Objective: Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America.
Methods: Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999–2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests.
Results: The overall HIV seroprevalence was 1.2% (range 0.0%–4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8–8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2–24.8). In addition, multiple (⩾3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries.
Conclusions: Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.
- AORs, adjusted ORs
- ELISA, enzyme linked immunosorbent assay
- FCSW, female commercial sex workers
- IDU, injecting drug users
- MSM, men who have sex with men
- ORs, odds ratios
- STI, sexually transmitted infections
- risk factors
- South America
- sex workers
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Financial support: This study was supported by the US Military HIV Research Program at the Walter Reed Army Institute of Research, and by the US Naval Medical Research Center, Silver Spring, MD, Work Unit Number No 62787A S17 H B0002.
Disclaimer: The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official position of the US Departments of the Army or Navy, the US Department of Defense, the US Government, the Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, or any other organization listed.
Human use statement: The study protocol was approved by the Naval Medical Research Center’s Institutional Review Board under Protocol # NMRCD.2000.0002 (DoD 31523), Protocol # NMRCD.1999.0002 (DoD 30590), Protocol # (DoD 30583), Protocol # NMRCD.1999.0001 (DoD 30587), Protocol # NMRCD.2002.0006 (DoD 31590), Protocol # NMRCD.1998.0001 (DoD 30578), and Protocol (DoD 31513) in compliance with all federal regulations governing the protection of human subjects.