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In many countries significantly higher rates of HIV infection have been documented among sex workers compared to most other population groups.1 We have analysed HIV risk behaviour among the female commercial sex workers in Vinnitsa, Ukraine, because this issue is still unstudied in the country.
The study protocol was approved by the ethics committee of Vinnitsa Pirogov Medical University. Data collection was carried out in May to July, 2003 using a cross sectional design with a self reported questionnaire method and was linked to the programme “Network of mobile and information support for female sex workers” operated by the non-government organisation (NGO) “Stalist.” This programme provides informational support, medical service, and condoms for female sex workers in Vinnitsa region. Trained outreach workers of NGO “Stalist” performed recruitment of subjects on the major roads of the city. Oral informed consent in all cases was obtained.
Altogether, 58 sex workers were involved into the study. The age of the participating women ranged from 15 to 34 years, with a mean age of 23.1 years. Around 25 (44.8%) respondents provided financial support from others (parents, children, husband, etc). Even though nine (15.5%) women had said that they were married, only four (6.9%) were living with their husbands, and 46 (79.3%) did not have a husband or a regular sexual partner. In spite of the fact that 46 (79.3%) female sex workers believe that they are not at risk, our results show a high HIV risk profile in this group (table 1).
It is well known that use of injecting drugs is a powerful factor for HIV transmission, and our findings highlight considerable prevalence of injecting drug use among sex workers in Vinnitsa. High rates of sharing injecting paraphernalia were registered as well, which, in our opinion, is the consequence of being “injection dependent.” In Canada it was identified that needing help injecting was a strong risk factor for syringe sharing,2 and it is troubling that this risk factor has now been identified as a predictor of HIV seroconversion.3
Our data showed that permanent use of condoms was low, in spite of the fact that most of the respondents accepted that having sex without condoms increases the risk of HIV. Being on the margin of society, the ability of commercial sex workers to negotiate safer working conditions is limited. Their financial position can make them vulnerable to customers willing to pay more money for unprotected sex and other high risk practices.4 In addition, if a sex worker is under the influence of drugs while working, her judgment is impaired and it is less likely that safer sex methods will be used.
Thus, results of our study emphasise that providing informational support, medical service and condoms cannot entirely solve the HIV preventive problem among female sex workers in Vinnitsa, Ukraine. Sex workers’ vulnerability and dependence on clients, injecting drug use, significant rates of sharing injecting paraphernalia, and use of psychoactive substances before sexual contacts contribute significantly to the high HIV risk profile of this group.
Supported in part by the International Clinical, Operational and Health Services Research Training Award (ICOHRTA), grant number: 1 D43 TW05815–03, from the Fogarty International Center at the National Institutes of Health, PI: Dr Sten H Vermund.
PK designed the study, carried out statistical treatment and analysis of the data; VP supervised all procedures concerning data collection and editing, assisted in data analysis and drawing conclusions from the paper.
Conflict of interest: Not declared.
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