High rates of oral STIs among male sex workers in Vietnam

Male sex workers (MSW) in Vietnam have complex sexual partner profiles, including both male and female client partners and both male and female elective partners. Although sex practices vary across partner types, both active and receptive oral sex is common with all partner types. As a consequence of this complexity, MSWs are at high risk for becoming infected with oral STIs as well as for transmitting STIs to sex partners. Between 2009 and 2011, a community sample of MSWs, age 16–35 years, was recruited for participation in an epidemiological study of behavioural HIV risk (n=654) using time-location sampling methods. Information about demographic characteristics, substance use, types of sexual partners and practices, and health services utilisation was collected using structured surveys. Additionally, each subject was screened for HIV and STIs (including oral gonorrhoea, chlamydia, HPV). Overall, 31.0% of participants tested positive for one or more oral STI (57.3% in Ho Chi Minh City, 15.2% in Ha Noi, and 4% in Nha Trang); 99.5% had engaged in oral sex during this period. Focusing on the 30 days prior to screening, we compared the sexual practices of those who tested positive for one or more STI with those who tested negative; 56.4% of positives had oral sex with five or more client partners (vs 42.2% of negatives, p=0.001), and 51.2% had receptive anal sex with five or more client partners (vs 33.6% of negatives, p=0.001). No difference was seen in insertive anal sex. Health programmes have emphasised the role of unprotected anal intercourse in HIV transmission, perhaps contributing to the unintended assumption that oral sex confers little risk to health. Prevention programming for MSWs should include increased attention to oral sexual health, including education about safer oral sex practices, oral STI symptoms, and targeted interventions to improve engagement and retention in health services. Finally, we note that high rates of alcohol consumption were reported throughout this sample as well as among their sexual partners. Additional research is needed to assess the clinical impact that alcohol may have in compromising oral health, and thereby increasing risk for oral STIs among MSWs.