Health care of female commercial sex workers

Alcohol consumption in relation to work environment and key sociodemographic characteristics among female sex workers in China

The study explores the variation in pattern of alcohol use and related risk behaviors by types of sex work environments and sociodemographic characteristics among female sex workers (FSWs) in China. Data were collected from 1,022 FSWs in Guangxi, China, through a self-administered questionnaire. Chi-square and analysis of variance (ANOVA) were used to assess the variations. Results showed that younger FSWs were more susceptible than older FSWs to nearly all the risk drinking behaviors. FSWs of non-Han ethnicity as compared with those of Han ethnicity were more at risk of drinking large amounts of alcohol and having sex under the influence of alcohol. FSWs in entertainment establishments were most likely to have all kinds of risk drinking behaviors. Street-based FSWs were least likely to drink alcohol but more or equally likely to engage in alcohol-related sexual risk behaviors. The study highlights a need to develop tailored alcohol risk reduction intervention that takes into consideration these differences.

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries

BACKGROUND

Interventions to change behaviour among sex workers and their clients have been identified as a strategy to reduce HIV transmission. However, there has been no systematic review that has examined and summarized their effects.

OBJECTIVES

To identify and evaluate the effects of the studies performed on behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries.

SEARCH METHODS

Electronic searches were undertaken using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and other databases between January 1980 and July 2010. Experts in the field were contacted to locate any other studies.

SELECTION CRITERIA

Randomised controlled trials or specified quasi-experimental designs with comparison groups that examined the effects of behavioural interventions aimed at reducing the risk of HIV or sexually transmitted infections (STIs) transmission among sex workers in high-income countries. We reviewed studies for outcome relevance and methodological rigor.

DATA COLLECTION AND ANALYSIS

Two reviewers independently applied the inclusion criteria to potential studies, and any disagreements were resolved by discussion. Studies were assessed for completeness of reporting and extracted data.

MAIN RESULTS

A total of four studies were included, comprising two randomised controlled trials and two quasi-experimental pretest-posttest trials with control groups involving 1795 participants. No trials reported HIV prevalence/incidence as outcomes.Overall, the effects of behavioural interventions for sex workers in high-income countries on STI incidence did not differ significantly among two studies using a random effects model (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.11 to 1.98). Only one study found that the self-reported STI prevalence in clients of female sex workers was statistically significant (RR 0.09, 95%CI 0.01 to 0.72, P=0.02). There was no significant difference after behavioural intervention for condom use. Two studies demonstrated the effectiveness of intervention for knowledge of HIV transmission among sex workers (RR 1.82, 95%CI 1.55 to 2.14) and clients of sex workers (RR 1.93, 95%CI 1.46 to 2.55).

AUTHORS' CONCLUSIONS

There is limited evidence from randomised controlled trials for the effectiveness of behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries. Further randomised controlled trials are very likely to have important impacts on our confidence in the estimates of the effects, and are likely to change the estimates for effective interventions with outcomes of HIV incidence or prevalence and a variety of different settings among sex workers and their clients in high-income countries. Randomised controlled trials that test for the identification of effective interventions for HIV prevention with outcomes of biological endpoints, such as HIV incidence or prevalence, are needed for these neglected populations. More research is also needed for male or transgender sex workers and their clients in high-income countries.

Knowledge about sexually transmitted infections (STIs) and attitudes toward female sex workers with STI symptoms among health care providers in Laos

This study aimed to assess the knowledge and attitudes among health care providers (HCPs) providing sexually transmitted infection (STI) service to female sex workers (FSWs). A cross-sectional survey was performed in 6 districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 244 HCPs providing STI services were interviewed. In all, 54% of respondents had no STI training despite providing STI treatment. Misperceptions of STI causes, transmission routes, and symptoms were common among respondents. Attitudes differed neither between male and female respondents nor between those who had or had not received STI training. A higher proportion of pharmacists/drug sellers (68%) had negative attitudes followed by medical doctors (59%) and nurse/midwives (55%). The proportion of herbalists with negative attitudes (53%) was less in comparison with the other professionals. To improve the quality of STI services and to enhance FSWs' access to health care services, educational improvements of HCPs' knowledge about STIs and their attitudes are needed.

Alcohol use among female sex workers and male clients: an integrative review of global literature

AIMS

To review the patterns, contexts and impacts of alcohol use associated with commercial sex reported in the global literature.

METHODS

We identified peer-reviewed English-language articles from 1980 to 2008 reporting alcohol consumption among female sex workers (FSWs) or male clients. We retrieved 70 articles describing 76 studies, in which 64 were quantitative (52 for FSWs, 12 for male clients) and 12 qualitative.

RESULTS

Studies increased over the past three decades, with geographic concentration of the research in Asia and North America. Alcohol use was prevalent among FSWs and clients. Integrating quantitative and qualitative studies, multilevel contexts of alcohol use in the sex work environment were identified, including workplace and occupation-related use, the use of alcohol to facilitate the transition into and practice of commercial sex among both FSWs and male clients, and self-medication among FSWs. Alcohol use was associated with adverse physical health, illicit drug use, mental health problems, and victimization of sexual violence, although its associations with HIV/sexually transmitted infections and unprotected sex among FSWs were inconclusive.

CONCLUSIONS

Alcohol use in the context of commercial sex is prevalent, harmful among FSWs and male clients, but under-researched. Research in this area in more diverse settings and with standardized measures is required. The review underscores the importance of integrated intervention for alcohol use and related problems in multilevel contexts and with multiple components in order to effectively reduce alcohol use and its harmful effects among FSWs and their clients.

Health needs and service use of parlour-based prostitutes compared with street-based prostitutes: a cross-sectional survey

OBJECTIVES

To compare the health needs of prostitutes (sex workers) working in massage parlours with that of those working on the streets.

DESIGN

Cross-sectional survey.

SETTING

Inner city, UK.

POPULATION

Women aged 16 years and older selling sex in massage parlours.

METHODS

Interviewer-administered questionnaires were undertaken with 71 parlour workers, and results were compared with our previous findings for street sex workers.

MAIN OUTCOME MEASURES

Self-reported experiences of health and service use.

RESULTS

In comparison with street sex workers, parlour sex workers were less likely to report chronic (43/71 versus 71/71; P < 0.001) and acute (10/71 versus 35/71; P < 0.001) illnesses but more likely to be registered with a GP (67/71 versus 59/71; P = 0.06). They were more likely than street sex workers to have been screened for sexually transmitted infections in the previous year (49/71 versus 33/71; P = 0.011) and more likely to use contraception in addition to condoms (34/71 versus 8/71; P < 0.001). They were less likely to be overdue for cervical screening (5/46 versus 19/48; P = 0.001), and more of those booked for antenatal care in the first trimester attended all follow-up appointments (28/37 versus 14/47; P < 0.001). Fewer parlour sex workers used heroin (4/71 versus 60/71; P < 0.001), crack cocaine (5/71 versus 62/71; P < 0.001) or injected drugs (2/71 versus 41/71 versus; P < 0.001) They reported fewer episodes of intercourse per week (mean 14 versus 22; P < 0.001) with fewer different men (mean 11 versus 19; P < 0.001), less of whom were new (mean 8 versus 13; P < 0.001).

CONCLUSIONS

The two groups had very different health experiences, risk-taking behaviour and use of services. To be effective in improving health, different types of service delivered in different settings for different groups are required.

The cost-effectiveness of an outreach clinical model in the management and prevention of gonorrhea and chlamydia among Chinese female sex workers in Hong Kong

BACKGROUND

Social marginalization and stigmatization in usual medical care setting may refrain female sex workers (FSWs) from seeking usual medical care for sexually transmitted infections in Hong Kong.

GOAL

To evaluate the cost-effectiveness of using an outreach approach for treatment and prevention of gonorrhea and chlamydia among FSWs.

STUDY DESIGN

A decision tree was designed to simulate the outcomes of 2 alternatives: (1) outreach service providing treatment of gonorrhea and chlamydia and counseling to FSWs (outreach arm) and (2) no outreach service (control arm). Five tiers of outcomes were estimated for each study arm: (1) total direct medical cost, (2) number of FSWs infected with gonorrhea, (3) number of new cases of gonorrhea in clients transmitted by FSWs, (4) number of FSWs infected with chlamydia, and (5) number of new cases of chlamydia in clients transmitted by FSWs. Clinical inputs were estimated from literature, and cost analysis was conducted from the perspective of a public health organization.

RESULTS

Compared to the control group, the marginal savings per new case of infection averted (marginal cost divided by marginal cases of infection) of the outreach group were $10,988 (US dollars) per case of gonorrhea averted in FSWs, $685 per case of gonorrhea averted in clients, $9643 per case of chlamydia averted in FSWs, and $220 per case of chlamydia averted in clients ($1=7.8 Hong Kong dollars).

CONCLUSIONS

An outreach clinic is potentially less costly and more effective in preventing transmission of gonorrhea and chlamydia between FSWs and their clients in Hong Kong.