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The recent announcement that a prime-boost combination of two HIV vaccine candidates had a partial protective efficacy of around 31% in phase III clinical trials in Thailand is encouraging,1 2 but for the foreseeable future the prevention of HIV acquisition will continue to require a multifactorial response.3 In resource-poor countries where heterosexual transmission is the dominant mode of infection, the promotion of evidence-based behavioural and biomedical prevention strategies that effectively reach vulnerable individuals most at risk of HIV and sexually transmitted infections are paramount. Female sex workers (FSWs) and their clients may represent a significant source of new HIV infections, particularly in the early stages of the epidemic.4 5 Although 100% condom usage is the gold standard for HIV and STI risk reduction for FSWs and their clients, condoms are not always available, nor are they always used, due to women's limited ability to negotiate safer sexual practices in commercial or transactional relationships.6
Sexually transmitted infections (STI) such as Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct) can increase cervico-vaginal HIV shedding in women, while Ng results in greater shedding in the semen of men infected with HIV.7 This can lead to a higher likelihood of HIV transmission with an RR of about 3 for a number of STIs in both …