Impact of improved condom supply on condom use by prostitute women

Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers

OBJECTIVE

To compare the seroincidence of HIV infection among female sex workers in Abidjan, Côte d'Ivoire before and during an intervention study to control sexually transmitted diseases (STD) and to study the effect of two STD diagnosis and treatment strategies on the prevalence of STD and on the seroincidence of HIV infection.

METHOD

A screening facility for STD and HIV had been available since October 1992 for female sex workers. From June 1994, women who were HIV seronegative or HIV-2 positive during the screening could enroll in the intervention study in which participants reported once a month to a confidential clinic where they received health education, condoms and STD treatment if indicated. Women in the study were randomized either to a basic STD diagnosis and treatment strategy, which included a gynecologic examination when symptomatic, or to an intensive strategy that included a gynecologic examination regardless of symptoms. An outcome assessment every 6 months included a gynecologic examination, HIV serology and laboratory tests for STD.

RESULTS

Of 542 women enrolled in the study, 225 (42%) had at least one outcome assessment. The HIV-1 seroincidence rate during the intervention study was significantly lower than before the study (6.5 versus 16.3 per 100 person-years; P = 0.02). During the study, the HIV-1 seroincidence rate was slightly lower in the intensive than in the basic strategy (5.3 versus 7.6 per 100 person-years; P = 0.5).

CONCLUSION

National AIDS control programs should consider adopting as policy the type of integrated approach used in this intervention study for HIV prevention in female sex workers.

Coping with HIV/AIDS in Durban's commercial sex industry

This paper describes coping mechanisms used by commercial sex workers (CSWs) and their partners in confronting the threat of HIV. Data are part of a study exploring sexuality and HIV-related issues among members of the Durban commercial sex industry. Participants were 100 female CSWs, 25 male trucker driver clients and ten male personal partners. Data were collected using semi-structured questionnaires, focus group discussions and in-depth interviews. Analysis revealed high HIV-awareness and high prevalence of risky sexual behaviour. While they were acutely aware of the sex industry's potential role in HIV spread, study participants chose to remain sexually involved and engage in high risk sexual practices with both professional and personal partners. Men and women adopted several strategies to cope with the possibility of HIV infection: (1) denial of risk, (2) fatalism, (3) economic rationalization, (4) partner categorization through selective condom use, (5) purposeful ignorance of HIV status, and (6) abnegation of responsibility for practising safe sex. Among the most significant findings is the difference in study participants' handling of HIV risk and employing coping mechanisms in personal versus professional sexual situations. The implications of these coping strategies for HIV education, message development and intervention in the commercial sex industry and in general are discussed.