Day S, Ward H, Perrotta L. Prostitution and risk of HIV: male partners of female prostitutes

Academic Department of Public Health, St Mary's Hospital Medical School, London.
BMJ Clinical Research (Impact Factor: 14.09). 09/1993; 307(6900):359-61. DOI: 10.1136/bmj.307.6900.359
Source: PubMed


To describe risk behaviours for infection with HIV in male sexual partners of female prostitutes.
A cross sectional study.
Genitourinary medicine clinic, St Mary's Hospital, London.
112 self identified male sexual partners of female prostitutes: 101 who reported commercial sexual relationships only, five who reported non-commercial relationships only, and six who reported both commercial and non-commercial relationships.
Reported risk behaviours for infection with HIV.
Of the 40 men who had had previous HIV tests or were tested during the study, two (5%) were infected with HIV. Of the men who would answer the questions, 34/94 reported having sex with other men, 2/105 reported using injected drugs, 8/105 had a history of blood transfusion, 14/108 reported a past history of gonorrhoea, 44/102 reported paying for sex abroad, and 8/92 said that they had also been paid for sex. Of the 55 men who reported paying for vaginal intercourse in the past year, 45 (82%) said that they had always used a condom. In contrast, of the 11 non-paying partners of prostitutes, only two (18%) reported ever using a condom with their partners.
Men who have sex with female prostitutes cannot be assumed to be at risk of infection with HIV only by this route: homosexual contact may place them at greater risk. Despite the heterogeneity among male sexual partners of prostitutes, patterns of use of condoms were uniform when they were considered as a reflection of the type of relationship a man had with a female prostitute rather than a consequence of an individual's level of risk.

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    • "other sexual partners [11]. Also, in two studies from the UK, men who paid for sex were more likely to engage in sex with men [12] [13]. However, many of these studies have been on selected groups of men and few studies have examined this issue using a randomly selected population. "
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    ABSTRACT: To estimate the prevalence, time trends and factors associated with paid sex among men. Norwegian Sex Surveys using similar questions in 1992, 1997 and 2002 were analyzed using a cohort analysis and logistic regression. The questionnaires included demographic background, and several aspects of sexual behaviour. The following questions on paid sex were included: ''Have you ever paid for sexual services?'' ''If yes, how many times?'', ''How old were you the first time?'', ''How old were you the last time?'', and ''Did you use a condom the last time?'' Of the 4,545 men who answered this question, 585 (12.9%) reported ever having paid for sex. There was a marked decline overall in reporting from 26.2% in the cohort born in 1927-34, to 5.9% in the cohort born in 1975-84 (p < 0.001). However, there was an increase in the last cohort after the age of around 23 years (p = 0.1). Having paid for sex was significantly associated with being single, being on a disability pension, early sexual debut and having multiple other sex partners; these men were less likely to use condoms when having sex with a cohabiting partner (p < 0.01) and more likely to have had a sexually transmitted infection (p < 0.001). Having paid for sex is associated with high risk sexual behaviour and represents a public health problem. Preventive measures should address men's behaviour across social groups and marital status and explore the trend among younger men.
    Scandinavian Journal of Public Health 11/2009; 38(2):135-40. DOI:10.1177/1403494809352531 · 1.83 Impact Factor
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    • "The picture that emerges consistently from the research is that a significant minority of clients visit prostitutes more than once. However, estimates of frequency vary considerably, from four visits per year (Day et al., 1993) to 28 (Thomas et al., 1990 in Kinnell, 2006; and Groom and Nandwandi, 2006). "
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    ABSTRACT: This rapid evidence assessment of the published research literature is part of the Tackling Demand for Prostitution Review (Home Office, 2008a), which aimed to assess what further action the Government and other agencies could do to reduce the demand for prostitution. Research studies from selected countries were included in this review (220 studies were reviewed and 181 met the inclusion criteria). The findings presented highlight the characteristics and motivations of those who procure sex, the contexts in which they procure sex, and 'what works' in tackling the demand for prostitution. The report found that methodological difficulties plague research into clients of prostitutes. There are many gaps in the research and much of the evidence is weak or inconclusive, particularly with regard to 'what works' in reducing demand. It was also noted that prostitution is a policy domain for which the 'right' answer may not be determined solely by reference to the evidence. There are moral, political and other influences that need to be considered when tackling the demand for prostitution. Key findings
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    • "Elieson (1992) observed that men who were identified as clients of female sex workers had twice the rate of condom use of clients who had sex with male sex workers. Day (1993:360) reported that among men in London who had sex with female prostitutes, 43 percent also had sex with men, 18 percent did not consistently use condoms and 2 percent had injected drugs. Clients rarely acquired a social identity as did sex workers, however, nor were they condemned for the spread of diseases, targeted with STD prevention initiatives and confronted with legal restraints. "
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    ABSTRACT: State, medical and media discourses have traditionally positioned female sex workers as "reservoirs of infection", holding them responsible in particular for the transmission of HIV/AIDS. Drawing on in-depth interviews and fieldwork with Canadian sex workers in four urban centers, this study found that condom use in commercial sexual encounters was exceptionally high and self reporting rates of HIV/AIDS and other STDs were remarkably low. Participants had high levels of knowledge concerning the consequences of HIV infections, the benefits of condom use and a positive attitude toward condom application. Despite the fact that sex workers are marginalized in the larger society, power differentials favoured the more knowledgeable prostitutes in client interactions, allowing them to nullify risk-taking behaviour and to establish self-efficacy, confidence and negotiating skills. Also examined were the strategies employed by New Zealand sex workers surrounding the 1987 HIV/AIDS epidemic that posed a recognizable health, social and legal threat to prostitutes. Serving as a visible link between public health agencies and sex workers, the New Zealand prostitutes' rights movement focused on a public discourse that was credited with considerable success in preventing disease transmission among sex workers, clients and the public. A shift in social stigma from disease bearers to pedagogical models of safer sex practice has important consequences to legitimate prostitution as a credible service and to combat the effects of stigmatization and criminalization. Implications for the development of HIV/AIDS prevention campaigns are discussed in a Canadian context.
    12/2007: pages 55-71;
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