Epidemiological Profile of Men Who Have Sex with Men: First Data about Male Sex Workers in Central African Republic (CAR)

Objectives: Sex work is not well documented among African men. The aim of this study was to describe the epidemiological profile of men who have sex with men (MSM) and eventually to determine the proportion of sex workers (SW) among them, as well as the proportion of MSM who have been victims of gender-based violence (GBV). Material and Methods: A cross-sectional study coordinated by the Direction de la Médecine du Travail was carried out at the headquarters of the association ALTERNATIVES in Bangui Bangui from July 1 to October 31, 2021. Consenting MSM present during the study period were systematically included. Sociodemographic variables, those relating to the future vision of the activity and to GBV were collected and analyzed using Epi-Info version 7 software. Results: Forty MSM with an average age of 23 years and mainly secondary education (75.0%) were included. The vast majority of MSM were unemployed (85.0%). 45.0% had been victims of GBV and wanted to stop working as an MSM (47.5%), and almost 2/3 (65.0%) would accept another income-generating activity in exchange for the MSM. Violence was sexual (32.5%), economic (22.5%), physical (20.0%), verbal (12.5%) and psychological (12.5%). Conclusion: The MSM were mainly young, poorly educated, unemployed, and almost half were victims of GBV. The desire to change MSM activity to another income-generating activity alongside that of MSM shows that many of them are SW, workers in the informal sector. This must be taken into account in prevention activities, even if the data needs to be confirmed on a much larger sample.

Prevalence of Gender-Based Violence among Sex Workers in Bangui, Central African Republic (CAR)

Background: Violence against women has become an international public health and human rights issue in recent decades. The violence suffered by sex workers is of little interest for research, yet it constitutes a major health and safety problem. We propose to assess the extent of the phenomenon of gender-based violence (GBV) among sex workers (SWs) in the city of Bangui in the CAR. Methodology: This is a descriptive cross-sectional epidemiological study covering the period from July to October 2021 carried out among SWs in Bangui, the capital of the CAR. Given that the SWs association had only 159 members in Bangui, an exhaustive sampling was retained. Were included in the study, any SW present during the data collection period and having given their written consent. The parameters studied were socio-demographic characteristics: age, sex, residence, level of education, marital status, and characteristics linked to violence: the notion of violence during their professional activity, the type of violence, the declaration and the declaration if necessary, the response and management of this violence. The data collected was analyzed using Epi info version 7 software. Results: Of the 159 SWs that counted the association, 108 had been included. The average age was 27.0 years with extremes of 14 and 46 years. The age groups of 25 to 34 years were the most represented (43.5%). Fifty-six SWs (51.9%) had reached the secondary level. Unemployed SWs were in the majority at 74.1%;Sixty-six (66) SWs in our sample (61.1%) had already been victims of violence during the exercise of their activity Sexual violence was the most represented (28.5%) followed by verbal violence (22.4%). Sixty-eight (62.9%) wanted to stop the professional activity of SWs and 93.1% would accept another income-generating activity in place of sex work. Conclusion: It is necessary to supervise SWs and protect them within the framework of respect for human rights, rather than criminalizing them and the exploiters flouting their human dignity and putting their lives in danger. .

Herpes Simplex Virus Type 2 Risks in Female Sex Workers in the China-vietnam Border County of Hekou

Objective To survey the prevalence and risk factors of HSV-2 among Chinese and Vietnamese female sex workers （FSW） in the border county of Hekou, Yunnan Province, China. Methods A cross-sectional survey was conducted on demographics, sexual behavior, medical history, and drug use among FSWs. Laboratory samples were obtained to test for HSV-2 and other STIs such as HIV, Syphilis, Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Bacterial vaginosis, and Yeast infections. Cervicitis and genital warts were also diagnosed. Results Of the 345 FSWs who participated in this study, 112 （32.5%） were ethnic Chinese and 233 （67.5） were Vietnamese. Among FSWs in Hekou, the prevalence rates were 58.3% for HSV-2, 5.5% for HIV, and 4.1% for bacterial vaginosis （BV）. Age 〈21 （OR： 0.5; 95% CI： 0.3, 0.8）, duration of commercial sex work 〈3 months （OR： 0.5; 95% CI： 0.3, 0.8）, oral and vaginal sex with the last client （as opposed to only vaginal sex） （OR： 1.6; 95% CI： 1.0, 2.7）, HIV （OR： 11.4; 95% Cl： 1.5, 87.2）, and bacterial vaginosis （BV） （OR 5.6; 95% CI： 1.2, 26.9） were significantly correlated with HSV-2 infection. Conclusion Multivariate analysis showed that several factors were significantly correlated with the high prevalence of HSV-2 in FSWs in the border area between China and Vietnam. Further studies and interventions are needed for HSV-2 epidemiology in the border area.

Reported Willingness and Associated Factors Related to Utilization of Voluntary Counseling and Testing Services by Female Sex Workers in Shandong Province,China

Objective To explore reported willingness and factors associated with utilization of voluntary counseling and testing services by female sex workers （FSWs） in China and to offer recommendations to optimize use of such services. Methods A questionnaire to explore willingness to use VCT was designed based on social ecological theory and formative qualitative research. A cross-sectional survey was conducted among FSWs from entertainment venues. Single and multiple logistic regression analyses were employed to examine factors associated with reported willingness to utilize VCT. Results A total of 970 FSWs provided valid questionnaires, with 69% （669） expressing willingness to utilize VCT. Factors at the interpersonal level associated with reported willingness included knowledge about VCT, desire to get help if diagnosed as HIV positive, ability to imagine life after an HIV positive diagnosis, and perceived support for VCT from peers, managers, and family members. Availability of free antiretroviral （ARV） treatment represented a factor at policy level. Other factors included intention to leave sex work in the near future, having had a previous HIV test, and lack of a suspected STD history. Conclusions The rate of reported willingness to use VCT among FSWs was substantially higher than that of actual VCT utilization （11%）. The next step is to explore the connection between reported willingness and actual use. Based on these findings, peer education, VCT knowledge dissemination, and free ARV treatment should be emphasized to increase FSWs＇ willingness to use VCT.

HIV-infected Female Sex Workers High Risk Behavior and Attitude Changes in Kaiyuan City, Yunnan Province, China

Objective To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future. Methods A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners. Results Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients. Conclusion It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved.

Gonorrhoea among Sex Workers in China: Prevalence, Risk Factors, and Resistance to Antibiotics

Objective To study gonorrhoea among sex workers in China as to prevalence, risk factors, and resistance to antibiotics Subjects & Methods From March 1998 to October 1999, 966 sex workers from Guangzhou were recruited into a sexually transmitted diseases (STD) care and prevention programme through various outreach activities. Data collection was standardized. Cervical samples were tested for the presence of Neisseria (N.) gonorrhoea by culture. The agar dilution method was performed to determine susceptibilities of 85 isolates to penicillin, ciprofloxacin, spectinomycin and ceftriaxone. The production of B-lactamase was determined by paper acidometric testing. Results The prevalence of gonorrhoea was 9%. Independent predictors for the disease were inconsistent condom use, lack of regular salary, absence of a previous STD check-up in the preceding 12 months, and a concurrent trichomoniasis or chlamydial infection. Dysuria, vaginal malodour, and the presence of (muco) purulent discharge at genital examination were also independently associated with gonorrhoea. Of the 85 N. gonorrhoea isolates, 3.5% was penicillinase producing (PPNG) and 7% plasmid-mediated tetracycline resistant (TRNG). Of the non-PPNG strains 74% was insensitive to penicillin, while 52% and 47% were resistant or less susceptible to ciprofloxacin, respectively. One strain exhibited decreased susceptibility to ceftriaxone. All strains were susceptible to spectinomycin. Conclusion A high level of resistance to penicillin and ciprofloxacin was seen, but strains were sensitive to ceftriaxone and spectinomycin. Several personal or medical characteristics were independently associated with the presence of gonorrhoea. Women diagnosed with gonorrhoea should receive concurrent treatment for chlamydial infection.

Female Sex Workers and Their Association with Self-Help Groups in Thane, Maharashtra, India: A Comparative Analysis in the Context of HIV Program Outcome

Objectives: Understanding the role of Self-Help Group (SHG) in light of the evolving dynamics of sex work needs to be delved into to strategize HIV interventions among FSWs in India. This paper aims to study the HIV program outcome among the FSWs associated with SHGs and FSWs not associated with SHGs in Thane, Maharashtra. Study Design: This cross-sectional study was undertaken from the Behavioral Tracking Survey (BTS) conducted among 503 FSWs in Thane in 2015. Two-stage probability based conventional sampling was done for selection of brothel and bar based FSWs, while Time Location Cluster (TLC) sampling was done for home, lodge and street based sex workers. Methods: Bivariate and multivariate logistic regression were performed to compare and contrast between FSWs associated with SHG and those not associated with SHG with respect to the utilization of HIV related services by them. “Condom use”, “consistent condom use”, “contact with peer-educators”, “counseling sessions” and “HIV testing” were chosen as indicators on HIV service utilization. Results: 8% (38) of FSWs are registered with SHG;92% aged ≥25 years, 47% illiterate, and 71% are currently married. The likelihood of utilizing HIV services including, knowledge on HIV/AIDS and its mode of transmission (OR: 5.54;CI: 1.87 - 16.60;p Conclusions: Considering the improved HIV program outcomes among FSWs associated with SHG, HIV interventions among FSWs could consider facilitating the formation of SHGs with FSWs as one of the key strategies to empower the community for ensuring better program outcomes.

Prevalence of HBsAg and Antibodies to Hepatitis C Virus among Female Sex Workers in Bangui

Introduction: Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) infection is a public health problem. Sex workers remain a vulnerable group. Objective: To determine the prevalence of HBsAg and hepatitis C virus (HCV) antibody transport among female sex workers (FSW) in Bangui. Patients and Methods: All FSW carriers of HBsAg and/or anti-HCV Antibodies were collected in a 6-month cross-sectional analytical study. The HBsAg research used the Monolisa HBsAg® (BioMérieux®) technique, sandwich ELISA. HCV serology consisted of the search for anti HCV antibodies by monolisa HCV (BioMérieux®), Elisa of the sandwich type. HIV serology used two Elisa tests (Genscreen® and Vironostika®). Data analysis was done using Epi Info 3.5.1 software. The Chi2 test was used for comparison with a significance level p < 0.05. Results: Among the 345 FSW enrolled, 41 (11.9%) were carriers of HBsAg and 3 (0.8%) had anti HCV antibodies. The mean age was 21.3 years in HBsAg-positive FSW and 25 years in FSW with anti-HCV antibodies. FSW with HBsAg engaged in informal trade (n = 17), prostitution in bars or on the street (n = 15) and prostitution in the city (n = 9). On the other hand, the 3 FSW carrying anti-HCV antibodies were engaged in prostitution in the city. The 41 FSW HBsAg positive and 304 FSW HBsAg negative had at least 3 sexual partners. Anal penetration during sexual intercourse was acknowledged by 20 FSW carrying HBsAg and 101 FSW HBsAg negative (p = 0.0518). Among the 3 FSW (0.8%) carrying anti-HCV antibodies, 2 were carrying HBsAg. HIV serology was positive in 66FSW (19.13%) including 15 FSW coinfected with HIV/HBV (p = 0.0025). Conclusion: The prevalence of hepatitis B is high among FSW. Awareness and prevention action must be taken in favor of this key population.

Risk Factors and Syndromic Management of Sexually Transmitted Infections among Sex Workers in the Kadiolo Circle

Sexually transmitted infections constitute a gateway for the human immunodeficiency virus by the presence of ulcerations and local inflammatory manifestations, thus increasing the risk of transmission. The aim of the study was to assess the sexual behavior and syndromic management of sexual infections among female sex workers in the Kadiolo circle. Material and method: This was a descriptive cross-sectional study carried out in the Kadiolo circle from January 1 to December 31, 2014. It focused on clandestine or posted sex workers, aged 15 and over. Results: We collected 465 sex workers aged 15 and 49, aged 26.6 on average and from Ivory Coast 52%, Nigeria 26.2% and Mali 9.7%. Educational attainment was higher with 2.4%. Posted sex workers represented 92.5% and housed in brothels with a stay of 6 months with 53.3%. They were single with 70.8% of cases and about 72.9% lived alone and without a spouse. The age at first sexual intercourse was between 15 - 19 years with 76.6% of cases. The number of first commercial sex was between 15 - 19 years (26%) and 20 - 24 years (45.8%). Usual condom use with regular sex partners was 22.1%. Condom use was almost compulsory at 89.7% with occasional clients or non-regular sexual partners. The average number of clients per day was five (5). The major reason for consultation was vaginal discharge 16.4% followed by abdominal pain. The human immunodeficiency virus test was not compulsory and only 86 workers or 18.5% accepted with a positive result of 11 people or 12.8% of cases. Conclusion: Sexually transmitted infections are common especially as they affect young people.

Rating of CCR5-Delta 32 Homozygous Mutation in Sudanese HIV Patients and Sex Workers

Background: Prevention against human immunodeficiency virus (HIV) includes natural resistance in the population;mainly frequency of cysteine-cysteine chemokine receptor type-5 (CCR5-delta 32 mutation). By knowing the frequency of this resistance in the community, the proportion of the population susceptible to infection can be determined. This study aimed to detect for the first time the rate of CCR5-delta 32 mutation in Sudanese individuals with HIV and sex workers. Methods: Cross-sectional study was followed in the parade from 2019 through 2021, study groups were Sudanese with HIV and sex workers. Sero-negativity of sex workers was confirmed by a rapid immunochromatography test (ICT). A blood sample was targeted for DNA isolation. PCR amplification was accomplished for CCR5 wild type and CCR5-delta 32 mutation genes using specific primers. Result: Among HIV patients, males, basic education level and ages below 60 years were commonly recorded while ages below 40 years, secondary education level and single marital status were predominated in sex workers. All HIV patients were positive for CCR5 wild type and negative for CCR5-delta 32 genotype. The sex workers group showed a frequency of 3.5% (97/200) for homozygous CCR5-delta 32 mutation. Conclusion: The rating of homozygous CCR5-delta 32 genotype in studied Sudanese sex workers was relatively more than other results obtained from African countries, and the mutation was significantly detected among sex workers group (P value = 0.008) when compared to the studied HIV group.

Herpes Simplex Virus Type 2 (HSV-2) and HTLV-1 &2 among Female Sex Workers in Ouagadougou, Burkina Faso

Background: Herpes Simplex Virus type-2 (HSV-2) infection is one of the most common worldwide sexually transmitted and female sex workers are most at risk for these infections. Beside HSV-2, Human T-lymphotropic virus (HTLV) is one of these infections with a high risk of sexual transmission. HTLV-1 causes T-cell leukaemia and myelopathy. Little is known about the HSV-2, HTLV-1 and HTLV-2 infections among female sex workers in West Africa in general, and particularly in Burkina Faso. The aim of this study aimed to estimate HSV-2 and HTLV-1/2 seroprevalence among female sex workers, in Ouagadougou in order to inform HIV prevention programs. Methods: Archived sera samples of a biological and behavioral cross-sectional study among female sex workers (FSWs) in Ouagadougou were tested for HSV-2 and HTLV-1/2. Sera samples collected from February to May 2013 were previously tested for HIV and syphilis and stored with participants’ additional consent for further infection testing. Antibodies against HSV-2 and HTLV-1/2 detection tests were performed using Enzyme-Linked Immuno-Sorbent Assay (ELISA) methods. Results: HSV-2 seroprevalence was approximately 75.7% (95% CI: 70.8-79.9) among FSWs. It ranged from 69.3% among FSWs under 24 years of age, to 88.5% among those who were at least 30 years old. Furthermore, HSV-2 seroprevalence was high among FSW with no formal education (87.7%) and decreased significantly among those with at least primary education (76.0%) and others with secondary education and above (64.9%). Regarding HTLV-1/2, 11.2% (95% CI: 8.3 - 15.1) of FSWs were positive. By age group, 11.8% were positive among FSWs under 25 years of age;15.2% among those 25 to 29 years of age, and 5.8% among those over 30 years of age. Conclusion: HSV-2 and HTLV-1&2 infections are common among FSWs, which confirms the need for effective and preventive interventions such as sex education and early screening.

HIV/AIDs Risk Perception and Sexual Behavior among Commercial Female Sex Worker in Thailand

Background: Commercial female sex workers (CFSWs) are considered a high-risk group for HIV/AIDs. The prevalence of HIV/AIDs trends to increase among those groups also in Thailand. An adequate perception of the degree to which one is at risk of having HIV is necessary for behavioral change and of safe behaviors. HIV/AIDs risk perception among CFSWs was needed to reduce HIV/AIDs infection. Methods: A cross-sectional study was conducted among 141 CFSWs in Bangkok, Thailand. Participants were selected using convenient and purposive sampling methods for January to October 2019. Self-access questionnaire was used for collecting data with the reliability testing of 0.82. Logistic regression employed to identify adjusted odd ratio between demographic data, sexual behaviors and HIV/AIDs risk perception, p-value less than 0.05 was considered statistically significant. Results: 51.77% of CFSWs perceived themselves at high risk for HIV/AIDs infection. Most CFSWs reported that they did not consistently use condom (57.45%), factors associated with perception risk of HIV/AIDs including education level (adjusted OR = 2.23, 95% CI = 1.07 - 4.54), knowledge of HIV and STDs (adjusted OR = 3.65 and 3.22. 95% CI = 1.89 - 3.91), Condom use (adjusted OR = 2.56, 95% CI = 1.05 - 2.90) years engaged in sex work, age of initiating in sex work, frequency of sex work in the last month and unplanned sex work were significant with risk perception of HIV/AIDs (adjusted OR = 3.33, 2.71, 2.67, 2.56 and 95% CI = 1.99 - 3.84, 1.72 - 3.32, 1.29 - 3.12, 1.05 - 2.78 respectively), and had HIV/STDs test (adjusted OR = 3.22, 95% CI = 2.11 - 3.95). Other used illicit drugs by injection, smoking and alcohol consumption had a strong association with the high perception of HIV/AIDs among CFSWs. Conclusion: Majority of CFSWs with risky sexual behaviors had a high HIV/AIDs risk perception. Effective educational programmes are necessary to enable CFSWs to correctly assess their own HIV/AIDs risk and change risk behaviors based on self-assessment of actual risk.

Impact of TI Programmes Intervention under National AIDS Control Programme among Female Sex Workers in India: Evidence from Integrated Biological and Behavioural Survey, 2014-15

Background: A better understanding of the impact of Targeted Interventions (TI) services on Female Sex Worker (FSW) behaviours can help in informing and strengthening future TI efforts under National AIDS Control Programme (NACP). Methods: National Integrated Biological and Behavioural Survey (IBBS) 2014-15 has been analysed in the paper. Descriptive statistics and logistic regression analysis were used to understand factors affecting condom use. Propensity score matching (PSM) was done to understand the impact of the TI services on condom use at the last act and consistent condom use in the last three months among FSWs. Results: Younger FSWs aged 15 - 25 years were 1.4 times (95% CI: 1.04 - 1.77) more likely to use consistent condoms in the last three months compared to older over 45 years after controlling for other socio-economic and programme variables. The matched samples estimate ATET i.e. the average treatment effect on treated for consistent condom use in the last three months shows that a 6.0% (CI: 4.7 - 7.3) increase in consistent condom use in the last three months in the FSWs who received information on STI/HIV from peer educator and outreach worker. There is also a 6.0% (4.7 - 7.2) increase in condom use in the last act for FSWs who received the referral services at STI clinics, HIV testing, and detox centres. Conclusions: It is evident that the TI programme has a positive impact on behavior change among FSWs which can prove beneficial to curtail the spread of HIV to the partners and onward transmission to the general population.

Differences of HIV/AIDS Related Knowledge,Attitudes and Practices Between Commercial Sex Workers and Their Clients

Objective: To compare the HIV/AIDS related knowledge,attitudes and pratices (KAP) among the commercial sex workers (CSWs) with that of their clients in Shenzhen. Methods: A total of 124 female CSWs and 155 men,detained for selling or purchasing sexual services, were interviewed using a structured questionnaire. Results: CSWs scored higher than their clients on AIDS/HIV knowledge scores, though the difference was not significant and both groups only scored near 50%. ""Almost always""condom use rates were significantly higher for CSWs. Most of the women but fewer men knew condom use could prevent HIV/AIDS infection. The main reason for not using condoms among the women was the unwillingness of their customers. A higher proportion of the CSWs (9.7%) than men (2.6%) had ever used illegal drugs. The mean age of first sexual intercourse (18.2±2.1) and first commercial sex (20.2±3.9)among the CSWs were lower than that of the men (22.2±0.3and 27.1 ± 0.6, respectively). Conclusion: New health education programs promoting condom use should be developed to raise awareness about HIV/AIDS, particularly among men. CSWs and clients are high-risk groups for HIV/AIDS infection and transmission.

STUDY ON HIV/STDS KNOWLEDGE AND RISK BEHAVIORS RELATED FACTORS AMONG FEMALE SEX WORKERS IN SHANGHAI,CHINA

Objective To assess the HIV/STDs knowledge and risk behaviors related factors among female sex workers(FSWs)in Shanghai,China.Methods A cross-sectional study was conducted in 5 districts(including 3 suburbs and 2 urban districts).A total of 324 FSWs from 88 massage parlors and hair-beauty salons participated in the survey.An interviewer-administrated questionnaire was used to collect information.Results The average score of HIV/STDs knowledge was 15.2±3.9.Multivariate analyses indicated that limited education [odds ratio(OR):8.6,95% confidence interval(CI):2.9-25.6],coming from suburbs [odds ratio(OR):3.7,95% confidence interval(CI):2.0-6.8],monthly income less than 1500 RMB(220 US$)[odds ratio(OR):3.9,95% confidence interval(CI):1.9-8.1],without HIV/STDs-related education experience(OR:5.2,95% CI:2.8-9.5),and coming from provinces of low epidemic(OR:2.7,95% CI:1.1-6.6)were significant predictors of lower HIV/STDs knowledge.And 29.5% FSWs had sex without a condom when clients paid much more money,and 46.3% had the experience of condom broke or slipped during commercial sexual intercourse.Conclusion Health promotion should be conducted to enhance HIV/STDs knowledge and reduce risk behaviors among FSWs from suburbs with limited education in Shanghai especially.

Are Truckers Being over Stigmatized as HIV Carriers in India? Evidences from Behavioral and Biological Cross-Sectional Surveys among Clients of Female Sex Workers

This paper examines whether truckers have been over-stigmatized as HIV carriers in the country. Data were taken from cross-sectional surveys of clients of female sex workers conducted in 2006-2007 in 12 districts of the country. A total 4822 clients of female sex workers were covered in the survey. Low-income skilled/semi-skilled men, including non-agricultural/casual labor, and petty businessmen/small shop owners, have the largest share in the clients’ population. There was no significant difference between truckers and other sub-group of clients’ population in terms of consistent condom use with female sex workers and prevalence of HIV or STI. These evidences suggest that the contribution of truckers in HIV epidemic in India might to similar to other sub-groups of clients’ population. Thus, truckers might have been over-stigmatized as HIV carriers in the country. However, there is no doubt that truckers constitute an extremely important target group for the HIV prevention programs and these efforts must be continued to prevent new HIV infections in the country.

Impact of an HIV Prevention Intervention on HIV Risk Behavior and Sexually Transmitted Infection among Female Sex Workers in Tamil Nadu, India

Background: In 2003 a large-scale HIV prevention program was launched for key populations in six high HIV prevalence states of India. This paper assesses the effect of exposure to the intervention on condom use with commercial clients and experiences of sexually transmitted infection (STI) among female sex workers (FSWs) in Tamilnadu, a southern Indian state, between 2006 and 2009. Methods: Data were drawn from two rounds of cross-sectional surveys conducted in 2006 (N = 2010) and 2009 (N = 2500) among FSWs in Tamilnadu, recruited through probability-based sampling. A series of multivariate logistic regression models were constructed to examine the association between exposure to the intervention and change over time with condom use and self-reported STI. All the analyses were performed using STATA 11.1. Results: Overall, 48% of FSWs in 2006 and 90% in 2009 reported exposure to the intervention. Compared to 2006, there was a considerable increase in the proportion of FSWs reporting consistent condom use with regular and occasional clients at follow-up (2009). Further, the increase in consistent condom use over time with occasional (adjusted OR = 3.53, 95% CI: 2.47 - 5.05) and regular clients (adjusted OR = 4.97, 95% CI: 3.43 - 7.16) was significantly higher among FSWs exposed to the intervention than those not exposed. Additionally, a significant decline was observed in self-reported STI overtime among FSWs exposed to the intervention compared to their counterparts (adjusted OR = 0.39, 95% CI: 0.26 - 0.59). Conclusion: The HIV prevention program in Tamilnadu resulted in increased consistent condom use and a decrease in self-reported STI among FSWs exposed to intervention. These findings suggest that HIV prevention programs should aim to saturate coverage among key populations to sustain the gains achieved.

Heightened risk of unintended pregnancy among sex workers and sex worker organizations’response during the stringent COVID-19 containment measures in East and Southern Africa

The UNFPA 2022 State of the World Population(SWOP)report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy,but did not adequately address the grave situation of female sex work­ers(FSWs),who experience the worst sexual and reproductive health outcomes,especially during humanitarian crises.This study assesses the risks of unintend­ed pregnancy among FSWs and sex worker organizations?response during the stringent COVID-19 containment measures in East and Southern Africa(ESA).A mixed-methods approach consisting of a desk review,key informant interviews and an online survey was used for data collection.Key informants and survey re­spondents included representatives of sex worker-led organisations and networks,organisations providing services to sex workers,development partners,advocacy organisations and donors,with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic.In total,21 key informants were interviewed and 69 respondents participated in the online survey,with representation from 14 out of 23 countries in the ESA region.The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers’access to contraception and risk of unintended pregnancy.Look­ing to the uncertain future of humanitarian crises,the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions,such as sex workers.

HIV and syphilis infections among street-based female sex workers in China, 2010-2012

Background Female sex workers （FSW） were high-risk population for HIV and other sexually transmitted diseases （STD） earlier,and now are an important driver of the HIV/AIDS epidemic in China.Sentinel surveillance for FSW was set up to monitor the trend of HIV prevalence and risk behavior-related HIV infection.This study collected the data on street-based FSW from HIV sentinel surveillance system to understand HIV and syphilis infections,risk behaviors,and intervention in China from 2010 to 2012.Methods The study population was the street-based FSW who were recruited for the national HIV integrated biological and behavioral surveillance between 2010 and 2012.Demographic information,HIV-related risk behaviors,and HIV and syphilis testing results were described and trend analysis was performed.Results Between 2010 and 2012,the number of street-based FSW surveyed was 3725,3425,and 3335,respectively.HIV knowledge awareness rate significantly increased from 74.6% in 2010 to 76.8% in 2011 and 82.2% in 2012 （P 〈0.01）.More FSW consistently used condom in the last month （49.0% in 2010; 51.0% in 2011; and 59.0% in 2012） and in the last commercial sex （72.0% in 2010; 78.5% in 2011; and 80.0% in 2012） over time.The proportions of individuals who received HIV testing in the last year were 31.2% （2010）,37.0% （2011）,and 36.9% （2012） （P-trend 〈0.01）.HIV prevalence rate changed from 1.5% in 2010 to 1.4% in 2011 and 2.3% in 2012 （P-trend=0.01）.Syphilis prevalence rate was 6.9%,7.2%,and 7.1% in the same period.The top three provinces with the highest average HIV prevalence rates over the 3 years were Guangxi （5.9%）,Yunnan （4.2%）,and Sichuan （1.2%）.Conclusions Street-based FSW are at high risk of HIV and syphilis infections.Intervention efforts need to target streetbased FSW who are of old age and minority,who use illicit drugs and have syphilis infection.

A community-based comprehensive intervention to reduce syphilis infection—among low-fee female sex workers in China:a matched-pair,community-based randomized study

Background:Low-fee female sex workers(FSWs)are at high risk of acquiring and spreading human immunodeficiency virus(HIV)/sexually transmitted diseases(STDs)in China.There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections.Thus,this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair,comiDunity-based randomized intervention trial carried out in 12 cities in three provinces in China.Methods:Four cities from Guangxi Zhuang Autonomous Region,four from Yunnan Province,and four from Hunan Province were paired and participants received either the intervention package(including condom promotion,HIV and syphilis testing,reimbursement for syphilis treatment costs,and free anti-retroviral therapy or the current standard of care.Venue-based,convenience sampling was used to recruit FSWs.A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months.Generalized linear mixed models(GLMM)were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.Results:A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up.GLMM results showed that syphilis infeaion was reduced by 49%in the intervention group compared to the current standard of care group(P=0.0378,OR=0.51;95%CI:0.27-0.96).FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old(P<0.0001,OR=2.38,95%CI:1.55-3.65).The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education(P<0.05,OR=0.43,95%CI:0.63-0.93).Conclusions:This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs.Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.Trial registration:CHiCTR-TRC-12002655.