HIV and Sexual Risk Behavior among Commercial Sex Workers in the Netherlands

Abstract

In 2002-2005, a cross-sectional study to assess the potential for HIV transmission was carried out among 557 female and male-to-female transgender commercial sex workers (CSW) in three cities in the Netherlands. Female CSW (F-CSW), drug-using female CSW (DU), and transgender sex workers were recruited in street-based and establishment-based sites. An anonymous questionnaire was administrated by interviewers and a saliva sample was collected for HIV antibody testing. The overall HIV prevalence was 5.7% (31/547; 10 samples were excluded because of "intermediate" test results). HIV was more prevalent among transgender (18.8%, 13/69) and DU (13.6%, 12/88) sex workers than among F-CSW (1.5%, 6/390). Of the HIV positive CSW, 74% were unaware of their infection. Consistent condom use with clients was 81%. Regular condom failure with clients was reported by 39%. In multivariate analyses, transgender sex workers (OR = 22.9), drug-using CSW who ever injected drugs (OR = 31.1), African (OR = 19.0), and South European ethnicity (OR = 7.2) were independently associated with HIV. Condom failure (PRR = 2.0), anal sex (PRR = 2.1), and drug use (PRR = 3.8) were associated with inconsistent condom use with clients. There is a potential risk for further spread of HIV, through clients and (private) partners of sex workers, to the general population. Targeted health promotion activities are indicated for transgender sex workers and drug-using female CSW; active HIV testing must be continued.

Prevalence of and factors mediating HIV infection among sex workers in Lisbon, Portugal: the 5-year experience of a community organisation

“…A high transgender prevalence has been reported in other Western European countries (18.8–27.4%), although not as high as observed in this study 2 3. Male prevalence in Portugal is below that observed in Germany and Spain 3 4.…”

Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers

“…This difference was not entirely consistent, suggesting that community-level factors shaping the local organisation of sex work in turn shape health behaviours 6. In some contexts, street sex work carries more risk than indoor venues, while the reverse has also been shown 11 53. Structural policies in the country of destination are key to shaping risk behaviours among migrants.…”

“…Evidence points to the role of gender in shaping risk among migrant populations, as indicated by the reduced prevalence of HIV among South American FSWs migrating internally and internationally29 34 35 but an elevated prevalence among transgender migrants from South America working in the Netherlands and Italy 53 55. As in other studies, our findings illustrate the importance of injecting drug use in increasing the risk of HIV among FSWs31 34 35 53 and higher levels of drug use among non-migrants than among migrant populations 37 46…”

Risk-taking behaviours and HIV infection among sex workers in Portugal: results from a cross-sectional survey

“…Increased risk of HIV infection can result from multiple exposures: large number and concurrency of sexual partners, inconsistent condom use,7 8 intersection with injecting drug use9 10 and presence of other sexually transmitted infections (STIs) 7 11. In addition, among SW, infection risk and the adoption of unsafe behaviours vary across economic strata, sociocultural context and work environments 12.…”