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Prostitute women and public health

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Abstract

Though some findings from Africa confirm the importance of prostitutes in the heterosexual transmission of HIV, as in Nairobi, sexual activity alone has not been described as the principal risk elsewhere in the world. The most important risk factor for prostitutes in the West is sharing needles and syringes for drugs. We studied a cohort of prostitute women in London to assess their risks of infection with HIV.
receiving
long
term
haemodialysis.3
In
the
present
trial
we
showed
that
though
a
magnesium
free
dialysis
fluid
corrected
the
hypermagnesaemia,
it
failed
to
show
a
related
improvement
in
the
renal
itch.
In
addition,
the
fall
in
the
serum
magnesium
concentration
was
associ-
ated
with
an
increased
concentration
of
parathyroid
hormone,
as
has
been
previously
noted,'
with
the
potential
of
producing
renal
osteodystrophy
in
the
long
term.
The
lack
of
response
might
have
been
due
to
the
brevity
of
the
magnesium
free
dialysis.
A
longer
treatment
period
was
avoided
as
we
thought
that
the
patients'
reliability
in
completing
the
visual
analogue
charts
was
likely
to
deteriorate,
and
the
hyper-
magnesaenia
was
corrected
within
a
week.
Alter-
natively,
the
serum
magnesium
concentrations
may,
like
phosphate,3
be
acting
as
a
marker
for
the
adequacy
of
dialysis,
and
this
is
being
investigated.
I
Anonymous.
Uraemic
pruritis
[Editorial].
BrMedJ
1980;281:1025.
2
Coburn
JW,
Popovtzer
MM,
Massry
SG,
Kluman
CR.
The
physiochemical
state
and
renal
handling
of
divalent
ions
in
chronic
renal
failure.
Arch
Intern
Med
1969;124:302-1
1.
3
Carmichael
Al,
McHugh
MM,
Martin
AM,
Farrow
M.
Serological
markers
of
renal
itch
in
patients
receiving
long
term
haemodialysis.
Br
Med
J
1988;2%:
1575.
4
Graf
H,
Kovarik
J,
Stummvoll
HK,
Wolf
A.
Disappearance
of
uraemic
pruritis
after
lowering
dialysate
magnesium
concentration.
BrMedJ
1979;ii:
1478-9.
5
Nilsson
P,
Johansson
SG,
Danielson
BG.
Magnesium
studies
in
haemodialysis
patients
before
and
after
treatment
with
low
dialysate
magnesium.
Nephron
1984;37:25-9.
(Accepted
8
September
1988)
Department
of
Anthropology,
London
School
of
Economics
and
Political
Science,
London
WC2
S
Day,
MA,
research
officer
Academic
Department
of
Community
Medicine,
St
Mary's
Hospital,
London
W2
H
Ward,
MB,
research
fellow
in
epidemiology
Praed
Street
Clinic,
St
Mary's
Hospital,
London
W2
J
R
W
Harris,
FRCP,
senior
consultant
in
genitourinary
medicine
Correspondence
to:
Ms
S
Day,
Praed
Street
Clinic,
St
Mary's
Hospital,
London
W2
INY.
Prostitute
women
and
public
health
S
Day,
H
Ward,
J
R
W
Harris
Prostitute
women
have
been
allotted
a
key
role
in
models
of
heterosexual
transmission
of
human
immunodeficiency
virus
(HIV).
Prostitutes
are
assumed
to
be
especially
exposed
to
infection
with
HIV
because
they
have
a
greater
than
average
number
of
sexual
partners,
and
infected
prostitutes
may
then
play
an
important
part
in
spreading
the
virus.
Debates
on
public
health
initiatives
reflect
this
concern
with
recommendations
for
registering
and
screening
prosti-
tutes.1
Though
some
findings
from
Africa
confirm
the
importance
of
prostitutes
in
the
heterosexual
trans-
mission
of
HIV,
as
in
Nairobi,2
sexual
activity
alone
has
not
been
described
as
the
principal
risk
elsewhere
in
the
world.
The
most
important
risk
factor
for
prosti-
tutes
in
the
West
is
sharing
needles
and
syringes
for
drugs.
We
studied
a
cohort
of
prostitute
women
in
London
to
assess
their
risks
of
infection
with
HIV.
Patients
and
results
Ninety
one
women
were
followed
up
for
a
median
of
seven
months
at
the
Praed
Street
Clinic
over
17
months
to
December
1987.
Questions
about
use
of
condoms
showed
that
the
women
practised
safer
sex
with
clients
than
with
private
sexual
partners
(boyfriends)
at
their
first
visit
and
that
this
pattern
was
maintained
over
time
(table).
Four
of
34
women
attending
the
clinic
in
the
last
three
months
of
1987
reported
inconsistent
use
of
condoms
with
clients.
This
partly
depended
on
the
type
of
client:
one
sexual
encounter
with
a
new
client
was
unprotected
compared
with
28
encounters
with
regular
clients,
who
pay
the
same
woman
repeatedly
for sex.
Changes
in
use
of
condoms
in
91
women
attending
the
Praed
Street
Clinic
to
December
1987
No
always
using
condoms
No
reporting
At
first
visit
At
last
visit
Type
of
sexual
intercourse
this
type
to
clinic
to
cLinic
Vaginal
with
clients
91
54
68*
Oral
with
clients
57t
22
28*
Anal
with
clients
3t
2
1
Vaginal
with
boyfriends
71
4
8
*p<O.05.
t
10
Women
stopped
selling
oral
sex
during
follow
up.
tOne
woman
stopped
selling
anal
sex
during
follow
up.
A
total
of
187
prostitutes
were
tested
with
their
consent
for
HIV-1.
Three
(1
6%)
were
positive
for
antibodies
to
HIV;
two
had
shared
needles
in
the
past,
and
one
had
probably
been
infected
by
her
boyfriend,
who
was
positive
for
the
virus.
Infection
in
this
woman,
who
did
not
use
needles,
may
have
been
due
to
the
general
practice
of
unsafe
sex
at
home.
Information
obtained
from
prostitutes
in
the
cohort
during
inter-
views suggested
that
half
of
their
boyfriends
had
other
sexual
partners,
but
possible
risks
associated
with
these
men
were
unclear.
Comment
We
did
not
find
any
evidence
that
prostitutes'
fairly
high
rates
of
change
of
client
were
placing
them
at
special
risk
of
infection
with
HIV.
Their
safety
at
work
depends
partly
on
the
extent
to
which
condoms
protect
against
infection
with
HIV4
and
also
on
the
prevalence
of
HIV
in
the
population
of
clients.
Women
in
the
cohort
who
used
condoms
all
the
time
had
notably
fewer
infections
with
common
genital
pathogens
than
inconsistent
users
(H
Ward,
unpublished
observa-
tions).
No
client
of
a
prostitute
in
London
has
been
found
to
be
positive
for
antibodies
to
HIV
at
the
clinic
(data
not
shown).
The
current
pattern
of
infection
with
HIV
and
the
use
of
condoms
in
our
cohort
carry
an
important
methodological
implication.
Risks
of
infection
in
pros-
titute
women
are
not
associated
only
with
a
high
rate
of
change
of
clients.
Risks
associated
with
shared
injecting
equipment
are
well
established,3
and
risks
associated
with
private
sexual
relationships
are
becoming
evident.5
Though
public
health
measures
designed
to
increase
use
of
condoms
among
clients
and
prostitutes
may
yield
good
results,
introducing
the
use
of
condoms
into
all
sexual
relationships
is
more
difficult.
Regular
clients
and
boyfriends,
who
have
qualitatively
different
relationships
with
the
women,
are
often
unwilling
to
use
condoms.
Enumerating
stigmatised
populations
such
as
prosti-
tutes
is
not
possible,
and
therefore
findings
from
our
study
can
be
generalised
only
with
caution.
A
trend
to-
wards
universal
use
of
condoms
with
new
clients
and
in-
creasing
use
with
regular
clients
and
boyfriends
is,
however,
encouraging.
1
Centres
for
Disease
Control.
Antibody
to
human
immunodeficiency
virus
in
female
prostitutes.
MMWR
1987;36:157-61.
2
Piot
P,
Plummer
FA,
Rey
MA,
et
al.
Retrospective
seroepidemiology
of
HIV
infection
in
Nairobi
populations.
J
Infect
Dis
1987;155:1108-12.
3
Des
Jarlais
D,
Friedman
S.
HIV
infection
among
intravenous
drug
users.
AIDS
1987
;1:67-76.
4
Van
de
Perre
P,
Jacobs
D,
Sprecher-Goldberger
S.
The
latex
condom,
an
efficient
barrier
against
sexual
transmission
of
AIDS-related
viruses.
AIDS
1987;1:49-52.
5
Rosenberg
MJ,
Weiner
JM.
Prostitutes
and
AIDS:
a
health
department
priority?
AmJ
Public
Health
1988;78:418-23.
(Accepted
3
October
1988)
BMJ
VOLUME
297
17
DECEMBER
1988
1585
... This trust and respect seemed to outweigh the risks. This phenomenon of non-condom use with regular boyfriends is not peculiar to Malawi, but has been reported elsewhere (Day et al., 1988;Wilson et al., 1990;Bloor, 1995). As the active sites showed a significant difference in condom use with paying partners, but not with regular non-paying, it must be assumed that this trend is countrywide. ...
... It is the 'grey areas' such as condom use with regular non-paying partners that is of concern. No solution has yet been found to this problem (Day et al., 1988;Hooykaas et al., 1989;Pickering et al., 1993), although Wilson et al. (Wilson et al., 1990) advocates the inclusion of boyfriends in health education interventions. ...
... Digital communication technologies present opportunities to enhance safety such as via screening by both sex worker and client, but digitally mediated crimes against sex workers have been documented (Jones, 2015;. Much traditional work on risk is grounded around the notion that women sex workers are at increased risk of violence, poor sexual health and increased mental health issues (Campbell, 1991;Day et al., 1988;Harcourt et al., 2001;. Many of these claims are based on gender, and women as sex workers are at increased risk because they are women. ...
... In addition, having sex with prostitutes-gigolos might expose them to the risk of contracting sexually transmitted diseases such as HIV [44], which is far less likely to happen with a sexual assistant, who definitely is much more controlled and much less promiscuous. ...
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This article aims at analyzing the issue of in individuals with disability (subjects with physical and/or mental disabilities) and the new professional figure of the sexual assistant, already accepted and adopted in some parts of Europe. The sexual assistant as a professional figure has been raising many moral and practical dilemmas and additionally is a controversial figure. A service, which can offer to these particular subjects, the possibility to explore their sexuality raises many questions concerning the social, legal and moral issues, which may or may not legitimize the adoption of this practice. Moreover it can be difficult to disentangle all the complexities and issues that may be created by this professional figure. Beyond the problems that such an approach undoubtedly raises, it is a fact that the sexuality of people with disabilities is often neglected or denied. This new professional figure has the merit to underline and highlight the problem.
... There are very few repeated encounters in our data, but it is possible that repeated contacts occur by other means and are thus unobservable to us. The research indeed reports that repeated and long-term sexual contacts between sex workers and clients are not uncommon 32,33 . Last, our analysis abstracts from safe-sex practices of clients and sex workers as well as from the particular sexual services provided during the encounters. ...
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Sex workers are traditionally considered important vectors of transmission of sexually transmitted infections (STI). The role of clients is commonly overlooked, partially due to the lack of evidence on clients' position in the sexual network created by commercial sex. Contrasting the diffusion importance of sex workers and their clients in the map of their sexual encounters in twoWeb-mediated communities, we find that from diffusion perspective, clients are as important as sex workers. Their diffusion importance is closely linked to the geography of the sexual encounters: as a result of different movement patterns, travelling clients shorten network distances between distant network neighborhoods and thus facilitate contagion among them more than sex workers, and find themselves more often in the core of the network by which they could contribute to the persistence of STIs in the community. These findings position clients into the set of the key actors and highlight the role of human mobility in the transmission of STIs in commercial sexual networks.
... The use of condoms is influenced by many factors, particularly characteristics of the client and sex worker, cultural setting, and type of establishment (Pickering et al., 1993). It was found that sex workers rarely used condoms with regular clients (Day etal., 1988; Aim et al., 1989). Our earlier study showed that most sex workers in Singapore were aware of the seriousness of AIDS and were consequently keen to use condoms (Wong et al., 1994a). ...
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We evaluated the impact of a behavioural intervention programme on condom use and gonorrhoea incidence among female brothel-based sex workers in Singapore. All 128 sex workers from one locality were assigned to an intervention group and 125 sex workers from another relatively comparable locality served as controls. The intervention programme concentrated on developing sex workers' condom negotiation skills, and on gathering support from peers, brothel keepers and health staff in promoting condom use. The three outcome measures are self-reported success in persuading clients to use condoms, refusal of sex without a condom, and cumulative gonorrhoea incidence as measured by the percentage of sex workers with a new occurrence of a positive culture in the 5 month period before and after the intervention. The intervention group showed a statistically greater improvement in negotiation skills as compared to the controls. Sex workers exposed to the intervention were almost twice as likely than controls to always refuse unprotected sex (adjusted rate ratio of 1.90, 95% CI: 1.22-2.94). Cumulative gonorrhoea incidence declined considerably (77.1%) in the intervention group but only moderately (37.6%) in the control group.
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Full-text available
HIV is more efficiently acquired during receptive anal intercourse (AI) compared to vaginal intercourse (VI) and may contribute substantially to female sex workers’ (FSW) high HIV burden. We aim to determine how common and frequent AI is among FSW globally. We searched PubMed, Embase and PsycINFO for studies reporting the proportion of FSW practising AI (prevalence) and/or the number of AI acts (frequency) worldwide from 01/1980 to 10/2018. We assessed the influence of participant and study characteristics on AI prevalence (e.g. continent, study year and interview method) through sub-group analysis. Of 15,830 identified studies, 131 were included. Nearly all (N = 128) reported AI prevalence and few frequency (N = 13), over various recall periods. Most studies used face-to-face interviews (N = 111). Pooled prevalences varied little by recall period (lifetime: 15.7% 95%CI 12.2–19.3%, N = 30, I² = 99%; past month: 16.2% 95%CI 10.8–21.6%, N = 18, I² = 99%). The pooled proportion of FSW reporting < 100% condom use tended to be non-significantly higher during AI compared to during VI (e.g. any unprotected VI: 19.1% 95%CI 1.7–36.4, N = 5 and any unprotected AI: 46.4% 95%CI 9.1–83.6, N = 5 in the past week). Across all study participants, between 2.4 and 15.9% (N = 6) of all intercourse acts (AI and VI) were anal. Neither AI prevalence nor frequency varied substantially by any participant or study characteristics. Although varied, AI among FSW is generally common, inconsistently protected with condoms and practiced sufficiently frequently to contribute substantially to HIV acquisition in this risk group. Interventions to address barriers to condom use are needed.
Chapter
Prostitution can be defined as the exchange of sexual services for money or things of monetary value, such as drugs (1). Prostitution can play a role in the transmission of sexually transmitted agents, such as human immunodeficiency virus (HIV). One of the first reports of HIV antibody in female prostitutes suggested extremely high rates of infection. According to evidence reported from Ngoma, Rwanda, in 1985, 29 (88%) of 33 female prostitutes who had been seen at a sexually transmitted disease (STD) clinic and 7 (28%) of 25 male clients of female prostitutes were infected with HIV (2). This chapter presents the following points: 1) to describe the prevalence of HIV antibody in prostitutes and their clients tested in different parts of the world during 1985–1989; 2) to present public health interventions that might interrupt HIV transmission to and from prostitutes; and 3) to look at the effects of various interventions on self-reported sexual and preventive health behaviors, HIV seroprevalence, and the incidence of HIV or other sexually transmitted infections.
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This article examines how cultural assumptions about the status of commercial sex workers in Britain are produced (and reproduced) through social discourses, representations and practices which are articulated differently across space. Specifically, by developing ideas that sexual, gender and bodily identities are constructed through the repeated inscription of moral geographies on the topography of the city, the article seeks to demonstrate how the marginal status of female street prostitutes has been mapped onto, and out of, particular sites. Focusing on recent high-profile community protests against prostitution in Birmingham (UK), the article highlights the way that moral narratives and discourses were deployed by protestors in their attempt to construct an idea of community predicated on the exclusion of 'immoral' sex workers. This process was by no means straightforward, with the protestors, police and local press invoking different (and sometimes contradictory) notions of appropriate sexual, gender and racial behaviour in their identification of prostitutes as immoral. The article concludes that conflicting judgements as to whether commercial sex work blends into or trangresses the character of particular places engenders a spatial order which frequently serves to 'other' street prostitutes, 'placing' them in marginal sites.
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Harm minimization approaches have been recommended to reduce the risks of transmission of HIV for injecting drug users by the elimination of sharing injecting equipment. The risks associated with the sexual behaviours of these individuals have been given less emphasis, and where considered have been in terms of the threat to non-drug partners and potential penetration of HIV infection into the general population. Data are presented from four survey studies conducted between 1985 and 1990 focusing on both drug-taking behaviours and sexual activities. These provide evidence for larger shifts, over this period, in injecting practices than in sexual behaviours. The risks associated with sexual activities for injecting drug users and their sexual partners are considered. It is concluded that counsellors have an important role to play in introducing a second phase of harm minimization that involves interventions to modify sexual behaviours and offers integrated services for injecting drug users and their families.
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Research on the epidemiology of HIV infection among IV drug users is still at a relatively early stage. Multilocation studies that would permit better geographic comparisons are greatly needed. Multi-method studies within single geographic areas are also needed to assess possible biases with respect to sample recruitment and data collection procedures. The continuation of the epidemic provides a changing historical context that complicates any comparisons. Despite these problems, there are some consistencies that can be seen across studies. Studies of HIV seroprevalence among IV drug users show wide variation among cities in the United States and Europe. The time that the virus was introduced into the IV drug using group within the city is one factor in explaining these differences; other cross-city factors have yet to be identified. Once HIV has been introduced into the IV drug use group within a particular geographic area, there is the possibility of rapid spread up to seroprevalence levels of 50% or greater. Thus, a currently low seroprevalence rate should not be seen as a stable situation. Frequency of injection and sharing of equipment with multiple other drug users (particularly at shooting galleries) have been frequently associated with HIV exposure. Being female, ethnicity (in the USA) and engaging in prostitution also may be associated with increased risk for HIV exposure, suggesting that prevention programs should include special consideration of sex and ethnic differences. Studies of AIDS risk reduction show that substantial proportions of IV drug users are changing their behavior to avoid exposure to HIV. This risk reduction is probably more advanced in New York, with its high seroprevalence and incidence of cases, but is also occurring in cities with lower seroprevalence and limited numbers of cases. The primary forms of risk reduction are increasing the use of sterile equipment, reducing the number of needle sharing partners, and reducing the frequency of injection. These behavior changes are very similar to the frequently identified behavioral risk factors associated with HIV exposure, suggesting that they should be effective in at least slowing the spread of HIV among IV drug users. No linkage of risk reduction to decreases in seroconversion has yet been shown, however, and greater risk reduction is clearly required. A variety of prevention strategies will probably be needed to reduce the spread of HIV among IV drug users. Prevention of initiation into drug injection is an undeniable long-term goal for the control of HIV infection, but there is very little research being conducted in this area.
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With increasing competition for resources, health departments are faced with the question of whether to target female prostitutes as a high priority component of AIDS prevention strategy. Prostitutes are considered to be a reservoir for transmission of certain sexually transmitted diseases (STDs). However, a variety of studies suggest that human immunodeficiency virus (HIV) infection in prostitutes follows a different pattern than that for STDs: HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity alone does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV. Emerging data from heterosexual groups similarly suggest a low rate of heterosexual transmission, particularly from women to men. Prostitutes who do not use intravenous drugs probably face their highest risk from steady partners who may be infected with HIV and other STDs and with whom barrier protection is generally not used. Nevertheless, there are good reasons for health departments to place high priority on prevention efforts directed to prostitutes: 1) prostitutes often have other risky behaviors such as drug use; and 2) prostitutes are reachable, being a group which is already in the health care system administered by health departments.
Article
Among 446 sera from prostitutes in Nairobi, the prevalence of antibody to human immunodeficiency virus (HIV) rose from 4% in 1981 to 61% in 1985. None of 118 men with chancroid seen in 1980 had antibody to HIV compared with 15% of 107 such men in 1985. Among pregnant women, 2.0% were seropositive in 1985 versus none of 111 in 1981. Seropositive prostitutes and women with sexually transmitted diseases (STDs) tended to have more sex partners and had a higher prevalence of gonorrhoea, and in women with STDs, significantly more seropositive women practiced prostitution. Pregnant women and men with STDs who were born in the most-western region of Kenya were more likely to have antibody to HIV than were such groups from other geographic areas. Our results indicate that the AIDS virus was recently introduced into Kenya, that HIV can rapidly disseminate in a high-risk group of heterosexuals, and that prostitutes may have significantly contributed to the spread of the virus.
Antibody to human immunodeficiency virus in female prostitutes
Centres for Disease Control. Antibody to human immunodeficiency virus in female prostitutes. MMWR 1987;36:157-61.