Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers
- Michele R Decker1,2,
- Andrea L Wirtz2,3,
- Stefan D Baral2,3,
- Alena Peryshkina4,
- Vladmir Mogilnyi4,
- Rachel A Weber3,
- Julie Stachowiak2,
- Vivian Go3,
- Chris Beyrer2,3
- 1Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 2Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 4AIDS Infoshare, Moscow, Russia Federation
- Correspondence to Dr Michele R Decker, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe St., E4142, Baltimore, MD 21212, USA;
Contributors Study concept: MRD, RAW, CB, AP and JS; acquisition of data: AP, VM, JS and CB; analysis and interpretation of data: MRD, SDB, RAW and ALW; drafting of manuscript: MRD and ALW; critical revision of manuscript for important intellectual content: SDB, AP, VM, RAW, VG, JS and CB.
- Accepted 31 December 2011
- Published Online First 27 January 2012
Background/objectives The HIV prevalence in Eastern Europe and Central Asia continues to increase. While injection drug use (IDU) is leading factor, heterosexual transmission is on the rise. Little is known about female sex workers (FSWs) in the region despite the central role of commercial sex in heterosexual sexually transmitted infection (STI)/HIV transmission globally. The authors evaluated the prevalence of STI/HIV among Moscow-based FSWs and potential risk factors including IDU, sexual risks and violence victimisation.
Methods Moscow-based FSWs (n=147) completed a clinic-based survey and STI/HIV testing over an 8-month period in 2005.
Results HIV prevalence was 4.8%, and 31.3% were infected with at least one STI including HIV. Sexual behaviours significantly associated with STI/HIV included anal sex (adjusted odds ratio (AOR) 3.48), high client volume (three or more clients daily, AOR 2.71), recent subbotnik (sex demanded by police; AOR 2.50) and regularly being presented with more clients than initially agreed to (AOR 2.45). Past year experiences of physical violence from clients and threats of violence from pimps were associated with STI/HIV (AOR 3.14 and AOR 3.65, respectively). IDU was not significantly associated with STI/HIV. Anal sex and high client volume partially mediated the associations of abuse with STI/HIV.
Conclusions Findings illustrate substantial potential for heterosexual STI/HIV transmission in a setting better known for IDU-related risk. Many of the STI/HIV risks observed are not modifiable by FSWs alone. STI/HIV prevention efforts for this vulnerable population will benefit from reducing coercion and abuse perpetrated by pimps and clients.
- HIV women
- epidemiology (general)
- risk behaviours
- behavioural intervention
Funding This study was supported by the National Institute on Drug Abuse (R01 DA15005) and by the Fogarty International Center (FIC # 2 D 43 TWOOOO10-20-AITRP).
Competing interests None.
Ethics approval Johns Hopkins Bloomberg School of Public Health.
Provenance and peer review Not commissioned; externally peer reviewed.