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. 1997 Jun;73(3):161–168. doi: 10.1136/sti.73.3.161

Sex workers and the control of sexually transmitted disease.

S Day 1, H Ward 1
PMCID: PMC1195814  PMID: 9306894

Abstract

OBJECTIVES: To describe and assess measures to control sexually transmitted diseases (STDs) among sex workers and their partners. METHODS: A review of medical, historical and social literature, focusing on selected cases. RESULTS: Measures to control disease in sex workers today are often prompted by concerns about HIV transmission. However, the literature shows that prostitution varies from one place and time to another, together with the risk of sexually transmitted disease. A broad social definition of prostitution rather than a narrow reference to levels of sexual activity is important for effective disease control, as an understanding of the relation between social disadvantage and sexual activity enables the provision of occupational services that sex workers actually want and use. Social prejudice and legal sanctions cause some sex workers and their partners to avoid even the most appropriate and accessible specialist services. Therefore targeted programmes can only complement, and not replace, general measures to control STDs, which are developed for other social groups or the local population as a whole. CONCLUSIONS: Sex workers and sex work differ from one place to another and so a single model for STD control is inappropriate. None the less, occupational health risks suggest a general need for specialist services. Where these do not compound the disadvantages that sex workers already suffer, medical services are likely to offer significant benefits in prevention, early diagnosis, and treatment of STDs. As the stigma of prostitution leads many people to remain invisible to services, a general health infrastructure and anti-discriminatory measures will be equally important to effective disease control.

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Selected References

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  1. Andrus J. K., Fleming D. W., Harger D. R., Chin M. Y., Bennett D. V., Horan J. M., Oxman G., Olson B., Foster L. R. Partner notification: can it control epidemic syphilis? Ann Intern Med. 1990 Apr 1;112(7):539–543. doi: 10.7326/0003-4819-112-7-539. [DOI] [PubMed] [Google Scholar]
  2. Asamoah-Adu A., Weir S., Pappoe M., Kanlisi N., Neequaye A., Lamptey P. Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana. AIDS. 1994 Feb;8(2):239–246. doi: 10.1097/00002030-199402000-00012. [DOI] [PubMed] [Google Scholar]
  3. Bhave G., Lindan C. P., Hudes E. S., Desai S., Wagle U., Tripathi S. P., Mandel J. S. Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India. AIDS. 1995 Jul;9 (Suppl 1):S21–S30. [PubMed] [Google Scholar]
  4. Blackmore C. A., Limpakarnjanarat K., Rigau-Pérez J. G., Albritton W. L., Greenwood J. R. An outbreak of chancroid in Orange County, California: descriptive epidemiology and disease-control measures. J Infect Dis. 1985 May;151(5):840–844. doi: 10.1093/infdis/151.5.840. [DOI] [PubMed] [Google Scholar]
  5. Cameron D. W., Simonsen J. N., D'Costa L. J., Ronald A. R., Maitha G. M., Gakinya M. N., Cheang M., Ndinya-Achola J. O., Piot P., Brunham R. C. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. doi: 10.1016/s0140-6736(89)90589-8. [DOI] [PubMed] [Google Scholar]
  6. Campbell C. A. Prostitution, AIDS, and preventive health behavior. Soc Sci Med. 1991;32(12):1367–1378. doi: 10.1016/0277-9536(91)90197-k. [DOI] [PubMed] [Google Scholar]
  7. Celentano D. D., Akarasewi P., Sussman L., Suprasert S., Matanasarawoot A., Wright N. H., Theetranont C., Nelson K. E. HIV-1 infection among lower class commercial sex workers in Chiang Mai, Thailand. AIDS. 1994 Apr;8(4):533–537. doi: 10.1097/00002030-199404000-00018. [DOI] [PubMed] [Google Scholar]
  8. D'Costa L. J., Plummer F. A., Bowmer I., Fransen L., Piot P., Ronald A. R., Nsanze H. Prostitutes are a major reservoir of sexually transmitted diseases in Nairobi, Kenya. Sex Transm Dis. 1985 Apr-Jun;12(2):64–67. doi: 10.1097/00007435-198504000-00002. [DOI] [PubMed] [Google Scholar]
  9. Dallabetta G. A., Miotti P. G., Chiphangwi J. D., Liomba G., Canner J. K., Saah A. J. Traditional vaginal agents: use and association with HIV infection in Malawian women. AIDS. 1995 Mar;9(3):293–297. [PubMed] [Google Scholar]
  10. Day S., Ward H., Perrotta L. Prostitution and risk of HIV: male partners of female prostitutes. BMJ. 1993 Aug 7;307(6900):359–361. doi: 10.1136/bmj.307.6900.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. De Cock K. M., Porter A., Odehouri K., Barrere B., Moreau J., Diaby L., Kouadio J. C., Heyward W. L. Rapid emergence of AIDS in Abidjan, Ivory Coast. Lancet. 1989 Aug 19;2(8660):408–411. doi: 10.1016/s0140-6736(89)90590-4. [DOI] [PubMed] [Google Scholar]
  12. Djomand G., Greenberg A. E., Sassan-Morokro M., Tossou O., Diallo M. O., Ekpini E., Ghys P., Soro B., Brattegaard K., Yapi A. The epidemic of HIV/AIDS in Abidjan, Côte d'Ivoire: a review of data collected by Projet RETRO-CI from 1987 to 1993. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Nov 1;10(3):358–365. [PubMed] [Google Scholar]
  13. Edlin B. R., Irwin K. L., Faruque S., McCoy C. B., Word C., Serrano Y., Inciardi J. A., Bowser B. P., Schilling R. F., Holmberg S. D. Intersecting epidemics--crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994 Nov 24;331(21):1422–1427. doi: 10.1056/NEJM199411243312106. [DOI] [PubMed] [Google Scholar]
  14. Elias C. J., Heise L. L. Challenges for the development of female-controlled vaginal microbicides. AIDS. 1994 Jan;8(1):1–9. doi: 10.1097/00002030-199401000-00002. [DOI] [PubMed] [Google Scholar]
  15. Elifson K. W., Boles J., Sweat M. Risk factors associated with HIV infection among male prostitutes. Am J Public Health. 1993 Jan;83(1):79–83. doi: 10.2105/ajph.83.1.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Faugier J., Cranfield S. Reaching male clients of female prostitutes: the challenge for HIV prevention. AIDS Care. 1995;7 (Suppl 1):S21–S32. doi: 10.1080/09540129550126795. [DOI] [PubMed] [Google Scholar]
  17. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  18. Hanenberg R. S., Rojanapithayakorn W., Kunasol P., Sokal D. C. Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet. 1994 Jul 23;344(8917):243–245. doi: 10.1016/s0140-6736(94)93004-x. [DOI] [PubMed] [Google Scholar]
  19. Heise L. L., Elias C. Transforming aids prevention to meet women's needs: a focus on developing countries. Soc Sci Med. 1995 Apr;40(7):931–943. doi: 10.1016/0277-9536(94)00165-p. [DOI] [PubMed] [Google Scholar]
  20. Kane S. C. Prostitution and the military: planning AIDS intervention in Belize. Soc Sci Med. 1993 Apr;36(7):965–979. doi: 10.1016/0277-9536(93)90088-l. [DOI] [PubMed] [Google Scholar]
  21. Kreiss J. K., Koech D., Plummer F. A., Holmes K. K., Lightfoote M., Piot P., Ronald A. R., Ndinya-Achola J. O., D'Costa L. J., Roberts P. AIDS virus infection in Nairobi prostitutes. Spread of the epidemic to East Africa. N Engl J Med. 1986 Feb 13;314(7):414–418. doi: 10.1056/NEJM198602133140704. [DOI] [PubMed] [Google Scholar]
  22. Kreiss J., Ngugi E., Holmes K., Ndinya-Achola J., Waiyaki P., Roberts P. L., Ruminjo I., Sajabi R., Kimata J., Fleming T. R. Efficacy of nonoxynol 9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. JAMA. 1992 Jul 22;268(4):477–482. [PubMed] [Google Scholar]
  23. Kunawararak P., Beyrer C., Natpratan C., Feng W., Celentano D. D., de Boer M., Nelson K. E., Khamboonruang C. The epidemiology of HIV and syphilis among male commercial sex workers in northern Thailand. AIDS. 1995 May;9(5):517–521. [PubMed] [Google Scholar]
  24. Laga M., Alary M., Nzila N., Manoka A. T., Tuliza M., Behets F., Goeman J., St Louis M., Piot P. Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers. Lancet. 1994 Jul 23;344(8917):246–248. doi: 10.1016/s0140-6736(94)93005-8. [DOI] [PubMed] [Google Scholar]
  25. Laga M., Manoka A., Kivuvu M., Malele B., Tuliza M., Nzila N., Goeman J., Behets F., Batter V., Alary M. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan;7(1):95–102. doi: 10.1097/00002030-199301000-00015. [DOI] [PubMed] [Google Scholar]
  26. Laga M., Nzila N., Goeman J. The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa. AIDS. 1991;5 (Suppl 1):S55–S63. [PubMed] [Google Scholar]
  27. Lurie P., Fernandes M. E., Hughes V., Arevalo E. I., Hudes E. S., Reingold A., Hearst N. Socioeconomic status and risk of HIV-1, syphilis and hepatitis B infection among sex workers in São Paulo State, Brazil. Instituto Adolfo Lutz Study Group. AIDS. 1995 Jul;9 (Suppl 1):S31–S37. [PubMed] [Google Scholar]
  28. Lurie P., Hintzen P., Lowe R. A. Socioeconomic obstacles to HIV prevention and treatment in developing countries: the roles of the International Monetary Fund and the World Bank. AIDS. 1995 Jun;9(6):539–546. doi: 10.1097/00002030-199506000-00002. [DOI] [PubMed] [Google Scholar]
  29. Martin H. L., Jr, Jackson D. J., Mandaliya K., Bwayo J., Rakwar J. P., Nyange P., Moses S., Ndinya-Achola J. O., Holmes K., Plummer F. Preparation for AIDS vaccine evaluation in Mombasa, Kenya: establishment of seronegative cohorts of commercial sex workers and trucking company employees. AIDS Res Hum Retroviruses. 1994;10 (Suppl 2):S235–S237. [PubMed] [Google Scholar]
  30. Mastro T. D., Limpakarnjanarat K. Condom use in Thailand: how much is it slowing the HIV/AIDS epidemic? AIDS. 1995 May;9(5):523–525. [PubMed] [Google Scholar]
  31. McKeganey N. P. Prostitution and HIV: what do we know and where might research be targeted in the future? AIDS. 1994 Sep;8(9):1215–1226. doi: 10.1097/00002030-199409000-00002. [DOI] [PubMed] [Google Scholar]
  32. Morse E. V., Simon P. M., Osofsky H. J., Balson P. M., Gaumer H. R. The male street prostitute: a vector for transmission of HIV infection into the heterosexual world. Soc Sci Med. 1991;32(5):535–539. doi: 10.1016/0277-9536(91)90287-m. [DOI] [PubMed] [Google Scholar]
  33. Moses S., Manji F., Bradley J. E., Nagelkerke N. J., Malisa M. A., Plummer F. A. Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya. Lancet. 1992 Aug 22;340(8817):463–466. doi: 10.1016/0140-6736(92)91778-7. [DOI] [PubMed] [Google Scholar]
  34. Moses S., Plummer F. A., Ngugi E. N., Nagelkerke N. J., Anzala A. O., Ndinya-Achola J. O. Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS. 1991 Apr;5(4):407–411. [PubMed] [Google Scholar]
  35. Nelson K. E., Beyrer C., Natpratan C., Eiumtrakul S., Celentano D. D., Khamboonruang C. Preparatory studies for possible HIV vaccine trials in northern Thailand. AIDS Res Hum Retroviruses. 1994;10 (Suppl 2):S243–S246. [PubMed] [Google Scholar]
  36. North R. L., Rothenberg K. H. Partner notification and the threat of domestic violence against women with HIV infection. N Engl J Med. 1993 Oct 14;329(16):1194–1196. doi: 10.1056/NEJM199310143291612. [DOI] [PubMed] [Google Scholar]
  37. Nzila N., Laga M., Thiam M. A., Mayimona K., Edidi B., Van Dyck E., Behets F., Hassig S., Nelson A., Mokwa K. HIV and other sexually transmitted diseases among female prostitutes in Kinshasa. AIDS. 1991 Jun;5(6):715–721. doi: 10.1097/00002030-199106000-00011. [DOI] [PubMed] [Google Scholar]
  38. Ou C. Y., Takebe Y., Weniger B. G., Luo C. C., Kalish M. L., Auwanit W., Yamazaki S., Gayle H. D., Young N. L., Schochetman G. Independent introduction of two major HIV-1 genotypes into distinct high-risk populations in Thailand. Lancet. 1993 May 8;341(8854):1171–1174. doi: 10.1016/0140-6736(93)91001-3. [DOI] [PubMed] [Google Scholar]
  39. Piot P., Plummer F. A., Rey M. A., Ngugi E. N., Rouzioux C., Ndinya-Achola J. O., Veracauteren G., D'Costa L. J., Laga M., Nsanze H. Retrospective seroepidemiology of AIDS virus infection in Nairobi populations. J Infect Dis. 1987 Jun;155(6):1108–1112. doi: 10.1093/infdis/155.6.1108. [DOI] [PubMed] [Google Scholar]
  40. Plummer F. A., Nagelkerke N. J., Moses S., Ndinya-Achola J. O., Bwayo J., Ngugi E. The importance of core groups in the epidemiology and control of HIV-1 infection. AIDS. 1991;5 (Suppl 1):S169–S176. [PubMed] [Google Scholar]
  41. Rodrigues J. J., Mehendale S. M., Shepherd M. E., Divekar A. D., Gangakhedkar R. R., Quinn T. C., Paranjape R. S., Risbud A. R., Brookmeyer R. S., Gadkari D. A. Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India. BMJ. 1995 Jul 29;311(7000):283–286. doi: 10.1136/bmj.311.7000.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Scott G. R., Peacock W., Cameron S. Outreach STD clinics for prostitutes in Edinburgh. Int J STD AIDS. 1995 May-Jun;6(3):197–200. doi: 10.1177/095646249500600310. [DOI] [PubMed] [Google Scholar]
  43. Van de Perre P., Clumeck N., Carael M., Nzabihimana E., Robert-Guroff M., De Mol P., Freyens P., Butzler J. P., Gallo R. C., Kanyamupira J. B. Female prostitutes: a risk group for infection with human T-cell lymphotropic virus type III. Lancet. 1985 Sep 7;2(8454):524–527. doi: 10.1016/s0140-6736(85)90462-3. [DOI] [PubMed] [Google Scholar]
  44. Ward H., Day S., Mezzone J., Dunlop L., Donegan C., Farrar S., Whitaker L., Harris J. R., Miller D. L. Prostitution and risk of HIV: female prostitutes in London. BMJ. 1993 Aug 7;307(6900):356–358. doi: 10.1136/bmj.307.6900.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Weir S. S., Roddy R. E., Zekeng L., Feldblum P. J. Nonoxynol-9 use, genital ulcers, and HIV infection in a cohort of sex workers. Genitourin Med. 1995 Apr;71(2):78–81. doi: 10.1136/sti.71.2.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Yorke J. A., Hethcote H. W., Nold A. Dynamics and control of the transmission of gonorrhea. Sex Transm Dis. 1978 Apr-Jun;5(2):51–56. doi: 10.1097/00007435-197804000-00003. [DOI] [PubMed] [Google Scholar]

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