SEX WORK

HIV, sexually transmitted infections, and risk behaviours in male sex workers in London over a 10 year period

G Sethi¹, B M Holden¹, J Gaffney¹, L Greene¹, A C Ghani² and H Ward²

¹ Department of Genitourinary Medicine, St Mary’s NHS Trust, London W2, UK
² Department of Infectious Disease Epidemiology, Imperial College London W2, UK

Correspondence to:
Correspondence to:
G Sethi
Department of Genitourinary Medicine, St Thomas’ NHS Trust, Lambeth Palace Road London SE1, UK; cindy.sethi{at}gstt.nhs.uk

Objectives: To describe changing characteristics of men who sold sex in London between 1994 and 2003.

Methods: A baseline survey of 823 male sex workers attending a specialist clinic, plus follow up of 628 men for 1379 person years.

Results: Men recruited earlier (1994 to 1996) were more likely than those recruited later (2000 to 2003) to be UK born and to self define as homosexual. Later recruits included more men from South/Central America and eastern Europe and a higher proportion reported regular female partners. Baseline prevalence of HIV was 9% (59/636), and multivariate analysis showed an associated with injecting drug use and unprotected sex with a casual partner. During follow up there were 49 incident cases of HIV. Survival analysis showed earlier recruitment (1994–6) to be associated with a higher incidence of HIV. The prevalence of gonorrhoea increased over time.

Conclusions: Men who sell sex are at risk of HIV and other STIs, but these risks do not appear to be directly linked to sex work. The changing demographics of these men is associated with different patterns of infection and poses challenges for service delivery.

Abbreviations: CMPs, casual male partner; EIA, enzyme immunoassay; ELISA, enzyme linked immunosorbent assay; FTA, fluorescent treponemal antibody; MSWs, male sex workers; NGU, non-gonococcal urethritis; NSU, non-specific urethritis; RPR, rapid plasma reagin; STI, sexually transmitted infections; TPHA, Treponema pallidum haemagglutination assay; UPAI, unprotected anal intercourse; UPOI, unprotected oral intercourse

Keywords: HIV; sexually transmitted infections; prostitution; epidemiology; London

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