Sex Workers' Sexual Health and Peer Education Project in Goroka, Eastern Highlands Province, Papua New Guinea.

We conducted a survey among female sex workers in Goroka, Eastern Highlands Province, Papua New Guinea to evaluate the frequency of sexually transmitted disease (STD) symptoms they suffered, their STD and HIV (human immunodeficiency virus) transmission knowledge and health-seeking behaviours, the forms that their HIV risk perception took, and the types and quantities of educational resources to which they had access and in fact used. This survey was a part of a larger study of sex workers that was carried out in two other cities, Lae, the capital of Morobe Province, and Port Moresby, the nation's capital. We interviewed 190 self-identified female sex workers who had been recruited between January 1999 and October 1999 through peer-mediated contacts. In an average one-week period, the women had intercourse with two customers, two to three times, and one boyfriend once or twice. In the surveyed group, 83% of the women had a history of symptomatic STDs and 73% had gone to an STD clinic for treatment. Of the women who used condoms at all, 7% used them each time they had sex with clients, but only 3% used them each time they had sex with steady partners. The remaining 93% of the women used condoms on some occasions or not at all. Most women (72%) knew about male-female transmission of HIV, but fewer cited other sexual and non-sexual modes of transmission. The majority of the women (71%) felt that they were of low or unknown risk of acquiring HIV infection. When asked where or to whom they would go when concerned about AIDS (acquired immune deficiency syndrome) or STDs, most women (93%) said that they would go to a health care provider. Evaluating the sex workers' understanding of STDs and HIV has been essential in designing education and intervention projects so as better to address the future morbidity and mortality associated with STDs and AIDS.

High prevalence of sexually transmitted infections among female sex workers in the eastern highlands province of Papua New Guinea: correlates and recommendations.

BACKGROUND: More than 200 female sex workers (FSWs) participating in commercial sex along the Highlands Highway of Papua New Guinea were identified in a previous survey. This has implications for the spread of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) to areas and population groups serviced by the road. GOAL: The goal of this study was to estimate the prevalence of gonorrhea, chlamydia, syphilis, trichomoniasis, and HIV among FSWs in Goroka and Kainantu in the Eastern Highlands Province (EHP) and to identify correlates that could be considered in intervention and control. STUDY: Self-identified FSWs recruited through the Goroka Sex Workers Peer-Mediated Programme were invited to participate. All consenting FSWs underwent pretest counseling and provided sociodemographic and behavioral data using a structured questionnaire. The women were also asked to self-collect vaginal specimens and to provide peripheral blood to detect the respective STIs and HIV. RESULTS: Results were available for 211 FSWs. None of the women were positive for HIV. The overall estimated rates for gonorrhea, chlamydia, syphilis, and trichomoniasis were 21%, 19%, 24%, and 51%, respectively. Seventy-four percent were positive for at least 1 STI and 43% had multiple STI infections. High-risk sexual behaviors were found to be common among the women, including low and inconsistent use of condoms, with most of them attributing this to unavailability, dislike by or familiarity with clients, and being drunk and/or high on marijuana. CONCLUSIONS: STIs are prevalent among FSWs in Goroka and Kainantu in the EHP and are maintained by widespread high-risk sexual behaviors, including low use of condoms. Implications for their spread through the highway warrants increased efforts in intervention. Apart from a need to promote condom acceptance, distribution, and use, other high-risk sexual behavior and correlates identified in this study provide important considerations for intervention and control in this population.