Background In Central America, studies have been conducted in several countries to provide baseline estimates of the prevalence of human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs), and to elucidate behaviours associated with HIV/STIs among Female Sex Workers (FSW). This study reports the results from the first behavioural and biological surveillance survey conducted in Belize.

Methods We used a census-based approach to recruit FSWs in four districts of Belize. FSW at least 18 years of age who reported vaginal or anal sex in exchange for money during the previous 12 months were invited to participate in the study. Participants were administered a questionnaire through audio computer-assisted self-interview and tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), Treponema pallidum (TP), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG)). Proportions, medians, interquartile ranges (IQR), and 95% confidence intervals were calculated using STATA 9.0.

Results A total of 220 FSWs were enrolled in the study. Median age was 25 years old (IQR: 21–30). Consistent condom use with clients in the last month was 81.33% (95% CI: 74.16 – 87.22), and with occasional partners was 63.11% (95% CI: 53.03 –72.41). Approximately 57.27% (95% CI: 50.45–63.9) had received an HIV test in the last 12 months. HIV prevalence was 0.91% (95% CI: 0.11–3.26%). The most prevalent STI was HSV-2 (51.63%, 95% CI: 44.73–58.48), followed by CT; (19.79%; 95% CI: 14.33–26.23), TV (18.18%; 95% CI: 12.93–24.47), and MG (11.23%; 95% CI: 7.09–16.65). Syphilis and NG prevalence was observed at < 3%.

Conclusions We found low prevalence of HIV in FSWs in Belize. However, risky sexual behaviours and STI prevalence remain a problem. Improved prevention strategies aimed at consistent condom use and access to HIV/STI testing are needed for the control and prevention of infections among FSW.