Background and objectives: In two different studies, we evaluated the human immunodeficiency virus (HIV) seroprevalence rate and the condom use in a group of female sex workers working in Italy.
Study design: In the first study we collected data on HIV serologic testing of female sex workers; in the second study, we evaluated the use of condoms and high-risk sexual practices by sex workers with their clients and nonpaying partners.
Results: Overall, 131 of 802 (16%) were HIV positive: 36 of 558 (6%) professional sex workers and 95 of 244 (39%) sex workers who used intravenous drugs. There was a significant increase of seroprevalence among professional sex workers between 1988 to 1990 and 1991 to 1995 (2% versus 11%, P < or = 0.001), whereas among the sex workers who used intravenous drugs, the increase was not significant (37% versus 40%, P = 0.70). Similarly, the HIV seroprevalence in the Italian professional sex workers is constant in the two periods of time (2% versus 1%). In the second study, 97 of 102 (95%) sex workers reported regular condom use with clients, whereas 63% of sex workers reported they never used them with nonpaying partners. Fourteen sex workers reported having nonpaying partners who used intravenous drugs and 6 reported having nonpaying bisexual partners; 8 of these 20 partners were HIV positive.
Conclusion: The results of the first study showed a significant increase of seroprevalence among professional sex workers, whereas the high seroprevalence among sex workers who used intravenous drugs was constant. The results of the second study showed that sex workers may be at higher risk for HIV infection through noncommercial sexual intercourses.
PIP: HIV seroprevalence and condom use among female sex workers (FSWs) in Italy were investigated in two studies, with particular emphasis on trends before and after 1990--the year of arrival for most immigrant FSWs. The first study enrolled 802 FSWs (176 foreigners) presenting to sexually transmitted disease and HIV clinics in 14 cities in northern Italy in 1988-95. Overall, 131 women (16%) tested HIV-positive; 36 of these women were professional FSWs (6% of 558) and 95 were from the subgroup of FSWs who used intravenous (IV) drugs (39% of 244). HIV seroprevalence among professional FSWs increased significantly between 1988-90 (2%) and 1991-95 (11%); the corresponding increase among drug-injecting FSWs (37% to 40%) was not significant. The increase in HIV in the professional subgroup was caused by the influence of immigrant FSWs; seroprevalence in Italian-born FSWs remained constant in both time periods (2% and 1%, respectively). The second study investigated the condom use patterns of 102 FSWs from 9 Italian cities. 97 FSWs (96%) reported always using a condom with clients, but only 6 (5%) used condoms consistently with nonpaying partners. 14 FSWs had nonpaying partners who used IV drugs and 6 reported nonpaying bisexual partners; 8 of these 20 men were reportedly HIV-infected. Of the 75 sex workers who reported being tested for HIV, 4 (5%)--all of whom were IV drug users--were HIV-positive. These findings indicate that FSWs who use IV drugs or are from foreign countries represent high-risk subgroups. They further suggest that professional FSWs may be at higher risk for HIV infection through noncommercial than commercial sexual encounters.