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Female sex workers are often forced to work underground and away from their local communities. Historical records show that female sex workers have been frequently singled out for social control and treated as a distinct section of the community. This social rejection and isolation has serious repercussions on the health provisions to them and on their willingness to seek medical care.
In some countries, including Iran, presence of prostitution and sexually transmitted infections (STIs) is systematically denied, being considered a taboo by the government and the majority of the society. There is no official record of the prevalence of prostitution in Iran. Sex workers in Iran are suffering from unavailability of medical services and knowledge about STIs. Social stigmatisation stops these resource deprived women from seeking proper medical care and treatment.
In a follow up study in 2002 in Kermanshah, Iran on 100 men with gonorrhoea most of whom had met a female sex worker before the infection, Zargooshi1 reported an average 84% failure rate of standard therapies. This was much higher than the 12–25% resistance rate in the study by Zirak-Zadah et al in 1977 of sex workers of Shahre-Now (a brothel in Tehran before 1979), whose infection and resistance rate were similar to their American counterparts of that era.2 In those days sex workers had health coverage, something totally ignored these days. Fear of stigmatisation and prosecution, and high rate of self treatment seem to be responsible for the high rate of resistance to standard therapies.
The increasing rate of STIs and HIV/AIDS is alarming! Young girls and boys are among the high risk populations.3 The ministry of education has taken some steps forward and is now working hard on preventive education against STIs with special focus on HIV/AIDS,3,4 though there is no definite programme for the out of school children.
According to the ministry of health, injecting drug use (62.78%) and sexual contact (7.27%) are the two main routes of transmission of HIV/AIDS in Iran, and 26.12% of the cases are grouped under “unspecified route of transmission” according to the report.5 Lack of any reliable records of the underground sex industry makes the data shaky.
Though in Iran commercial sex is not so widespread as in many other countries, sex workers should be considered as patients and efforts should be made to provide appropriate health coverage and preventive education on STIs and HIV/AIDS with no prejudice. Adhering to unfounded propaganda and denial of the social realities propagates the social ills with catastrophic public health consequences.