Decline in sexually transmitted disease prevalence in female bolivian sex workers : impact of an HIV prevention project

• Published in: AIDS (London) Vol. 12; no. 14; pp. 1899 - 1906
• Main Authors: LEVINE, W. C, REVOLLO, R, AGÜERO, L. W.-D, PAREJA, R, MIRANDA, P, RANSOM, R. L, ZAIDI, A. A, MELGAR, M. L, KURITSKY, J. N, KAUNE, V, VEGA, J, TINAJEROS, F, GARNICA, M, ESTENSSORO, M, LEWIS, J. S, HIGUERAS, G, ZURITA, R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-10-1998
• Subjects: Adult; AIDS/HIV; Biological and medical sciences; Bolivia - epidemiology; Condoms; Female; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus 1; Human viral diseases; Humans; Infectious diseases; Medical sciences; Multivariate Analysis; Prevalence; Program Development; Risk Factors; Sex Work; Sexual Behavior; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - prevention & control; Tropical medicine; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Women's Health; South America; Bolivia; America; Human; Immunopathology; Prevalence; AIDS; Immune deficiency; Epidemiology; Infection; Prevention; Prostitution; Sexually transmitted disease; Viral disease; Risk factor; Female
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/00002030-199814000-00022

To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data.
Cross-sectional and longitudinal analysis of data from an open-enrollment cohort.
One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia.
A total of 508 female CSW who work at brothels and attend a public STD clinic.
Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization.
Prevalence of gonorrhea, syphilis (reactive plasma reagin titer > or = 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence.
From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (Cl), 0.41-0.97], syphilis (OR, 0.39; 95% Cl, 0.23-0.64), and trichomoniasis (OR, 0.44; 95% Cl, 0.32-0.71). In 1995, HIV seroprevalence among CSW was 0.1%.
Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.