Prevalence of HIV/STIs and correlates with municipal characteristics among female sex workers in 13 Mexican cities / Prevalencia de VIH/ITS y correlaciones con carácterísticas municipales entre trabajadoras sexuales en 13 ciudades mexicanas

Abstract: Objective: To identify correlates of HIV/STI prevalence among 13 cities with varying sizes of female sex worker (FSW) populations and municipal characteristics in Mexico. Materials and methods: FSWs underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia. Logistic regression explored variations in HIV/STI prevalence. Results: Among FSWs (n=1 092), prevalence across 13 sites was: HIV: 0.4% (range: 0%-1.4%): syphilis: 7.8% (range: 0%-17.2%); chlamydia: 15.3% (range: 5.7%-32.2%); gonorrhea: 2.9% (range 0%-13.8%), and any HIV/STI: 23% (range: 9.9%-46%). Municipalities with high human development scores and a lower municipal marginalization index had higher odds of combined HIV/STI prevalence. After controlling for site-specific variability in municipal characteristics, greater risk of HIV/STIs was associated with lower education, having a spouse diagnosed or treated for an STI, unaffordability of condoms, and having non-Mexican clients. Conclusions: Prevalence of HIV/STIs varies across Mexican municipalities indicating the need for surveillance to identify hotspots for targeted resource allocation.

Resumen: Objetivo: Identificar correlaciones de la prevalencia de VIH / ITS entre 13 ciudades con diferentes tamaños de población de trabajadoras sexuales y características municipales en México. Material y métodos: Las trabajadoras sexuales fueron entrevistadas y recibieron pruebas de VIH, sífilis, gonorrea y clamidia. La regresión logística exploró las variaciones en la prevalencia del VIH/ITS. Resultados: Entre las trabajadoras sexuales (n = 1 092), la prevalencia en 13 sitios fue: VIH: 0.4% (rango: 0-1.4%): sífilis: 7.8% (rango: 0-17.2%); clamidia: 15.3% (rango: 5.7-32.2%); gonorrea: 2.9% (rango 0-13.8%) y cualquier VIH/ITS: 23% (rango: 9.9-46%). Los municipios con altos puntajes de desarrollo humano y menor índice de marginación municipal tuvieron una mayor probabilidad de prevalencia combinada de VIH/ITS. Después de controlar la variabilidad específica del sitio en las características municipales, el mayor riesgo de VIH / ITS se asoció con menor educación, tener un cónyuge diagnosticado o tratado para una ITS, imposibilidad de conseguir condones y tener clientes no mexicanos. Conclusiones: La prevalencia de VIH/ITS varía entre los municipios mexicanos, lo que indica la necesidad de una vigilancia para identificar hotspots para la asignación selectiva.

Syphilis in female sex workers: an epidemiological study of the highway system of the state of Pará, northern Brazil

Abstract INTRODUCTION: Female sex workers (FSWs) are considered a bridge for transmission of pathogens from high-risk to general populations. We assessed the epidemiological status of syphilis in FSWs along the Pará highway system. METHODS: Two hundred and twenty-two FSWs were interviewed and samples were analyzed using rapid qualitative tests and real-time polymerase chain reaction. RESULTS: The prevalence of syphilis was high (36.94%). The high rate of prostitution, use of illicit drugs, and search for financial resources increased Treponema pallidum transmission through unprotected sex. CONCLUSIONS: Several characteristics of FSWs were identified, which reinforce the need for measures guaranteeing their health and protection.

High-risk behaviors for hepatitis B and C infections among female sex workers

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

Incentives and barriers to HIV testing among female sex workers in Ceará / Incentivos e barreiras ao teste de HIV entre mulheres profissionais do sexo no Ceará

ABSTRACT OBJECTIVE Estimating HIV prevalence and describing the incentives and barriers for HIV testing among female sex workers. METHODS This cross-sectional study recruited 402 women aged 18 years or older, residing in Fortaleza, state of Ceará, Brazil, who reported having had sexual intercourse in exchange for money in last four months. The sample was recruited using Respondent Driven Sampling, between August and November 2010. RESULTS The 84.1% of the sample tested and the estimated prevalence of HIV infection was 3.8%. The sample was young (25 to 39 years ), single (80.0%), with one to three children (83.6%), had eight or more years of schooling (65.7%), and belonged to social classes D/E (53.1%). The majority worked in fixed locations (bars, motels, hotels, sauna - 88.9%), and prostitution was their only source of income (54.1%). About 25% of the sample did not know where to test in the public health sector and 51.8% either never tested or hadn't tested for over a year or more. The main reported barriers to testing were the perceptions that there was no risk of becoming infected (24.1%), and, alternatively, fear of discrimination if the test was positive (20.5%). Incentives for testing were the greater availability of testing sites (57.0%) and health facilities with alternative schedules (44.2%). CONCLUSIONS Prevalence for HIV was similar to that found in other Brazilian cities in different regions of the country, although higher than the general female population. Non-traditional venues not associated with the health system and availability of testing in health units during non-commercial hours are factors that encourage testing. Not considering oneself to be at risk, fear of being discriminated against and not knowing testing locations are barriers.

RESUMO OBJETIVO Estimar a prevalência do HIV e descrever os incentivos e barreiras à realização do teste para o HIV entre mulheres profissionais do sexo. MÉTODOS Este estudo transversal recrutou 402 mulheres de 18 anos ou mais, residentes em Fortaleza, CE, que informaram ter tido relação sexual em troca de dinheiro nos últimos quatro meses. A amostra foi recrutada por meio da técnica Respondent Driven Sampling, entre agosto e novembro de 2010. RESULTADOS A adesão ao teste de HIV foi de 84,1% e a prevalência estimada da infecção pelo HIV foi de 3,8%. A amostra era jovem (25 a 39 anos), solteira (80,0%), com um a três filhos (83,6 %), tinham oito anos ou mais de estudo (65,7%) e pertencia às classes sociais D/E (53,1%). A maioria exercia a profissão em locais fechados (bares, motéis, hotéis, sauna - 88,9%), e a prostituição era a única fonte de renda (54,1%). Cerca de 25% da amostra desconhecia onde o teste de HIV era realizado na rede pública e 51,8% nunca fez o teste ou se testou há um ano ou mais. As principais barreiras ao teste foram acreditar que não corre risco de se infectar (24,1%) e o medo da discriminação caso o teste fosse reagente (20,5%). Os incentivos foram relacionados à maior oferta de locais para o teste (57,0%) e de unidades de saúde com horários alternativos (44,2%). CONCLUSÕES A prevalência foi semelhante à encontrada em outras cidades brasileiras de diferentes regiões do país, apesar de superiores a de mulheres não profissionais do sexo. A disponibilidade do teste em locais não relacionados à saúde e a oferta nas unidades básicas em horário não comercial são fatores que incentivam a realização do teste. Não se considerar sob-risco, medo de ser discriminada e desconhecimento dos locais onde o teste é realizado podem ser uma barreira para a realização do exame.

Smoking among female sex workers: prevalence and associated variables / Tabagismo em mulheres profissionais do sexo: prevalência e variáveis associadas

ABSTRACT Objective: To assess the prevalence of smoking and associated variables in female sex workers (FSWs) Methods: This was a quantitative cross-sectional study involving FSWs in the city of Botucatu, Brazil, who completed a sociodemographic questionnaire, including data regarding smoking status, motivational stage of change, and degree of nicotine dependence, as well as the Perceived Stress Scale and the Hospital Anxiety and Depression Scale Results: We included 83 FSWs. The mean age was 26.8 years. Among the participants, 58 (69.8%) had at least a high school education, only 26 (31.3%) resided in the city of Botucatu, 59 (71.1%) were smokers, 5 (6.0%) were former smokers, 74 (89.2%) regularly consumed alcohol, and 43 (51.8%) used illicit drugs. The majority of the women were classified as having an intermediate stress level, and 51 (61.4%) were classified as having possible or probable anxiety, whereas depression was found to be improbable in 57 (68.7%). The level of nicotine dependence was high among the smokers, the majority of whom showed no intention to quit smoking. Smoking was associated with illicit drug use (p = 0.0271) and with alcohol consumption (p = 0.0001), although not with the levels of stress, anxiety, or depression; nor was the age at smoking initiation associated with the length of time as an FSW (p = 0.4651) Conclusions: The prevalence of smoking among the FSWs evaluated here was much higher than the 8.3% reported for the overall female population of Brazil. Our findings show that FSWs are exposed to various risk factors inherent to their profession. Therefore, harm reduction is an important strategy to be adopted.

RESUMO Objetivo: Avaliar a prevalência de tabagismo e variáveis associadas em mulheres profissionais do sexo (MPS). Métodos: Estudo de corte transversal quantitativo com MPS na cidade de Botucatu (SP), as quais completaram um questionário sociodemográfico, incluindo informações sobre tabagismo, estágio motivacional para cessação do tabagismo e grau de dependência da nicotina, assim como a Escala de Estresse Percebido e a Escala Hospitalar de Ansiedade e Depressão. Resultados: Foram incluídas 83 MPS. A média de idade foi de 26,8 anos. Entre as participantes, 58 (69,8%) possuíam pelo menos o ensino médio, apenas 26 (31,3%) residiam em Botucatu, 59 (71,1%) eram fumantes, 5 (6,0%) eram ex-fumantes, 74 (89,2%) faziam uso de bebidas alcoólicas e 43 (51,8%) faziam uso de algum tipo de drogas. A maioria foi classificada com grau de estresse médio, 51 (61,4%) apresentaram nível de ansiedade possível ou provável, e 57 (68,7%) tiveram resultado improvável para depressão. O nível de dependência da nicotina foi elevado entre as fumantes. Dessas, a maioria não tinha intenção de parar de fumar. Houve associações do tabagismo com o consumo de drogas ilícitas (p = 0,0271) e com o uso de bebidas alcoólicas (p < 0,0001); porém, não houve associações do tabagismo com as questões de humor e nem da idade da iniciação tabágica com o tempo que trabalhavam como MPS (p = 0,4651). Conclusões: A prevalência de tabagismo entre as MPS estudadas se mostrou muito elevada quando comparada à da média nacional de mulheres (8,3%). Evidenciou-se que MPS estão expostas a diversos fatores de risco inerentes da própria profissão, sendo a redução de danos uma estratégia importante a ser trabalhada.

Viral hepatitis in female sex workers using the Respondent-Driven Sampling

ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.

Fatores associados à violência contra mulheres profissionais do sexo de dez cidades brasileiras / Factores asociados a la violencia contra mujeres profesionales del sexo de diez ciudades brasileñas / Factors associated with violence against female sex workers in ten Brazilian cities

Resumo: No Brasil, há um limitado número de estudos sobre violência contra mulheres profissionais do sexo, tema que vem instigando pesquisadores em todo o mundo, estimulados principalmente por possíveis associações desta com o HIV. Este trabalho objetiva estimar a prevalência de violência contra mulheres profissionais do sexo, segundo natureza e perpetrador, e identificar os fatores associados. Foi realizado um estudo transversal com dados de 2.523 mulheres profissionais do sexo de dez cidades brasileiras, recrutadas pelo método respondent-driven sampling (RDS). Os resultados mostraram que a prevalência de violência verbal foi de 59,5%; violência física 38,1%; sexual 37,8%. Violência física por parceiro íntimo, 25,2%; por clientes, 11,7%. Dentre os fatores associados à violência física estão: idade < 30 anos (ORa = 2,27; IC95%: 1,56-3,29); uso de drogas (ORa = 2,02; IC95%: 1,54-2,65); valor do programa até R$ 29,00 (ORa = 1,51; IC95%: 1,07-2,13). Conclui-se que as mulheres profissionais do sexo brasileiras vivenciam uma carga desproporcional de violência. Identificar fatores de vulnerabilidade é fundamental para as intervenções que garantam direitos humanos e controle do HIV.

Resumen: En Brasil, existe un limitado número de estudios sobre violencia contra mujeres profesionales del sexo, tema que ha interesado a investigadores en todo el mundo, estimulados principalmente por posibles asociaciones de ésta con el VIH. Este trabajo tiene como meta estimar la prevalencia de violencia contra mujeres profesionales del sexo, según su naturaleza y agresor, e identificar los factores asociados. Se realizó un estudio transversal con datos de 2.523 mujeres profesionales del sexo de diez ciudades brasileñas, captadas por el método respondent-driven sampling (RDS). Los resultados mostraron que la prevalencia de violencia verbal fue de un 59,5%; violencia física 38,1%; sexual 37,8%. Violencia física por compañero un 25,2%; por clientes un 11,7%. Entre los factores asociados a la violencia física están: edad < 30 años (ORa = 2,27; IC95%: 1,56-3,29); uso de drogas (ORa = 2,02; IC95%: 1,54-2,65); valor del programa de hasta R$ 29,00 (ORa = 1,51; IC95%: 1,07-2,13). Se concluyó que las mujeres profesionales del sexo brasileñas viven una carga desproporcional de violencia. Identificar factores de vulnerabilidad es fundamental para las intervenciones que garanticen derechos humanos y control del VIH.

Abstract: Few studies in Brazil have focused on violence against female sex workers, a theme that has attracted researchers' attention worldwide, especially due to possible associations with HIV. The current study aims to estimate the prevalence of violence against female sex workers according to type and perpetrator and to identify associated factors. A cross-sectional study was conducted with data on 2,523 female sex workers from ten Brazilian cities, and with the respondent-driven sampling (RDS). Prevalence of verbal violence was 59.5%, physical violence 38.1%, sexual violence 37.8%, intimate partner physical violence 25.2%, and violence by clients 11.7%. Factors associated with physical violence were age < 30 years (aOR = 2.27; 95%CI: 1.56-3.29), drug use (aOR = 2.02; 95%CI: 1.54-2.65), and price of trick ≤ BRL 29.00 or USD 9.00 (aOR = 1.51; 95%CI: 1.07-2.13). In conclusion, Brazilian female sex workers suffer a disproportional burden of violence. The identification of vulnerability factors is essential for interventions to safeguard human rights and control HIV.

HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions / Testes de HIV entre trabalhadoras do sexo na fronteira entre Brasil e Guiana Francesa: a necessidade de intervenções específicas / La prueba del VIH en las trabajadoras sexuales en la frontera entre la Guyana Francesa y Brasil: la necesidad de intervenciones específicas

The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. One third (31.5%) of the interviewed had never tested for HIV. Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, to be 30 or older, feeling at risk of HIV, not evaluating one's own risk towards HIV, and living in Oiapoque. These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.

A fronteira entre Guiana Francesa e Brasil é um lugar de intercâmbio econômico, cultural, social e sexual. Nessa área, onde o turismo sexual é particularmente desenvolvido, as mulheres profissionais do sexo representam uma população de alto risco de contágio pelo HIV. Os testes de HIV parecem ser um elemento importante da luta contra a epidemia. De fato, os primeiros testes de HIV dão acesso à prevenção e aos tratamentos. Foi realizada em 2011 uma pesquisa de conhecimento, atitudes, comportamentos e práticas sobre HIV/AIDS com mulheres profissionais do sexo ao longo da fronteira da Guiana Francesa com o Brasil. Foram entrevistadas 213 mulheres profissionais do sexo. Um terço (31,5%) delas nunca tinha feito o teste de HIV. Fatores associados a não realização do teste de HIV foram: a falta de conhecimento dos locais onde fazer o teste, ter idade igual ou acima de 30 anos, sentir-se em risco de contágio pelo HIV, falta de avaliação do risco de contágio pelo HIV e habitante do Oiapoque. Esses resultados sugerem claramente que intervenções direcionadas às mulheres profissionais do sexo são necessárias para que os testes sejam feitos regularmente.

La frontera entre la Guyana Francesa y Brasil es un lugar de intercambio económico, cultural y sexual. En esta zona, donde se desarrolla sobre todo el turismo sexual, las trabajadoras del sexo son una población de alto riesgo de VIH. La prueba del VIH parece ser un elemento en la lucha de esta epidemia. Además, la prueba inmediata del VIH permite el acceso a los tratamientos y la prevención. Se realizó una Encuesta de Conocimientos, Actitudes y Prácticas sobre el VIH/SIDA en 2011 entre las trabajadoras de sexo, trabajando en la frontera entre la Guyana Francesa y Brasil. Se entrevistaron a un total de 213 trabajadoras del sexo. Un tercio (31,5%) de las entrevistadas nunca se había hecho la prueba del VIH. Los factores asociados con no haberse hecho la prueba del VIH son la ausencia de conocimientos sobre los lugares, donde se realiza la prueba del VIH, tener 30 años o más, sentirse en riesgo de VIH, no evalúan su propio riesgo frente al VIH y viviendo en el Oiapoque. Estos resultados muestran claramente que las intervenciones específicas necesitan incentivos para estimular el uso regularmente de la prueba del VIH.

Toxoplasma gondii infection: seroprevalence and associated risk factors among primary schoolchildren in Lagos City, Southern Nigeria

INTRODUCTION: Toxoplasma gondii infection has been described as the most widespread zoonotic infection of humans and other animals. Information concerning T. gondii infection among schoolchildren is unavailable in Lagos City, Nigeria. METHODS: This cross-sectional study investigated the seroprevalence and risk factors associated with T. gondii infection among primary schoolchildren (PSC) from a community located in the center of Lagos, southern Nigeria, from November 2013 to March 2014. A total of 382 PSC were screened for the presence of sera anti-T. gondii antibodies using a latex agglutination test (TOXO Test-MT, Tokyo, Japan). A cutoff titer of ≥ 1:32 was considered positive, while titers ≥ 1:1,024 indicated high responders. Questionnaires were also used to obtain data on possible risk factors from parents/guardians. RESULTS: The overall seroprevalence was 24% (91/382), and 83.5% (76/91) of seropositive PSC were classified as high responders. Among the risk factors tested, including contact with cats and soil, consumption of raw meat and vegetables, and drinking unboiled water, none showed statistical significance after multivariate adjustment. No associations were observed among age, gender, body mass index (BMI), and parents' occupation/educational level. CONCLUSIONS: The findings in this study show evidence of active infection, and hence, there is need for urgent preventive measures in this city. Further investigation is required to clarify the transmission routes. Policy makers also need to initiate prevention and control programs to protect pregnant women and immunocompromised patients in particular because they are more severely affected by T. gondii infection. .

HIV risk practices by female sex workers according to workplace / Práticas de risco ao HIV de mulheres profissionais do sexo

OBJECTIVE To investigate differences in HIV infection- related risk practices by Female Sex Workers according to workplace and the effects of homophily on estimating HIV prevalence. METHODS Data from 2,523 women, recruited using Respondent-Driven Sampling, were used for the study carried out in 10 Brazilian cities in 2008-2009. The study included female sex workers aged 18 and over. The questionnaire was completed by the subjects and included questions on characteristics of professional activity, sexual practices, use of drugs, HIV testing, and access to health services. HIV quick tests were conducted. The participants were classified in two groups according to place of work: on the street or indoor venues, like nightclubs and saunas. To compare variable distributions by place of work, we used Chi-square homogeneity tests, taking into consideration unequal selection probabilities as well as the structure of dependence between observations. We tested the effect of homophily by workplace on estimated HIV prevalence. RESULTS The highest HIV risk practices were associated with: working on the streets, lower socioeconomic status, low regular smear test coverage, higher levels of crack use and higher levels of syphilis serological scars as well as higher prevalence of HIV infection. The effect of homophily was higher among sex workers in indoor venues. However, it did not affect the estimated prevalence of HIV, even after using a post-stratification by workplace procedure. CONCLUSIONS The findings suggest that strategies should focus on extending access to, and utilization of, health services. Prevention policies should be specifically aimed at street workers. Regarding the application of Respondent-Driven Sampling, the sample should be sufficient to estimate transition probabilities, as the network develops more quickly among sex workers in indoor venues. .

OBJETIVO Investigar diferenças nas práticas de risco à infecção pelo HIV segundo local de trabalho das mulheres profissionais do sexo e efeitos de homofilia na estimação da prevalência do HIV. MÉTODOS Foram utilizadas informações de 2.523 mulheres recrutadas por Respondent-Driven Sampling em estudo realizado em 10 cidades brasileiras, 2008-2009. Foram incluídas profissionais com 18 anos ou mais de idade. O questionário foi autopreenchido e incluiu perguntas sobre características da profissão, práticas sexuais, uso de drogas, testes periódicos de HIV e acesso aos serviços de saúde. Utilizaram-se testes rápidos para detecção de HIV. As participantes foram agregadas em dois grupos por local de trabalho: pontos de rua ou locais fechados, e.g., boates, saunas e termas. Foram utilizados testes Qui-quadrado de homogeneidade, levando-se em consideração as probabilidades desiguais de seleção, bem como a dependência entre as observações. Os efeitos de homofilia por local de trabalho foram pesquisados na estimação da prevalência do HIV. RESULTADOS As práticas de maior risco ao HIV associaram-se a: trabalhar em pontos de rua, menor nível socioeconômico, baixa cobertura de exame preventivo de câncer de colo de útero, elevado consumo de crack, maior prevalência de cicatriz sorológica de sífilis e maior prevalência de infecção pelo HIV. O efeito de homofilia foi maior entre as profissionais de locais fechados. Contudo, não afetou a estimativa da prevalência de HIV, mesmo utilizando o procedimento de pós-estratificação por local de trabalho. CONCLUSÕES Os resultados indicaram que as estratégias devem ser dirigidas à ampliação do acesso e à utilização dos serviços ...

Importancia del estudio del balance del contenido vaginal (BACOVA) en el control preventivo de las trabajadoras sexuales / Importance of studying the balance of vaginal content (BAVACO) in the preventive control of sex workers

El objetivo de este trabajo fue estudiar a un grupo de 229 trabajadoras sexuales de Comodoro Rivadavia (Chubut), atendidas en centros públicos de salud de dicha ciudad, mediante la aplicación del método conocido como balance del contenido vaginal (BACOVA). Este método comprende el estudio morfológico de la microbiota vaginal, como así también de la reacción infamatoria. Incluye el análisis del contenido vaginal en fresco y por tinciones de Gram y de Giemsa, de modo de integrar la exploración de todo el panorama biológico. El 35,37 % de estas mujeres presentó microbiota normal (MN); el 15,72 %, microbiota intermedia (MI); el 23,14 %, vaginosis bacteriana (VB) y el 10,48 %, vaginitis microbiana inespecífca (VMI). Los casos de vaginitis por levaduras y por Trichomonas vaginalis comprendieron el 8,30 % y 6,99 % de las mujeres, respectivamente. Se observó el desplazamiento de la MN hacia una MI, que se correspondió con el predominio de bacterias corineformes. Por otra parte, no se reconoció un marcado desequilibrio del contenido vaginal ante la colonización e infección por levaduras o por T. vaginalis: el 48 % de los casos de estas vaginitis convencionales no presentaron reacción infamatoria vaginal (RIV). El 24,89 % de los casos de MN presentaron una signifcativa RIV, y en más del 50 % de las mujeres se diagnosticaron disfunciones vaginales en ausencia de sintomatología. Estos resultados se podrían asociar a un incremento del riesgo gineco-obstétrico, lo que afecta la salud sexual y reproductiva de la población estudiada.

The aim of this work was to study the vaginal microenvironment in sex workers from Comodoro Rivadavia, Chubut. For that purpose, BAVACO procedures were applied. A total of 229 female sex workers attended public health centers. Vaginal secretions were analyzed by Gram and Giemsa stains. The following results were obtained: normal microbiota 35.37 %, intermediate microbiota 15.72 %, bacterial vaginosis 23.14 %, microbial nonspecifc vaginitis, Donders'"aerobic vaginitis" 10.48 %, yeast vulvovaginitis 8.30 %, and trichomoniasis 6.99 %. The intermediate microbiota was characterized by a decrease in the number of lactobacilli and the presence of diphtheroid bacilli cell types. The population studied shared increased values of vaginal dysfunctions. These results are considered risk factors for obstetric and gynecologic diseases.

Prevalencia de la infección por el VIH y de Treponema pallidum en mujeres trabajadoras sexuales de Argentina / Prevalence of HIV infection and Treponema pallidum in Argentine female sex workers

OBJETIVO: Estimar la prevalencia de infección por el virus de la inmunodeficiencia humana (VIH) y de Treponema pallidum en mujeres trabajadoras sexuales (MTS) de Argentina, y describir las características sociodemográficas de este grupo de población asociadas a la transmisión del VIH. MÉTODOS: Entre octubre de 2006 y diciembre de 2009 se realizó un estudio de corte transversal y un muestreo por conveniencia en MTS mayores de 18 años de nueve ciudades de Argentina. Un total de 1 255 mujeres participaron en este estudio. Se capacitó especialmente a un grupo de MTS para convocar a las otras mujeres a participar en talleres y a realizarse el diagnóstico del VIH y T. pallidum. RESULTADOS: Las características socio-epidemiológicas más destacadas de las MTS incluyeron un alto porcentaje de abuso sexual, escaso uso de preservativos con parejas sexuales no comerciales y un alto porcentaje de situaciones de violencia. La prevalencia del VIH fue de 2 por ciento (25/1 255, intervalo de confianza de 95 por ciento [IC95 por ciento]:1,2-2,8) y la de T. pallidum, de 22,4 por ciento (245/ 1 094, IC95 por ciento: 19,9-24,9). En las MTS de la ciudad de La Plata, la prevalencia del VIH fue significativamente más baja comparada con las participantes del resto del país (0,3 por ciento vs 2,7 por ciento, P < 0,05, respectivamente). CONCLUSIONES: La menor prevalencia del VIH y la mayor tasa de uso de preservativos informadas por las mujeres encuestadas de La Plata sugieren que la presencia de un lugar de atención sanitaria para MTS influye directamente en la disminución de sus conductas de riesgo y, por ende, en la infección por el VIH. La creación de centros de salud "amigables", como el que ya hay en dicha ciudad, contribuye a dar una respuesta integral al problema que enfrentan estas mujeres; asimismo, favorece su acercamiento al sistema de salud y contribuye así a revertir su situación de mayor vulnerabilidad y mayor riesgo frente al VIH y otras infecciones de transmisión sexual.

OBJECTIVE: Estimate the prevalence of human immunodeficiency virus (HIV) infection and Treponema pallidum in Argentine female sex workers (FSW), and describe the sociodemographic characteristics of this population group associated with HIV transmission. METHODS: A cross-sectional study and convenience sampling were conducted in FSW over 18 years of age in nine Argentine cities from October 2006 to December 2009. A total of 1 255 women participated in this study. A group of FSW was especially trained to invite other women to participate in the workshops and undergo screening for HIV and T. pallidum. RESULTS: The most noteworthy socioepidemiological characteristics of the FSW included a high percentage of sexual abuse, limited condom use with noncommercial sex partners, and a high percentage of violence. HIV prevalence was 2 percent (25/1 255, 95 percent confidence interval [95 percent CI]:1.2-2.8) and T. pallidum prevalence was 22.4 percent (245/1 094; 95 percent CI: 19.9-24.9). In the city of La Plata, HIV prevalence in FSW was significantly lower compared to that of other regions of the country (0.3 percent vs. 2.7 percent, P < 0.05, respectively). CONCLUSIONS: The lower HIV prevalence and the higher rate of condom use reported by the women from La Plata surveyed suggest that the presence of a health center for FSW has a direct influence on reducing risky behavior and, consequently, HIV infection. The creation of "friendly" health centers like the one already in this city contributes to providing a comprehensive response to the problems faced by these women and encourages use of the health system. It therefore helps reverse their vulnerability and higher risk of contracting HIV and other sexually transmitted infections.

Prevalencia de Trichomonas vaginalis en trabajadores sexuales / Trichomonas vaginalis prevalence in sex workers

La tricomoniasis es una infección de transmisión sexual (ITS) que se asocia a vaginitis, uretritis, cervicitis y enfermedad inflamatoria pélvica pudiendo producir infertilidad tubárica. El objetivo de este trabajo, de tipo retrospectivo longitudinal, fue determinar la prevalencia de Trichomonas vaginalis en una población de trabajadores sexuales en Mendoza, Argentina. Se estudió en forma retrospectiva una población de 720 personas asistidas por el Programa Provincial de ITS de Mendoza. Entre febrero de 2007 y junio de 2009 se procesaron 1692 muestras con un muestreo por reposición. La distribución por sexo fue de 687 mujeres y 33 varones con edades comprendidas entre 15 y 65 años. La prevalencia de tricomoniasis determinada en esta población en riesgo fue de 7.6% para las mujeres, sin encontrarse infecciones en el grupo de los hombres. La prevalencia hallada en este grupo en riesgo muestra una población con alta vulnerabilidad para contraer otras ITS de mayor gravedad. En otro sentido, sugiere una importante falta de adhesión al uso de barreras mecánicas para prevenir infecciones de transmisión sexual. Este trabajo justifica la elaboración de una guía de procedimientos para el manejo de la infección por tricomonas en el marco del Programa de Salud Reproductiva (PROSAR).

Trichomoniasis is a sexually transmitted infection (STI) usually associated to vaginitis, urethritis, cervicitis and pelvic inflammatory disease, which can cause infertility. The aim of this retrospective longitudinal study was to determine Trichomonas vaginalis prevalence in a population of male and female sex workers in Mendoza, Argentina. A cohort of 720 people who attended the STI Program in this province was retrospectively analyzed. From February 2007 up to June 2009, 1692 samples were processed using a reposition sampling method. The age and sex distribution of the population was: 687 women/33 men, from 15 to 65 years old. Trichomoniasis prevalence determined for this population at risk was 7.6% in women only, men did not present infection. The high prevalence shown for this risk group suggests a great vulnerability of this population to contract other more serious STIs. In another sense, it also shows a remarkable lack in the use of mechanical barriers to prevent sexually transmitted diseases (STDs). The present research justifies the elaboration of standardized procedures guide to diagnose T. vaginalis within the framework of the Reproductive Health Program (PROSAR).

Prevalencia de vaginosis bacteriana en trabajadoras sexuales chilenas / Prevalence of bacterial vaginosis in Chilean sex workers

OBJETIVO: Determinar la prevalencia de vaginosis bacteriana (VB) en trabajadoras sexuales chilenas y relacionar los hallazgos con variables sociodemográficas, sexuales y clínicas. MÉTODO: Se estudió una muestra de 379 trabajadoras sexuales que asistían para control a Unidades de Atención y Control de Salud Sexual de Chile. A todas se las entrevistó para obtener antecedentes sociodemográficos y sexuales, se les realizó evaluación clínica que incluyó características del flujo vaginal, pH y prueba de aminas, y se les tomó una muestra vaginal para tinción de Gram. Para el diagnóstico de VB se empleó el criterio de Nugent. Los datos fueron analizados con EPI-INFO 3.4.1 y BioStat, utilizándose un grado de significación de P < 0,005. RESULTADOS: La prevalencia de VB fue de 69,1 por ciento. El síndrome no se asoció a las variables sociodemográficas edad y escolaridad. Las mujeres que vivían (casadas o no) con su pareja tuvieron menos frecuencia de VB en comparación con las mujeres solteras (P < 0,001). No hubo variables sexuales asociadas a VB, en tanto que el empleo del dispositivo intrauterino (DIU) sí lo estuvo (P < 0,0001). La presencia de descarga vaginal, pH vaginal alterado y prueba de aminas positiva se asociaron a la infección (P < 0,0001). CONCLUSIONES: En coincidencia con otros estudios realizados distintos países, el presente trabajo observó que las trabajadoras sexuales chilenas tienen una alta prevalencia de VB, con mayor riesgo para aquellas que usan DIU como método de anticoncepción o que no conviven (casadas o no) con su pareja.

OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in Chilean sex workers and relate the findings to sociodemographic, sexual, and clinical variables. METHODS: A sample of 379 sex workers seen in Chilean Sexual Health Monitoring and Care Units for check-ups was studied. All of them were interviewed to obtain their sociodemographic and sexual history. A clinical examination was performed that included the characteristics of vaginal discharge, pH, and amine test. A vaginal sample was taken for Gram stain. The Nugent criteria were used for the diagnosis of BV. The data was analyzed with EPI-INFO 3.4.1 and BioStat, using a degree of significance of P < 0.005. RESULTS: BV prevalence was 69.1 percent. The syndrome was not associated with the sociodemographic variables, age or education. BV was less common in women (married or unmarried) who lived with their partners than in single women (P < 0.001). There were no sexual variables associated with BV, whereas use of intrauterine devices was related (P < 0.0001). The presence of vaginal discharge, abnormal vaginal pH, and positive amine test were associated with infection (P < 0.0001). CONCLUSIONS: Like other studies conducted in different countries, this study observed that Chilean sex workers have a high prevalence of BV, with greater risk for women who use IUDs for birth control or women (married or unmarried) who do not live with their partners.