Background Russia is currently experiencing one of the fastest growing HIV epidemics in the world. Transmission is concentrated among injection drug users and female sex workers (FSW), but sexual transmission to the general population is increasing. The prevalence of HIV among street-based FSW in St. Petersburg, many of whom use drugs, was 48% in 2003, but the role of their male clients in HIV transmission and bridging to the general population has yet to be studied.
Methods In a pilot study to determine feasibility of involving clients in a research study and describe HIV risk behaviours, we interviewed 62 clients during February–March of 2010 in St. Petersburg Russia. Recruitment methods included FSW and peer referrals and street intercept. Behavioural data collection covered condom use with different types of sex partners, substance use, and STI/HIV testing histories.
Results A majority of clients (74%) reported having non-FSW partners during the past 12 months, and nearly half of the total sample (47%) reported having regular non-FSW sex partners. Inconsistent condom use was reported by 39% of clients with FSW partners and 57% with their non-FSW partners. A majority of clients (58%) was classified as active or potential bridgers based on having both FSW and non-FSW partners and reporting inconsistent condom use with non-FSW partners. A majority (61%) also reported concurrent FSW and non-FSW partners. Nearly half (48%) of last reported sex contacts with FSW involved consumption of alcohol by the client. Non-injection and injection drug use in the past 30 days were reported by 15% and 7% of clients, respectively. Reported history of an STI was also common at 29%. A previous HIV test was reported by 74%; active/potential bridgers were significantly less likely than unlikely bridgers to have ever been tested for HIV.
Conclusions Results of this pilot study demonstrate the feasibility of successfully recruiting clients of FSW in a setting of epidemic growth and high HIV prevalence among FSW. A majority of clients of FSW also have non-FSW sex partners, and these partnerships are often concurrent. Condom use is sub-optimal with both FSW and non-FSW partners, and drug and alcohol use were common. These risk behaviours signal potential for HIV/STI transmission among male clients of FSW in St. Petersburg Russia, and indicate a pressing need to better understand the context and nature of risk for this potentially important bridging population.
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