and positive serology for syphilis. The results showed that the working site and the education level are contextual variables related to the risk of HSV-2 infection, where poorly educated and street FSWs had the highest probability of infection. Characteristics that represent periods of exposure to the virus as age and time working in prostitution were predictors of the HSV-2 infection.

PIP: The authors investigated the relationship between herpes simplex virus type 2 (HSV-2) infection and socioeconomic and demographic characteristics, sexual behavior, and history of STDs among female prostitutes in Mexico City. During 1993, 757 female prostitutes aged 18-76 years, of mean age 28.5 years, from a random selection of prostitution sites provided blood samples and answered a standardized questionnaire. The presence of HSV-2 antibodies was identified through Western blot assay, using type-specific recombinant glycoprotein gG2. Overall seroprevalences for the study population were 65.1%, 0.6%, 3%, and 6.4% for HSV-2, HIV, hepatitis B virus, and syphilis, respectively. There was no significant correlation between HIV and HSV-2 serological results, although all 5 HIV-seropositive women were HSV-2 seropositive. In a multivariate analysis, the presence of HSV-2 antibodies was correlated with relatively higher age and longer time working as prostitutes, low education, prostitution at a street site, and positive serology for syphilis.

Prevalence of gonococcal and chlamydial infections in commercial sex workers in a Peruvian Amazon city.

BACKGROUND: Iquitos Peru, a densely populated port city housing both a large military base and a booming tourist industry, provides a thriving market for commercial sex and, consequently, sexually transmitted disease (STD). The purpose of this study was to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) and to correlate those findings with social/behavioral characteristics. METHODS: One hundred CSWs, recruited through street and brothel outreach, were administered questionnaires. Urine specimens were collected for gonorrhea and chlamydia testing using ligase chain reaction assays. RESULTS: Twenty-eight percent of CSWs were positive for chlamydia (22%) or gonorrhea (14%). Registered CSWs were more likely to have worked more than 5 years (p = 0.03), report 10 or more partners (p = 0.002), and work in brothels (p < 0.001). Significant associations were also noted between infection status and age, with adolescents at increased risk (odds ratio [OR] = 4.13, p = 0.001), and duration of employment, with those employed less than 5 years at increased risk (OR = 3.72, p = 0.04). The latter association, however, was because of age. Also, most CSWs believed themselves to be at no/small risk or didn't know their risk of future gonococcal infection (30%/12% and 25%, respectively) and AIDS (25%/8% and 35%, respectively), with 11% perceiving AIDS as more of a threat. CONCLUSIONS: High infection rates, lack of knowledge regarding STD/HIV risk assessment, and other high-risk behavior prevalent among this population stress the need for STD intervention. The study further suggests that educational/risk assessment programs and risk reduction interventions could be successful.

PIP: This study aims to characterize the prevalence of gonococcal and chlamydial infections among commercial sex workers (CSWs) in Iquitos, Peru, which provides a thriving market for CSWs and, consequently, sexually transmitted diseases (STDs) and to correlate those findings with social/behavioral characteristics. About 100 CSWs, recruited through street (n = 37) and brothel outreach (n = 67), were interviewed through questionnaires. Urine specimens were collected for gonorrhea and chlamydial testing. Findings revealed that registered CSWs were significantly more likely to have worked in the sex trade for more than 5 years, report 10 or more sex partners per week, and to work in brothels. Nonetheless, there were no significant differences in age, average charge for sex, or STD prevalence between registered and unregistered CSWs. Overall, 28% of CSWs were positive for chlamydia (22%) and gonorrhea (14%). Furthermore, a number of CSWs stated that they did not know whether they were at risk or assessed their risk as being low for contracting gonorrhea or AIDS. There was no significant association between self-perception of STD risk and STD prevalence. High infection rates, lack of knowledge regarding HIV/AIDS and STD risk assessment, and other high-risk behaviors prevalent among this population stress the need for STD intervention programs and risk reduction behavior.

Sexual practices and prevalence of HIV, HTLV-I/II, and Treponema pallidum among clandestine female sex workers in Lima, Peru.

BACKGROUND AND OBJECTIVES: A survey was conducted to determine the sexual behavior practices and prevalence of HIV-1, HTLV-I/II, and T. pallidum infections among unlicensed female sex workers (FSWs) in Lima, Peru. GOAL OF THIS STUDY: To assess the role of unlicensed FSWs as a potential source of retroviral and T. pallidum infection. STUDY DESIGN: Female sex workers from 15 brothels were enrolled. Sera samples were obtained and tested for antibodies to HIV-1, HTLV-I, and Treponema pallidum. RESULTS: Of 158 FSWs studied, all were negative for HIV-1, 6 were positive for HTLV-I, and 5 were positive for Treponema pallidum. Of their male clients, 75% used condoms, whereas only 3% reported condom use with their steady partners. When condoms were always used by clients, the history of a sexually transmitted disease was significantly reduced (p < 0.01), and the prevalence of HTLV-I (p < 0.05) and syphilis was lower among these workers. CONCLUSION: Data suggested that the low rate of sexually transmitted diseases among FSWs reflected the high rate of condom use by their male clients.

PIP: A survey was conducted to determine the prevalence of HIV-I, human T cell leukemia virus I and II (HTLV-I/II), and Treponema pallidum infection and the associated risk factors for the transmission of these sexually transmitted diseases (STDs) among unlicensed female sex workers (FSWs) in Lima, Peru, to further define their role as a potential source of infection. Unlicensed FSWs from 15 brothels were enrolled in this study from March to June 1994. Serum samples were collected and tested for antibodies to HIV-I, HTLV-I, HTLV-II, and Treponema pallidum. Results revealed that of the 158 FSWs studied, all were negative for HIV-I; 6 were positive for HTLV-I, and 5 had T. pallidum antibodies. Of their male clients, 75% had used condoms for the past 6 months, whereas only 3% reported condom use with their steady partners. Among the workers who stated that condoms were always used, the frequency of a history of STDs, including genital ulcers and inguinal adenopathies, was lower compared to occasional users. Similarly, the prevalence of HTLV-I infection and syphilis was lower among these workers. In conclusion, the study results suggested that the low rate of STDs among FSWs reflected a high rate of condom use.

Female condom acceptability among sex workers in Costa Rica.

This study measured short-term female condom acceptability among 51 female sex workers in San José, Costa Rica. Each woman was trained in use of the female condom and was asked to use the device if clients refused to use male condoms during a 2-week study period (male condoms were also distributed). Two follow-up visits with short interviews were scheduled, including questions on general reaction to the female condom by the participants and their clients, ease and comfort of use, and preferences for male or female devices. At the first follow-up visit, 51% of the women reported they "liked the female condom very much" and 45% reported they "liked it somewhat." Similar results were reported after the second follow-up phase. Sixty-seven percent of the participants preferred the female condom over the male condom, and, according to the the women, over half of their clients liked the female condom "very much" or "somewhat." The most common problems during the first phase were difficulty to insert (61%) and discomfort (43%). However, during the second study phase a reduction in these problems (22% and 25%, respectively) and other use-related problems were noted. Although this new method is not yet available throughout Costa Rica, these results should encourage sexually transmitted diseases and HIV service organizations to make this method accessible to women.

PIP: Costa Rica has an estimated population of 3.2 million people. Contraceptive prevalence in the country was 75% in 1993, 99% of married or cohabiting women have heard about male condoms, and 96% know where to get them, but only 16% use them. Other barrier methods are either not widely used or are unavailable. Barrier contraceptive methods, however, are the only type of contraceptives which can be used to reduce the risk of contracting sexually transmitted diseases, including HIV. Even though female condoms are not yet widely available throughout Costa Rica, a study was conducted to assess short-term female condom acceptability among 51 female prostitutes in San Jose, Costa Rica. Each woman was trained how to use the female condom and asked to use it if clients refused to use male condoms during the 2-week study period. At the first of 2 scheduled follow-up visits, 51% of the women reported that they were thoroughly satisfied with the female condom, while 45% reported liking it somewhat. Similar results were reported after the second follow-up visit. 67% of the participants preferred the female condom over the male condom and the women reported that more than half of their clients liked the female condom either very much or somewhat. The most common problems encountered during the first phase of the study were difficulty in inserting the condom (61%) and discomfort (43%). However, the levels of these problems fell to 22% and 25%, respectively, during the second phase of study, while other use-related problems were noted. Study findings highlight the need to make female condoms more widely available in Costa Rica.

Measuring condom use among sex workers in the Dominican Republic.

The purpose of this paper is to assess the internal consistency of self-reported condom use among sex workers in Puerto Plata and Santo Domingo, Dominican Republic. We examined the responses to questions about condom use among 4 cross-sectional samples of sex workers. We compared measures based on: (1) questions using always-to-never scales; (2) questions about use with the past 5 clients; and (3) questions about use in the past week obtained from a retrospective coital log. In each sample, more women reported 'always' using condoms with clients than with each of the past 5 clients. In 3 of the 4 samples, only about half of the women who reported 'always' using condoms used condoms with the most recent 5 clients and with all clients in the past week. Internal consistency was significantly higher when the comparison was limited to use with the most recent 5 clients and use in the past week. Self-reported measures of condom use can be difficult to interpret. Assessing the internal consistency of several measures of use provides insight into the strengths and weaknesses of each measure.

PIP: Although evaluations of interventions to curtail the spread of HIV rely, to a large extent, on self-reported changes in behavior, the validity of self-reported condom use is difficult to assess. The internal consistency of self-reported condom use was investigated among four convenience samples of commercial sex workers in Puerto Plata (n = 408) and Santo Domingo (n = 604), Dominican Republic, interviewed before and after targeted HIV/AIDS educational programs. Three measures of condom use were assessed: 1) a measure based on reported frequency of use with new clients and regular clients using an always-to-never scale, 2) a measure of use with the most recent 5 clients, and 3) a measure based on a retrospective coital log of use with clients in the past 7 days. In each sample, more women reported "always" using condoms with clients than with each of the past 5 clients. The largest discrepancy was found in the second Puerto Plata sample, where 153 women (76%) reported always using condoms with clients, but only 96 women (47.5%) reported using condoms with each of the past 5 clients. "Sometimes" users were significantly more consistent in their responses than "always" users. Internal consistency was significantly improved (83-89%) when the comparison was limited to use with the most recent 5 clients and use in the past week.

Street-weary in Bogota. Voices of girls 3: Colombia.

PIP: In Colombia, people displaced by rural violence have crowded Bogota's slums, where inhabitants are plagued by alcoholism, drug dependency, and violence. Violence against children is epidemic in Colombia, and education, which is supposed to be free, is in reality so expensive that over a third of children fail to complete primary school. Street culture beckons children, and one agency has identified 7454 girl prostitutes in Bogota and believes there are another 1000 who have not yet been contacted. Most of these girls are from low-income families residing in inner-city slums, and many were sexually abused at an early age by a male relative. Almost all start using drugs, and more than 80% are infected with sexually transmitted diseases, including 15% who have HIV/AIDS. Even efforts to help these children can go astray, as some learn deviant behavior from fellow residents of children's homes. The biggest danger faced by girls and boys alike on the street is rape, and some children report being raped by policemen. The Renacer Foundation is working to rehabilitate children in its residential units and has achieved success in some cases. In other cases, success is slow to achieve and hard to maintain because it is difficult, if not impossible, for the children to recover from early abuse. Colombia lacks a nationwide needs assessment or primary intervention program to prevent early abuse and to help vulnerable girls. The only programs available to help the children already in trouble use outdated methods and are severely overcrowded.^ieng

[Prostitution and poverty in Santafe de Bogota]. / Prostitucion e indigencia en Santafe de Bogota.

PIP: The Chamber of Commerce of Bogota conducted a study of prostitution in the city with the participation of prostitutes themselves. In 1990, around 14,000 women were found to be working as prostitutes in the city's center, with 44% concentrated in the barrios of La Alameda, Las Nieves, and San Bernardo. Over 70% of the women were born outside of Bogota. 82% were aged 15-40 years; the age range was 9-60 years. 1200 minors were counted. A 1992 study in the sector of Chapinero revealed 3480 women working as prostitutes. 81% had migrated to the city and 96% were aged 15-40 years. Visible street prostitution was infrequent. A 1993 study of child prostitution in a smaller area than the 1990 center-city study revealed 2959 minors, suggesting that the number had nearly tripled. 60% were natives of the city. A 1994 study of 200 male prostitutes in the center-city found that 24% were natives of Bogota. 32% had left home before the age of 10. 89% had become prostitutes before their 16th birthday. 17% were HIV-seropositive; most of their clients were married men. In all cases, the factors leading to prostitution originated within the family and included physical mistreatment, sexual abuse by parents or stepparents, rejection and abandonment, as well as lack of income, unemployment, and lack of skills. Information on HIV infection was incomplete and ineffective. The number of indigent and homeless persons and that of drug addicts living on the streets of Bogota is not known. A large number of governmental and nongovernmental organizations attempt to provide help, but their efforts are not guided by any coherent plan of action.^ieng

Truck drivers in Brazil: prevalence of HIV and other sexually transmitted diseases, risk behavior and potential for spread of infection.

OBJECTIVES: To determine the prevalence of HIV and syphilis and related risk behavior in a sample of truck drivers in Santos, Brazil. SUBJECTS AND METHODS: A cross-sectional study was performed of 300 male truck drivers recruited in the port of Santos, Brazil, including a face-to-face interview and blood sampling for HIV and syphilis serology. RESULTS: Of 300 subjects, 4 (1.3%) were positive for HIV, 25 (8.3%) for syphilis by the Venereal Disease Research Laboratory (VDRL) test and 38 (13%) were positive for syphilis by the fluorescent treponemal antibody (absorbed) test (FTA-Abs). Seventy-one per cent had been employed as truck drivers for more than 10 years and 93% lived outside of Santos. Most participants were married (72%); 40% reported having more than one sex partner; 21% reported sex with commercial sex workers; 14% reported sex with girls that they met on the road; 16% had sex with other men's wives; and 3.3% reported sex with men during the past year. The use of rebite, an oral stimulant, was reported by 43% and was associated with being FTA-Abs-positive (P = 0.04). Being HIV-positive was associated with having sex with friends (P = 0.04), partners usually considered 'safe' by truck drivers. Being syphilis-positive (VDRL) was significantly associated with sex with partners also considered as 'safe', namely primary sex partners, steady partners and other men's wives. DISCUSSION: This is the first study to determine HIV and syphilis seroprevalence among truck drivers in South America. Findings confirm that this group has a high potential risk for HIV infection and other sexually transmitted diseases, and thus currently presents an opportunity for prevention.

Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers.

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five "sending towns" in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.

Dominican, Mexican, and Puerto Rican prostitutes: drug use and sexual behaviors.

PIP: HIV-related behaviors are reported in three groups of Hispanic prostitutes recruited in the US: 77 Dominicans recruited in the Washington Heights/Inwood section of New York City; 151 Mexicans recruited in El Paso, Texas; and 48 Puerto Ricans recruited in East Harlem, New York City, during 1989-91 in streets and brothels. Ethnographic interviews were conducted with a subsample of subjects (10 Puerto Ricans, 20 Mexicans, and 20 Dominicans) to examine the cultural meaning of risk behaviors. Structured interviews based on the NIDA AIDS Initial Assessment were conducted with the subjects to describe demographic characteristics and summarize levels of risk behaviors. Qualitative data showed that for the Mexican women in El Paso poverty, violence, drug dealing and transport, tourist clients, and an environment of illegality were the realities more than for the Dominican and Puerto Rican prostitutes. The Dominican sample in New York City transported to their new environment strong family values and proscriptions against drug use as well as prostitution in brothels on account of poverty-related motivations for the support of their children. The Puerto Rican women reflected acculturation evolved in two locations, as well as illicit drugs, violence, and abuse. 92% of the Dominican women, 71% of the Mexican women, and only 25% of the Puerto Rican women were born in their native countries. Only 10% of the Puerto Ricans, 36% of the Mexicans, and 53% of the Dominicans always used condoms. 58% of the Puerto Ricans, 21% of the Mexicans, and 13% of the Dominicans reported ever having a sexually transmitted disease (p 0.001). Of those tested by the project, only 2% of the Mexicans vs. 8% of the Dominicans were HIV positive. Among drug-addicted Puerto Ricans, the HIV seroprevalence rate was 40-50%. 79% of the Puerto Rican prostitutes were sex partners of iv drug users. For effective prevention, cultural diversity must be taken into account.^ieng

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

OBJECTIVES: To determine 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 microimmunofluorescence (MIF) test. RESULTS: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 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%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) 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 sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.

PIP: The prevalence of Chlamydia trachomatis infection was investigated in 129 commercial sex workers (CSWs) recruited on the streets in Kingston, Jamaica. The direct fluorescent antibody method detected C. trachomatis in endocervical cytobrush specimens from 21 women (16%). When the specimens were cultured, current chlamydial infection was detected by iodine staining in 31 (24%) and by monoclonal antibodies in 33 (25%). The microimmunofluorescence test for chlamydial antibodies was performed on clotted blood samples obtained from 64 CSWs and, as controls, 435 blood bank donors. A significantly higher seroprevalence rate was found among CSWs (95%) than blood donors (53%) (p 0.001). Among CSWs, the most common clinical manifestation of C. trachomatis infection was vaginal discharge. The presence of C. trachomatis infection was not related to previous history of pelvic inflammatory disease, sexually transmitted disease (STD), or condom use. Neisseria gonorrhoeae was isolated from 11 (9%) endocervical swabs. This study confirms the predominance of C. trachomatis among the bacterial causes of STDs in high-risk groups in Jamaica, and suggests a need for screening and treatment to control the spread and prevent the severe clinical sequelae of chlamydial infection.

Can you bet your life on a condom?

PIP: A number of studies have demonstrated that when used consistently and correctly, both male and female condoms prevent unplanned pregnancy and the spread of sexually transmitted diseases (STDs). For example, in a study of US navy personnel who reported having vaginal intercourse with prostitutes who had a high prevalence of gonorrhea, none of the 29 men who reported using condoms during their sex acts contracted gonorrhea or nongonococcal urethritis. However, 14% of the 499 nonusers became infected. The preponderance of evidence from 10 studies of high-risk populations in 7 countries where both the level of condom use and HIV infection were prospectively measured showed the consistent use of male condoms to protect against HIV acquisition in the range of 50-100%. Additional evidence in support of condom use comes from two studies involving HIV-discordant couples. A European study of 123 such couples who consistently and correctly used condoms found that no HIV-uninfected partner became infected with HIV by their partners. Similarly, 1 of 42 seronegative partners in HIV-discordant couples in Haiti became infected with HIV after having consistently used condoms. In both of these studies, 7-14% of couples who used condoms either consistently or not at all became infected. Since the government of Thailand began promoting 100% condom use among prostitutes and their clients, there has been a decline in both the level of curable STDs reported to clinics and HIV prevalence among Thai military recruits. Male and female condoms are effective even under typical imperfect conditions, and their consistent use should be encouraged at every opportunity.^ieng

Herpes simplex virus type 2 in Brazil: seroepidemiologic survey.

BACKGROUND: The incidence of genital herpes is increasing worldwide. Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among the sexually transmitted diseases (STDS). In order to investigate the sexual transmission of genital herpes infection in Brazil, the prevalence of specific antibodies to HSV-2, in populations of high and low risk for STDS was evaluated. METHODS: The population at low risk for STDS was composed of 155 voluntary blood donors at the University Hospitals between February and August, 1994. The population at high risk for STDS was composed of 85 HIV-seropositive persons, consisting of homosexual and promiscuous heterosexual men. A group of 20 highly active prostitutes was also studied between May and July, 1994. All blood samples were screened using an enzyme-linked immunosorbent assay (ELISA) that detects type-specific antibodies to HSV-2 glycoprotein G. Before donating blood, all persons in the study group were given a questionnaire concerning risk factors for acquisition of STDS and suitable to show the socioepidemiologic characteristics of the subjects. RESULTS: The prevalence of ELISA showing HSV-2 infections among HIV-seroposite persons, was 73% (P < 0.01). In the whole group at high risk for STDS, the prevalence was 72% (P < 0.05). Infection with HSV-2, as determined by seroprevalence, was significantly and independently associated with years of sexual activity, history of previous STDS, number of sexual partners in the previous month, number of pregnancies, and previous induced abortions, as well as the percentage of sexual acts involving receptive anal intercourse. CONCLUSIONS: The current strategy for diagnosing genital HSV-2 infection misses many cases. Newly developed type-specific serologic methods can identify cases of unrecognized or subclinical infection. With the high seroprevalence rates detected, routine screening for HSV-2-specific antibodies should be considered in populations at high risk for STDS.

PIP: The incidence of genital herpes is increasing worldwide and herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcerations among sexually transmitted diseases (STDs). Findings are reported from an assessment of the prevalence of antibodies to HSV-2 in low- and high-risk populations in Brazil. 155 voluntary blood donors and 85 HIV-seropositive homosexual and promiscuous heterosexual men were screened with ELISA for infection with HSV-2 during February-August 1994. 20 highly active prostitutes were also studied during May-July 1994. The subjects were of mean age 30 years, 70% were sexually active at the time of the study, and 6.55% used condoms. Antibodies to HSV-2 were detected in 29.1% of the blood donors, 73% of the HIV-seropositive men, and 72% of the overall high-risk group. Only 10%, however, admitted to ever having episodes of genital herpes. HSV-2 infection was significantly and independently associated with years of sexual activity, history of previous STDs, number of sex partners in the previous month, number of pregnancies, number of induced abortions, and the percentage of sex acts involving receptive anal intercourse. Routine screening for HSV-2 infection should be considered in populations at high risk for STDs.

Prevalence of HIV-1, HIV-2 and HTLV antibody, in Fortaleza, Ceara, Brazil, 1993-1994.

To evaluate the respective part of HIV-1, HIV-2, and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-1 varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.

PIP: During July 1993 to February 1994, in Ceara state, Brazil, researchers conducted a cross-sectional seroepidemiological survey of 814 pregnant women, 451 tuberculosis patients, 395 sexually transmitted disease (STD) patients, 496 female and 171 male commercial sex workers (CSWs), and 427 prisoners. They aimed to determine the prevalence of HIV-1, HIV-2, and human T lymphotropic virus (HTLV). All subjects lived in Fortaleza, where the HIV epidemic is recent. They tended to be poorly educated, poor, and not married. 28 persons were positive for HIV-1. The HIV-1 prevalence rate ranged from 0.25% in pregnant women to 2.92% in male CSWs. It was 0.44% for tuberculosis patients, 1.01% for STD patients, 1.61% for female CSWs, and 1.64% for prisoners. Indeterminate results occurred in 0.4% of all subjects. They were more common in tuberculosis patients than in other groups (1.1% vs. 0.3%; p = 0.023). No one tested positive for HIV-2. The prevalence of HTLV-I ranged from 0.12% in pregnant women to 1.21% in female CSWs. It was 0.44% for tuberculosis patients, 0.51% for STD patients, 0.58% for male CSWs, and 0.47% for prisoners. Five people (1 pregnant woman, 1 tuberculosis patient, 1 female CSW, and 2 prisoners) tested positive for HTLV-II. A 45-year-old, homosexual CSW, intravenous drug user who had tuberculosis was coinfected with HIV-1 and HTLV-I. The most common risk factor for HIV-1 infection was never used condoms (48% for female CSWs to 89% for STD patients). These findings indicate that Fortaleza has a low endemicity for HIV-1 infection and that HIV-1 is still limited to high risk groups (e.g., CSWs). The authors recommend that periodic cross-sectional surveys be conducted to study the dynamics of HIV-1 infection in this low prevalence area.

Use of spermicide and impact of prophylactic condom use among sex workers in Santa Fe de Bogota, Colombia.

BACKGROUND AND OBJECTIVES: Condom use is one of the most important preventive measures sex workers can take to reduce the risk of becoming infected with a sexually transmitted disease. However, a client may refuse to use a condom when requested. Some sexually transmitted disease prevention programs are recommending that sex workers use spermicide as an alternative prophylaxis when a condom is refused, yet little is known about the effect of this recommendation on prophylactic condom use. GOAL: To determine if using spermicide, either in conjunction with condoms or as a backup, influenced overall condom use among a group of sex workers at high risk of sexually transmitted diseases in Santa Fe de Bogota, Colombia. STUDY DESIGN: Participants were assigned randomly to one of three condom use groups: use of condoms only (Condoms Only), use of condoms and spermicides concurrently (Condom and Spermicide), or use of spermicide when condoms were refused (Spermicide as a Backup). A total of 199 sex workers entered the study and were asked to return for follow-up every 2 weeks for a period of 12 weeks. RESULTS: Women assigned to the Spermicide as a Backup group used a condom for an average of 78.1% of their reported acts of intercourse, compared with an average of 94.5% in the Condom Only and 92.3% in the Condom and Spermicide groups. However, women in the Spermicide as a Backup group used a condom or spermicide for an average of 96.9% of their acts of intercourse. Condoms were used for every intercourse act by less than 5% of the women in the Spermicide as a Backup groups, compared with 50.7% in the Condom Only group and 41.2% in the Condom and Spermicide group (P 0.001). When condoms were not used, client refusal was the primary reason reported. The incidence of sexually transmitted diseases and other urogenital inflammations in all groups was lower than expected. CONCLUSIONS: Among Colombian sex workers, condom use declined substantially when women were instructed to use spermicides if they were unable to persuade their partner to use a condom. However, these same women usually used the study spermicide as an alternate prophylaxis.

PIP: Some sexually transmitted disease (STD) prevention programs recommend that prostitutes use spermicide as an alternative prophylaxis when a condom is refused. 199 female sex workers in Santa Fe de Bogota, Colombia, participated in a study to assess the effect of this recommendation upon condom use. Women were randomly assigned to use condoms only, use condoms and spermicides concurrently, or use spermicide when condom use was refused. They were instructed to return for follow-up every 2 weeks for 12 weeks. Women in the spermicide-as-a-backup group used a condom for an average of 78.1% of reported acts of intercourse, compared to an average of 94.5% among the condom-only users and 92.3% among the women instructed to use both condoms and spermicide. Women in the spermicide-as-a-backup group used either a condom or spermicide for an average of 96.9% of their acts of intercourse, but less than 5% used a condom for every act of intercourse. 50.7% of women in the condom-only group and 41.2% in the condom/spermicide group used a condom for every act of intercourse. There was a lower than expected incidence of STDs and other urogenital inflammations in all groups.

Prevalence, incidence, and determinants of syphilis in female commercial sex workers in Mexico City.

GOAL: To determine the prevalence and the incidence of serologic markers for syphilis, and the characteristics associated with the risk of infection in female commercial sex workers in Mexico City. To identify female commercial sex workers at greater risk of infection with syphilis. STUDY DESIGN: The authors performed a cross-sectional study of 3,100 female commercial sex workers who sought human immunodeficiency virus testing at a National Council on AIDS clinic between January 1992 and April 1993. The authors collected information about socioeconomic and demographic characteristics, history of sexually transmitted diseases, sexual practices, and preventive measures against such diseases. All of the women provided a blood sample for identification of infection markers and in a subgroup of 1,802 women, repeat samples were obtained to estimate the rate of seroconversion to syphilis. RESULTS: Prevalence of syphilis was 8.2%, with an incidence of 2.4 per 100 person years. A positive linear relation between age and time working in commercial sex and prevalence of infection markers was observed. Women with less education, born in states other than Mexico City, and who worked on the street had significantly greater risks of infection with syphilis. CONCLUSIONS: Frequency of infection by both estimators is relatively low in the women studied. Characteristics related with periods of exposure such as age and time working in commercial sex, as well as socioeconomic and demographic characteristics, such as place of birth, education, and type of work site, were significantly related to the frequency of infection.

PIP: The goal of this study was to determine the prevalence and the incidence of serologic markers for syphilis and the characteristics associated with the risk of infection in female commercial sex workers (CSWs) in Mexico City. It also sought to identify female CSWs at greater risk of infection with syphilis. The authors performed a cross-sectional study of 3100 female CSWs who sought human immunodeficiency virus testing at a National Council on AIDS clinic between January 1992 and April 1993. The authors collected information about socioeconomic and demographic characteristics, history of sexually transmitted diseases, sexual practices, and preventive measures against such diseases. All of the women provided a blood sample for identification of infection markers, and in a subgroup of 1802 women repeat samples were obtained to estimate the rate of seroconversion to syphilis. Prevalence of syphilis was 8.2%, with an incidence of 2.4/100 person-years. A positive linear relation between age and time working in commercial sex and prevalence of infection markers was observed. Women with less education, born in states other than Mexico City, and who worked on the street had significantly greater risks of infection with syphilis. Frequency of infection by both estimators is relatively low in the women studied. Characteristics related to periods of exposure such as age and time working in commercial sex, as well as socioeconomic and demographic characteristics, such as place of birth, education, and type of work site, were significantly related to the frequency of infection.

HIV-1, HIV-2, HTLV-I/II and STD among female prostitutes in Buenos Aires, Argentina.

To determine the prevalence of HIV-1 and HTLV-I/II among female prostitutes from different areas of the city of Buenos Aires, we studied serum samples from 237 individuals (mean age: 25; range 17 to 39). Prostitutes were recruited from 16 different Buenos Aires locations with different economical status. Information on sexual behaviour, health and socioeconomic conditions was collected through a questionnaire. HIV-1 and HTLV-I/II antibodies (ab) were tested by ELISA (Abbott) and Particle agglutination (Fujirebio, Tokyo) respectively. Positive results were confirmed by immunofluorescence assay. Samples that were positive for HIV-1 antibodies were also tested for p24 antigen (Abbott). VDRL for syphilis was performed in all samples. Fifteen (6.3%) out of the 237 individuals were positive for HIV-1 antibodies. Moreover, 2 (0.8%) HIV-1 seropositive prostitutes were also positive for HTLV-I/II antibodies and for HIV p24-Ag. Even though PCR for HTLV-I/II was not performed, titration by IFA in these two samples suggests HTLV-I. Our serologic results indicate a relatively high HIV-1 infection among prostitutes working in Buenos Aires. As we previously mentioned for other risk groups, we found an association between HTLV-I/II and HIV-1 infection in this particular group. Although we did not find any significant difference between HIV-1 seropositivity and the variables analyzed through the questionnaire, the prevalence of HIV-1 infection was higher in prostitutes working in mask brothels ('sauna or massage houses') as compared with hotel or street prostitutes.

PIP: Serum samples from 237 female prostitutes of mean age 25 years recruited from 16 different Buenos Aires locations of differing economic status were studied to determine the prevalence of HIV-1 and HTLV-I/II in the subpopulation. The participants, aged 17-39 years, also provided data on their sex behavior, health, and socioeconomic conditions. The presence of HIV-1 and HTLV-I/II antibodies was assessed using ELISA and particle agglutination, respectively, with positive results confirmed by immunofluorescence assay (IFA). HIV-1-seropositive samples were also tested for p24 antigen. VDRL for syphilis performed upon all samples found 13.2% to have serological evidence of infection. All women had been treated for frequently occurring sexually transmitted diseases. 15 women tested seropositive for infection with HIV-1. Two HIV-1 seropositive prostitutes were also positive for HTLV-I/II antibodies and HIV p24-Ag. PCR for HTLV-I/II was not performed, but titration by IFA suggests HTLV-I. The study's serologic results indicate a relatively high prevalence of HIV-1 infection among prostitutes working in Buenos Aires. The prevalence of HIV-1 infection was higher among prostitutes working in mask brothels such as saunas and massage houses than among hotel and street prostitutes.