Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in Istanbul and Ankara, Turkey.

OBJECTIVES: Despite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies. METHODS: Female and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in Istanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots. RESULTS: FSWs were the largest KP identified in Istanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both Istanbul and Ankara. CONCLUSIONS: This study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in Istanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest.

[Screening of Human Immunodeficiency Virus and Other Sexually Transmitted Infections in a Group of Sex Workers in Indoor Settings in the Porto Metropolitan Area]. / Deteção da Infeção por Vírus da Imunodeficiência Humana e Outras Infeções Sexualmente Transmissíveis num Grupo de Trabalhadores/as do Sexo em Contexto Indoor na Área Metropolitana do Porto.

INTRODUCTION: Early diagnosis is a crucial tool for containing the human immunodeficiency virus and other sexually transmitted infections, particularly in key populations such as sex workers. Despite its relevance, there is a gap considering epidemiological studies and interventions aimed at the monitoring and diagnosis of sexually transmitted infections in Portugal. The objectives of this study are: (i) to contribute to a better understanding of the epidemiology of sexually transmitted infections; and (ii) to evaluate the transfer of screening methods from clinical settings to the outreach context in hidden populations such as sex workers. MATERIAL AND METHODS: The screening of sexually transmitted infections (human immunodeficiency virus 1/2, hepatitis B virus, hepatitis C virus, syphilis, chlamydia and gonorrhea) were carried out in a sample of 100 sex workers during the Porto G outreach intervention in the Metropolitan area of Porto, from September 2015 to September 2016. RESULTS: Six reactive cases for human immunodeficiency virus were identified, five of syphilis, eight of chlamydia and two of gonorrhea. No positive results were detected for hepatitis B virus and hepatitis C virus. The results were discussed considering the risk gradient and sexually transmitted infections vulnerability in the different sex workers' subgroups. DISCUSSION: The results of this study corroborate the need to promote comprehensive responses to populations most affected by the human immunodeficiency virus and other sexually transmitted infections, such as sex workers. Also, in this group, men who have sex with men and trans women have a higher prevalence than cis women. Intervention strategies should be informed by rigorous epidemiological studies. CONCLUSION: The adaptation of the screening methodology performed in a clinical setting to the proximity context has shown to be an innovative response in Portugal, especially in sentinel populations.

Introdução: O diagnóstico precoce é uma ferramenta incontornável na contenção do vírus da imunodeficiência humana e de outras infeções sexualmente transmissíveis, nomeadamente em populações-chave, das quais fazem parte os/as trabalhadores/as do sexo. Apesar da sua relevância são ainda escassos os estudos epidemiológicos e intervenções que visem a monitorização e diagnóstico das infeções sexualmente transmissíveis em Portugal. Os objetivos do presente estudo são: (i) contribuir para um conhecimento mais aprofundado da epidemiologia de infeções sexualmente transmissíveis e (ii) avaliar a adaptação de métodos de rastreio em meio clínico ao contexto de proximidade em populações ocultas como os/as trabalhadores/as do sexo.Material e Métodos: O rastreio de infeções sexualmente transmissíveis (vírus da imunodeficiência humana 1/2, vírus da hepatite B, vírus da hepatite C, sífilis, clamídia e gonorreia) foi realizado a 100 trabalhadores/as do sexo no âmbito da intervenção de proximidade realizada pelo Porto G na zona Metropolitana do Porto, entre setembro de 2015 e setembro de 2016.Resultados: Foram identificados seis casos reativos para vírus da imunodeficiência humana, cinco de sífilis, oito de clamídia e dois de gonorreia. Não foram detetados resultados positivos para vírus da hepatite B e vírus da hepatite C. Os resultados foram discutidos tendo em conta a gradação de risco e de vulnerabilidade de infeções sexualmente transmissíveis nos diferentes subgrupos de trabalhadores/as do sexo. Discussão: Os resultados deste estudo corroboram a necessidade de promover respostas integradas junto de populações mais afetadas pelo vírus da imunodeficiência humana e outras infeções sexualmente transmissíveis, como são os/as trabalhadores/as do sexo. Também neste grupo, os homens que fazem sexo com homens e as mulheres trans apresentam uma prevalência de vírus da imunodeficiência humana superior à das mulheres cis. As estratégias de intervenção devem ser informadas por estudos epidemiológicos rigorosos.Conclusão: A adaptação da metodologia de rastreio realizada em meio clínico ao contexto de proximidade demonstra ser uma resposta inovadora em território nacional, nomeadamente em populações sentinela.

A community-based comprehensive intervention to reduce syphilis infection among low-fee female sex workers in China: a matched-pair, community-based randomized study.

BACKGROUND: Low-fee female sex workers (FSWs) are at high risk of acquiring and spreading human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) in China. There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections. Thus, this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair, community-based randomized intervention trial carried out in 12 cities in three provinces in China. METHODS: Four cities from Guangxi Zhuang Autonomous Region, four from Yunnan Province, and four from Hunan Province were paired and participants received either the intervention package (including condom promotion, HIV and syphilis testing, reimbursement for syphilis treatment costs, and free anti-retroviral therapy or the current standard of care. Venue-based, convenience sampling was used to recruit FSWs. A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months. Generalized linear mixed models (GLMM) were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs. RESULTS: A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up. GLMM results showed that syphilis infection was reduced by 49% in the intervention group compared to the current standard of care group (P = 0.0378, OR = 0.51, 95% CI: 0.27-0.96). FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old (P <  0.0001, OR = 2.38, 95% CI: 1.55-3.65). The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education (P <  0.05, OR = 0.43, 95% CI: 0.63-0.93). CONCLUSIONS: This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs. Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs. TRIAL REGISTRATION: CHiCTR-TRC-12002655.

MATCH: A New Approach for Differentiating & Linking Series of Sex Worker Homicides and Sexual Assaults.

Sex workers as a group are one of the more common targets in serial homicide, yet the most likely to go unsolved. Part of the reason for this is the difficulty in linking individual crime scenes to a series, especially in those series where offenders not only target sex worker victims but also target non-sex worker victims. Inconsistencies in both victim targeting and behaviors engaged in across series add to the difficulties of linking and solvability in these types of crimes. The current study aimed to add to the current body of literature on serial crime linkage by examining not only the most salient behavioral indicators useful for crime scene classification of serial homicides that involve sex worker victims but also examine the trajectories of behavioral change that can help link apparently inconsistent crime scenes and proposes the new Model for the Analysis of Trajectories and Consistency in Homicide (MATCH). The study examines 83 homicide series, including 44 (53%) series where all victims were sex workers and 39 (47%) series that included a mix of sex workers and non-sex worker victims. Using the MATCH system allowed for the majority of series to be classified to a dominant trajectory pattern, over half as many as a traditional consistency analysis that focusses on behavioral similarity matching. Results further showed that Sex Worker Victim series were almost three times more consistent across their series than Mixed-Victim series, not only in victim selection but also in the overall behavioral patterns. Findings are discussed in line with theoretical and psychological issues relating to understanding the nature of behavioral consistency and the importance of going beyond simple matching toward a model that allows for the identification of consistency in seemingly inconsistent series, as well as investigative implications relating to linking serial crimes.

Sex Worker Homicide Series: Profiling the Crime Scene.

Contrary to popular misconceptions, offenders who kill sex workers as part of their series exhibit substantial variability in their victim selection and behavioral patterns, thus creating additional issues for the investigation of these crimes. This article first aims to outline differences in the demographics of crime scene actions present in homicide series with exclusively sex worker victims and series that includes both sex worker and non-sex worker victims, with the aim of understanding the crime scene aetiology of these two different types of series. Second, the research aims to determine between-series differences of victimology as well as crime scene action between sex worker series and mixed-victim series. Third, the research focuses on mixed-victim series and aims to determine the within-series similarities of victimology and crime scene actions, that is, what factors link sex worker victims and non-sex worker victims in the same series. Data were collected through a large-scale review of international media sources to identify solved serial homicide cases that have included at least one sex worker. Of the 83 series looked at, 44 (53%) included sex worker victims only, and 39 (47%) of the series included both sex worker and non-sex worker victims. The findings highlight the challenges that these types of crime present for investigation and the implications they have on current crime analysis research and practice, and results are discussed in line with theoretical and psychological issues relating to understanding differentiation and similarity, as well as investigative implications relating to linkage blindness and linking of serial crimes.

Spectrum of female commercial sex work in Bangui, Central African Republic.

Classification of professional and non-professional female sex workers (FSWs) into different categories, never previously reported in the Central African Republic (CAR), may be useful to assess the dynamics of the human immunodeficiency virus (HIV) epidemic, design operational intervention programmes to combat HIV and other sexually transmitted infections (STIs) and to adapt these programmes to the broad spectrum of sexual transactions in the CAR. Our study proposes a socio-behavioural classification of FSWs living in the CAR and engaged in transactional and commercial sex. Thus, the aims of the study were these: (i) to categorize FSWs according to socio-anthropologic criteria in Bangui and (ii) to examine the association between a selection of demographic and risk variables with the different categories of female sex work as an outcome. A cross-sectional questionnaire survey was conducted in 2013 to describe the spectrum of commercial sex work (CSW) in Bangui among 345 sexually active women having more than 2 sexual partners, other than their regular partner, during the prior 3 months and reporting to have received money or gifts in return for their sexual relationships. According to socio-behavioural characteristics, FSWs were classified into six different categories. Professional FSWs, constituting 32.5% of the interviewed women, were divided in two categories: pupulenge (13.9%), i.e., dragonflies (sometimes called gba moundjou, meaning literally look at the White) consisting of roamers, who travel around the city to hotels and nightclubs seeking wealthy clients, with a preference for French men; and the category of kata (18.6%), i.e., FSWs working in poor neighbourhoods. Non-professional FSWs, constituting 67.5% of the interviewed women, were divided into four categories: street and market vendors (20.8%), students (19.1%), housewives (15.7%) and unskilled civil servants (11.9%). In general, CSW in the CAR presents a remarkably heterogeneous phenomenon. Risk-taking behaviour regarding STI/HIV infection appears to be different according to the different categories of female CSW. The groups of katas and street vendors were poorer and less educated, consumed more alcohol or other psycho-active substances (cannabis, tramadol and glue) and, consequently, were more exposed to STI. Our results emphasise the high level of vulnerability of both poor professional FSWs (kata) and non-professional sex workers, especially street vendors, who should be taken into account when designing prevention programmes targeting this population for STI/HIV control purposes.

HIV prevalence and high-risk behaviour of young brothel and non-brothel based female sex workers in Nigeria.

BACKGROUND: Female sex workers (FSWs) have been identified as a core group in the transmission of HIV and other sexually transmitted infections (STIs). Young FSWs are particularly more vulnerable to HIV due to the combination of vulnerabilities associated with their youth and the sex work they engage in. This study aims to give more insight into HIV prevalence and sexual risk behaviour of young FSWs in Nigeria, by focusing on the differences between BB and NBB young FSWs. METHODS: Data was obtained from the Nigeria Integrated Biological and Behavioural Surveillance Survey (IBBSS) for high-risk groups conducted in 2010. IBBSS is a quantitative survey conducted amongst identified high-risk sub populations within Nigeria. HIV prevalence and risk behaviour data for young BB and NBB FSWs aged 15-24 years for nine states was extracted and analysed. RESULTS: A total of 1796 FSWs aged 15-24 years were interviewed during the survey, 746 (41.5%) were BB while 1050 (58.5%) were NBB. The HIV prevalence was higher among BB FSWs compared to the NBB FSWs (21.0% vs. 15.5%). BB FSWs reported less condom use with boyfriends and casual partners than NBB FSWs (26.3% vs. 45.5%) and (55.1% vs. 61.1%) respectively while risk of HIV infection due to injecting drug use was higher in NBB compared to BB FSWs (6.6% vs. 1.2%). CONCLUSION: Existing and future interventions on HIV prevention should focus on empowering young FSWs with innovative and sustainable approaches aimed at improving their health and wellbeing.

Speaking of sex workers: How suppression of research has distorted the United States' domestic HIV response.

Sex workers remain a vulnerable population at risk for HIV acquisition and transmission. Research suggests that interventions at the individual level, such as condom distribution, are less effective in preventing HIV among sex workers than structural changes such as allowing safer work settings and reducing the harassment and abuse of sex workers by clients and police. In the US, HIV incidence has not declined in the last decade. This may be due in part to its policy of wilful ignorance about sex work, but the data to resolve the question simply do not exist. Political actions such as PEPFAR's prostitution pledge and a congressional campaign against "waste, fraud and abuse" in research are products of an ideological environment that suppresses research on HIV prevention and treatment needs of sex workers. Even basic prevalence data are missing because there is no "sex worker" category in the US National HIV Behavior Surveillance System. However, international efforts are taking a public health approach and are calling for decriminalization of sex work, as the most effective public health strategy for reducing HIV incidence among sex workers. Although such an approach is not yet politically feasible in the US, some urgent practical policy changes can be implemented to improve data collection and generation of evidence to support HIV prevention and treatment programs targeting sex workers.

The typology of female sex workers in Dar-es-Salaam: implications to HIV and AIDS interventions targeting female sex workers in Tanzania.

OBJECTIVE: To establish the categories of female sex workers in Dar es Salaam. METHODS: We conducted in depth-interviews with 32 female sex workers (FSWs) in five geographic areas of Dar-es-Salaam known to be the primary residential and working places, three local government leaders in three of the five areas known to have brothels and two NGO representatives working with this population. RESULTS: There are about 14 categories of FSWs with fluid perceived 'boundaries', which could change given factors like the availability of clients, active prostitution control mechanisms, the weather, the female sex worker's need for money and the type of sexual services demanded. CONCLUSIONS: different categories provided by the study participants are only useful in the Dar-es-Salaam context but generalization to other places in Tanzania might not be quite possible. However, using these classifications provides an understanding of how they construct their real world with regard to sex work, experiences, (health) needs and shared characteristics that are important when planning for all aspects of research designs and the implementation of interventions targeting them. The Ministry of Health and Social Welfare (MoHSW), through the National AIDS Control Program (NACP), stakeholders and development partners should conduct more research in this area to generate more information that would facilitate lobbying and advocating for repealing colonial-rooted anti-prostitution laws and replacing them with policies aiming at assisting them.

Systematic differences in risk behaviors and syphilis prevalence across types of female sex workers: a preliminary study in Liuzhou, China.

BACKGROUND: Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined 2 possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. METHODS: From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect sociodemographic and behavioral information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the 2 categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. RESULTS: The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1%, respectively. Lifetime and active syphilis prevalence was higher among FSWs in the lowest price category (52.7% and 25.4%, respectively) and those working in streets (69.7% and 39.8%, respectively) or through telephone (46.3% and 17.0%, respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street- (adjusted odds ratio [AOR]: 38.7, 95% confidence intervals [CI]: 10.7-139.9) and telephone-based FSWs (AOR: 10.8, 95% CI: 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR: 15.2, 95% CI: 3.7-62.1) after adjusting for demographic and behavioral factors. CONCLUSIONS: Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted.