An Evaluation of STD/AIDS Health Education among Female Sex Workers in Entertainment Establishments in Jingjiang City

Objective: To explore effective ways of conducting STD/AIDS health education among female commercial sex workers in entertainment establishments and to promote implementation of an 100% condom use programme. Methods: In-depth interviews were carried out to collect qualitative information about demographic characteristics, STD/AIDS knowledge, attitude and risk behaviors of female sex workers. Female sex workers were selected by sampling and were given baseline survey and assessment after intervention. Based on the results of the interviews, a questionnaire was developed, and intervention measures were determined. These measures included face-to-face interviewing, counseling, and distribution of STD/AIDS information and condoms. Results: 196 and 182 female sex workers of the same population were interviewed separately before and after intervention. STDs/AIDS knowledge had significantly increased after one year's intervention (P <0.01). Knowledge increased in both the intervention group and the non-intervention group but the increase was more significant among sex workers who received the intervention. Risk behaviors remained at baseline levels in both groups. Conclusion: STD/AIDS health education among female sex workers in entertainment establishments was effective and may benefit society, but the strategies need to be adjusted to the female sex workers' lifestyles, particularly their high rates of mobility and high-risk behaviors.

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.

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.

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.

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.

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.

Increasing age and duration of sex work among female sex workers in South Africa and implications for HIV incidence estimation:Bayesian evidence synthesis and simulation exercise

Introduction:In sub-Saharan Africa,accurate estimates of the HIV epidemic in female sex workers are crucial for effective prevention and care strategies.These estimates are typically derived from mathematical models that assume certain demographic and behavioural characteristics like age and duration of sex work to remain constant over time.We reviewed this assumption for female sex workers in South Africa.Methods:We reviewed studies that reported estimates on either the age or the duration of sex work among female sex workers in South Africa.We used Bayesian hierarchical models to synthesize reported estimates and to study time trends.In a simulation exercise,we also investigated the potential impact of the"constant age and sex work duration"-assumption on estimates of HIV incidence.Results:We included 24 different studies,conducted between 1996 and 2019,contributing 42 estimates on female sex worker age and 27 estimates on sex work duration.There was evidence suggesting an increase in both the duration of sex work and the age of female sex workers over time.According to the fitted models,over each decade the expected duration of sex work increased by 55.6%(95%-credible interval[CrI]:23.5%–93.9%)and the expected age of female sex workers increased by 14.3%(95%-CrI:9.1%–19.1%).Over the 23-year period,the predicted mean duration of sex work increased from 2.7 years in 1996 to 7.4 years in 2019,while the predicted mean age increased from 26.4 years to 32.3 years.Allowing for these time trends in the simulation exercise resulted in a notable decline in estimated HIV incidence rate among sex workers over time.This decline was significantly more pronounced than when assuming a constant age and duration of sex work.Conclusions:In South Africa,age and duration of sex work in female sex workers increased over time.While this trend might be influenced by factors like expanding community mobilization and improved rights advocacy,the ongoing criminalisation,stigmatisation of sex work and lack of alternative employment opportunities could also be contributing.It is important to account for these changes when estimating HIV indicators in female sex workers.

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. .

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.

Correlates of HIV self-testing among female sex workers in China: implications for expanding HIV screening

Background:Human immunodefciency virus(HIV)self-testing may help improve test uptake among female sex workers.China has implemented many HIV self-testing programs among men who have sex with men,creating an opportunity for promotion among female sex workers.However,there is a limited literature on examining HIV selftesting among female sex workers.This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China.Methods:A venue-based,cross-sectional study was conducted among Chinese female sex workers in 2019.Participants completed a survey including social-demographic characteristics,sexual behaviors,and HIV self-testing history,the distribution of which were analyzed using descriptive analysis.Multivariable logistic regression was conducted to identify associations with HIV self-testing.Results:Among 1287 Chinese female sex workers,1072(83.3%,95%confdence interval[CI]81.2-85.3%)had ever tested for HIV,and 103(8.0%,95%CI 6.6-9.6%)had ever used HIV self-testing.More than half reported that the selftest was their frst HIV test(59.2%,61/103),around one-ffth reported HIV self-testing results infuenced the price of sex(21.4%,22/103).A minority of individuals reported ever experiencing pressure to undertake HIV self-testing(6.8%,7/103).After adjusting for covariates,HIV self-testing was positively associated with receiving anal sex in the past month(adjusted odds ratio[aOR]=2.2,95%CI 1.4-3.5),using drugs before or during sex(aOR=2.8,95%CI 1.8-4.5),injecting drugs in the past 6 months(aOR=2.6,95%CI 1.2-6.0),being diagnosed with other sexually transmitted infections(aOR=1.6,95%CI 1.0-2.5),tested for other sexually transmitted infections in the past six months(aOR=3.4,95%CI 2.1-5.5),ever tested in the hospital(aOR=3.4,95%CI 2.0-5.6),and ever tested in the community(aOR=1.5,95%CI 1.2-1.9).Conclusions:Our fndings suggest that HIV self-testing could expand overall HIV testing uptake,increase HIV testing frequency,reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers.HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.

Evaluation of an HIV-related behavior change project for female sex workers in Central China

Background As female sex workers （FSWs） were becoming the driving force behind the HIV epidemic in Central China, a project to promote condom use by FSWs was implemented from 2004 to 2009. In this study, we discussed the evaluation of the project, the factors associated with condom use among FSWs within the Chinese context, and proposed suggestions for future interventions for FSWs in China. Methods Two surveys using structured questionnaires were conducted in 2004 and 2009. Data collected from the surveys were analyzed and guided by a behavior change framework. We reviewed relevant articles to supplement the information that was not able to be obtained from the surveys. Results In general, the HIV prevalence among FSWs remained low （less than 1%） in the 5 years. With a high coverage of interventions for all FSWs in Central China, the project yielded better outcomes than the national average over the same time period. The awareness about HIV and condom use grew dramatically during the project period. The four factors/ determinants that influence the behavior of FSWs using condoms are population characteristics, opportunity, ability, and motivation. Statistical model shows that the significant variables for using a condom are age, availability of services, HIV- related knowledge, and intention. Conclusions With a high coverage of interventions for FSWs, the project achieved its goals. The differences among workplaces of FSWs may serve as a symbol of their socioeconomic status, patterns of condom use, and therefore risks of acauirina HIV.

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.

Risk factors of sexually transmitted infections among female sex workers in Republic of Korea

Background:Female sex workers(FSW)who live in urban areas in Republic of Korea have a particularly high risk of sexually transmitted diseases(STD).We investigated the prevalence of s STDs in FSWs in order to determine the factors associated with sexually transmitted infections in Korea.Methods:Study data were collected from 832 FSWs through a 2014 survey on the prevalence of STDs in high risk populations in Republic of Korea.We assessed the associations between sexually transmitted infections and demographic and risk behaviour variables through logistic regression analysis.Results:The risk probability of sexually transmitted infection was higher for those who drank alcohol often as well as those who had their first sexual experience at an early age.However,the effects of these factors were attenuated by working conditions.The risk probability of sexually transmitted infections was higher for those who engaged in sex with several customers per day as well as for those who did not practice regular condom use.Conclusions:The risk factors for sexually transmitted infections among FSWs in Republic of Korea are related to and affected by working conditions.Thus,multifaceted health interventions to protect FSWs and their sexual health are deemed necessary.

Sexual Behavior and Awareness of Sexually Transmitted Diseases Among Street-Based Female Sex Workers in the Florence Area, Central Italy

Objective:Street-based female sex workers are more likely to practice unprotected sex with multiple partners increases their risk of infection with sexually transmitted diseases.This study was performed to evaluate the understanding of and risk factors for sexually transmitted diseases among street-based female sex workers.Methods:A survey consisted of a sociodemographic section and a health section was conducted from June to August in two consecutive years(2012-2013)using an anonymous questionnaire compiled by street-based female sex workers in the area of Florence(Central Italy).A descriptive analysis of sociodemographic,epidemiological,and anamnestic variables was performed using common methods for proportions;associations between variables were assessed using univariate and bivariate logistic regression.Results:Totally 122 street-based female sex workers(mean age,24.1 years;age range,17-45 years)were enrolled,and were from Europe(63.1%)(mainly from Romania[48.4%]and Albania[13.1%]),Africa(31.2%)(specifically Nigeria),and South America(5.7%).Of the 122 street-based female sex workers,63%were married/engaged and 37%were single.More than half had been living in Italy and Florence for more than 1 year;72.8%stated that they possessed a residence permit and the others were illegal migrants.Eighteen(15%)street-based female sex workers also worked in the industry in neighboring European countries.Their level of education was generally high:58.1%had completed secondary school(lower secondary school and upper secondary school).A total of 81.4%stated that they perceived an actual fear of contracting human immunodeficiency virus;in fact,43.3%had never been tested for any sexually transmitted diseases except for human immunodeficiency virus.Conclusion:Despite the long-time involvement of street-based female sex workers in the commercial sex industry,the large numbers of clients and a strong perception of concerns about sexually transmitted diseases.This study confirms a low rate of condom use and blood screening,and corresponding science education and health screening efforts need to be strengthened in this high risk population.

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.

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.

Modelling Key Population Attrition in the HIV and AIDS Programme in Kenya Using Random Survival Forests with Synthetic Minority Oversampling Technique-Nominal Continuous

HIV and AIDS has continued to be a major public health concern, and hence one of the epidemics that the world resolved to end by 2030 as highlighted in sustainable development goals (SDGs). A colossal amount of effort has been taken to reduce new HIV infections, but there are still a significant number of new infections reported. HIV prevalence is more skewed towards the key population who include female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). The study design was retrospective and focused on key population enrolled in a comprehensive HIV and AIDS programme by the Kenya Red Cross Society from July 2019 to June 2021. Individuals who were either lost to follow up, defaulted (dropped out, transferred out, or relocated) or died were classified as attrition;while those who were active and alive by the end of the study were classified as retention. The study used density analysis to determine the spatial differences of key population attrition in the 19 targeted counties, and used Kilifi county as an example to map attrition cases in smaller administrative areas (sub-county level). The study used synthetic minority oversampling technique-nominal continuous (SMOTE-NC) to balance the datasets since the cases of attrition were much less than retention. The random survival forests model was then fitted to the balanced dataset. The model correctly identified attrition cases using the predicted ensemble mortality and their survival time using the estimated Kaplan-Meier survival function. The predictive performance of the model was strong and way better than random chance with concordance indices greater than 0.75.