AIDS knowledge, risk behaviors, and factors related to condom use among male commercial sex workers and male tourist clients in Bali, Indonesia

"I Couldn't Afford to Resist": Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya

Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use included extra-payment for condomless sex, low perceived HIV/STI risk with some sexual partners, perceived reduced pleasure associated with using condoms, alcohol use, and violence against male sex workers by clients. Future interventions should address individual- and structural-level barriers to condom use to promote effective condom use negotiation between male sex workers and male clients.

Women Who Trade Sexual Services from Men: A Systematic Mapping Review

Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.

HIV/AIDS Risk to Women Travelers in Thailand: Comparison of Japanese and Western Populations

Japanese and Western women travelers to Thailand were interviewed to determine factors associated with travel and risk of sexually transmitted HIV infection. Self-administered questionnaires ( n = 179) were collected at beach resort areas during July and August of 1995. Four travel attitude profiles were determined by a Principle Components Analysis. Japanese travelers reported attitudes consistent with “Relaxation/Romance,” and Western travelers attitudes consistent with “Sexual Adventure.” Both groups indicated that they would develop a sexual relationship with another traveler, as opposed to a local Thai. Japanese respondents were less likely to report carrying condoms, report the intention to use condoms, or report knowledge about AIDS in Thailand. They also reported less comfort with the open distribution of condoms and AIDS prevention information. Differing HIV risk beliefs and behaviors indicate that cultural factors should be taken into account when designing intervention messages and materials for any group.

CRF01_AE dominates the HIV-1 epidemic in Indonesia

BACKGROUND

The HIV epidemic in Indonesia remains concentrated in vulnerable populations, namely injecting drug users (IDUs), commercial sex workers (CSWs) and men who have sex with men (MSM). We aimed to determine the HIV-1 subtypes present in Indonesia and to establish the extent of the viral overlap between individuals with different risk factors.

METHODS

Venous blood samples were collected from HIV-positive individuals primarily from sexually transmissible infection clinics and drug rehabilitation centres in Bali and Jakarta, and applied to filter paper. A polymerase chain reaction-based assay designed to amplify a 330-bp region of the HIV-1 envelope was used to determine HIV-1 subtype result and to perform phylogenetic analysis.

RESULTS

Of the 175 individuals recruited to the study, a subtype result was obtained for 108 (62%). Four subtypes were found to exist in the population, CRF01_AE (n=96, 88.9%), B (n=10, 9.3%), C (n=1, 0.9%) and G (n=1, 0.9%). Of these 108 individuals, 65 (60%) were IDUs, and the remaining 40% were CSWs, MSM, transgender individuals, people with multiple sexual partners or those with no obvious risk factor. CRF01_AE was found to be more common among IDUs with 100% of individuals infected with this subtype. Subtype B was more common among MSM and CSWs (P=<0.001). Phylogenetic analysis revealed a lack of viral segregation between risk groups.

CONCLUSIONS

In Indonesia, CRF01_AE continues to dominate the HIV epidemic, although HIV subtype B is responsible for a significant number of sexually acquired infections.

Psychosocial factors in association with condom use during commercial sex among migrant male sex workers living in Shenzhen, mainland China who serve cross-border Hong Kong male clients

Male sex workers serving Hong Kong male clients in Shenzhen were surveyed (n = 199); 98.9% had been in Shenzhen for < or =3 years; 83.4% served local male clients; 82.8% had no family members/relatives in Shenzhen; 58.3% depended exclusively on sex work; 73% were bothered by one's sex work; and 81.7% found financial support unavailable when needed. About 29.1% had had unprotected anal intercourse (UAI) with Hong Kong male clients in the last month. UAI behavior was associated with exposure to HIV prevention services (OR = 0.08) and poor social support, being bothered by the sex work, substance use, and type of sex work venue (OR = 2.92-5.96).

High prevalence of sexually transmitted infections among young Peruvians who have sexual intercourse with foreign travelers in Cuzco

BACKGROUND

Sexual networking in popular tourist destinations is a problem worldwide. In Peru, locals sexually interacting with travelers bridge high-risk groups, the general population, and travelers.

METHODS

A cross-sectional study was conducted in Cuzco about sexual behavior among young Peruvians who admitted having sex with travelers. A subgroup of the participants had serologic testing for Chlamydia trachomatis, Herpes simplex virus (HSV) type 2, and Treponema pallidum.

RESULTS

Eighty-eight subjects volunteered for blood sampling. Their mean age was 22.9 years (+/-4.1) and 53.4% were male. The majority were single (86.2%), but 12.6% had a stable relationship. The median number of sexual partners in the 3 months prior to the study was 2 [interquartile range (IQR): 1-4]. During that period, 43.1% reported foreign partners, 28.4% reported foreign and Peruvian partners, 17% reported Peruvian partners, and the remaining 11.5% reported combinations of Peruvian, foreign, and sex workers partners. The median number of foreign partners in the 12-month period prior to the study was 4 (IQR: 2-8). Only 25.3% reported consistent condom use. Alcohol (69%) and drugs (36.8%) were commonly used before sexual activity. Seventy-eight percent tested positive for HSV type 2, 25% for C trachomatis, and 1.1% for T pallidum.

CONCLUSIONS

The core group of young Peruvians we report on demonstrated a high-risk sexual behavior and a high prevalence of sexually transmitted infections. Our results underscore the need for education on safer sex practices among this group and among travelers.

Where the boys are: sexual expectations and behaviour among young women on holiday

The main objectives of this study were to examine relationships between vacation sex expectations and travelling companionship type (solo, paired, or group), and behavioural outcomes such as engaging in a relationship while on vacation, procuring condoms, and initiating condom use with vacation sex partners among tourist women in Costa Rica. A brief interview was used to assess sociodemographic characteristics, vacation sex expectations and relationships, casual sex variables, and alcohol use among a convenience sample of 128 single female tourists 18 years of age or older. Univariate and multivariate analysis were used to examine relationships among variables of interest. Women who travelled solo or with a single female companion and women who anticipated having sex on holiday were more likely than other tourist women to report one or more vacation relationships, to have procured condoms, and to have initiated condom use with a vacation sex partner. Women who engage in unanticipated vacation relationships may be at increased risk of participating in unsafe sex with a partner met on holiday due to lack of condom procurement and/or initiation of condom use. The findings point to the importance of public health efforts to educate women regarding safer sex precautions when travelling on holiday.

The many faces of sex work

OBJECTIVE

To compile a global typography of commercial sex work.

METHODS

A Medline search and review of 681 "prostitution" articles was conducted. In addition, the investigators pooled their 20 years of collected papers and monographs, and their observations in more than 15 countries. Arbitrary categories were developed to compile a workable typology of sex work.

RESULTS

At least 25 types of sex work were identified according to worksite, principal mode of soliciting clients, or sexual practices. These types of work are often grouped under the headings of "direct" and "indirect" prostitution, with the latter group less likely to be perceived or to perceive themselves as sex workers. In general, policing sex work can change its typology and location but its prevalence is rarely affected. The public health implications of sex work vary widely.

CONCLUSION

Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.

Determinants of inconsistent condom use with female sex workers among men attending the STD clinic in Singapore

BACKGROUND/OBJECTIVES

Female sex workers and their male clients have been identified as risk groups for the transmission of STDs and HIV. Behavioural interventions targeting clients need to address inconsistent condom use among them. The aim of the study is to assess the sociodemographic, behavioural, and psychological factors associated with inconsistent condom use among clients of sex workers.

METHODS

229 male patients attending the STD clinic in Singapore who reported paying for sex in the previous 6 months were interviewed. Response rate was 91%.

RESULTS

Overall, 45% used condoms inconsistently; these clients were more likely to have poor STD knowledge, visit sex workers five or more times in the past 6 months, have lower self efficacy, less favourable social norms for condom use, and more likely to forget condom use when intoxicated (alcohol impaired decision making).

CONCLUSIONS

Behavioural interventions for clients need to improve STD/HIV transmission knowledge and focus on improving client's self efficacy in using condoms.

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.

HIV surveillance among men who have sex with men

OBJECTIVES

To review current approaches to HIV surveillance among men who have sex with men (MSM), identify illustrative best practices and lessons learned, and outline ways to enhance surveillance systems.

METHODS

Review of the literature and institutional guidelines for HIV/AIDS, sexually transmitted infection (STI), and behavioral surveillance and summary of results of an international workshop.

RESULTS

On-going formative research, HIV/AIDS and STI case reporting, HIV prevalence and incidence studies, and behavioral surveys are essential components of an effective HIV surveillance system for MSM. Alliances with key organizations and actors in MSM communities provide points of access, assist in the development of measures, and guide appropriate use of data. Sampling techniques (convenience, snowball, quota, microsite, time-location, and population-based) offering a range of methods, complexity, and cost have been successfully implemented in MSM communities. Plausible estimates of the size of MSM populations, which are ultimately crucial to the interpretation of surveillance data, can be improved upon using primary and secondary data.

CONCLUSIONS

The purpose of HIV surveillance among MSM is not only to monitor disease occurrence and its antecedents, but to regularly use data to plan and evaluate prevention and care programs, advocate for prevention resources, and improve the health, social welfare and human rights of MSM. Practical, incremental steps can be taken to improve HIV surveillance among MSM in all regions of the world in all stages of the epidemic.

HIV risk behavior and risk-related characteristics of young Russian men who exchange sex for money or valuables from other men

One of the world's newest HIV epidemics is emerging now in Russia and other countries of Central and Eastern Europe. We report on the HIV risk characteristics of young Russian men who exchange sex for money or valuables, a group that constitutes almost one-fourth of men surveyed recently in gay-identified venues in St. Petersburg. Among 96 MSM who have sex for economic gain, most reported multiple male and female partners, 45% had unprotected anal intercourse with their male partners in the past three months, and many not only received but also gave money or valuables themselves to their male partners. Relative to men who did not give sex for economic gain (n = 326), those who did were younger (n = .0001), less well-educated (p = .0001), and more often unemployed (p = .02). They also were less knowledgeable concerning even basic HIV risk reduction steps (p = .02) and held many misconceptions about safer sex. Men who exchanged sex for economic gain had more male (p = .001) and female partners (p = .01) in the past three months than men who did not, and one-third had been treated for STDs. In the context of Russia's rapid cultural and social changes, economic turmoil, and gay communities not yet experienced in AIDS, HIV prevention programs must be tailored to risk patterns and dynamics different than those found in the gay communities of many western countries.

Male sex workers in three Australian cities: socio-demographic and sex work characteristics

This article describes the socio-demographic and sex work characteristics of sex workers in Sydney, Melbourne, and Brisbane. A total of 185 male sex workers completed the questionnaire component of the study. The results of this study serve to debunk many of the myths surrounding the popular view of the male sex worker (MSW). The respondents in this study were on average 27 years old, and the majority had completed secondary education, with 30% having gained some form of tertiary qualification. Interestingly, those MSWs who had not completed secondary education were mostly street workers and were generally aged under 25 years. The majority of sex workers lived in rented accommodation, with only 6% reporting to be homeless. Half of all respondents identified as being "gay," 31% as "bisexual" and 5.5% as "straight." More than half of the respondents were in a permanent relationship. Only 7.3% of this group reported using heroin daily, although the majority consumed alcohol, tobacco, marijuana, and ecstasy. The majority of sex workers had been in the profession for less than six months, although some had been working in the industry for more than ten years. Most of the sex workers reported having taken an HIV test and a preference to offer safer sex. The article highlights ways in which the work context of MSW can be better understood and supported by education and public policy programs.

Factors associated with condom use for oral sex among female brothel-based sex workers in Singapore

BACKGROUND AND OBJECTIVE

The prevalence of oral sex increased from 27.1% in 1992 to 81.1% in 1997, with a concomitant increase in pharyngeal gonorrhea, among female sex workers in Singapore. The extent of condom use for oral sex among them is unknown.

GOAL

To determine the prevalence of and factors associated with consistent condom use during oral sex.

STUDY DESIGN

A cross-sectional study of 225 women randomly selected from the surveillance scheme register of female brothel-based sex workers with a history of oral sex documented in their medical records.

RESULTS

Slightly more than half (56.9%) consistently used condoms for oral sex compared to 97% for vaginal sex. Condom use was significantly higher among middle than high class sex workers (adjusted rate ratio: 1.52, 95% CI: 1.01-2.29) and those with negotiation skills (adjusted rate ratio: 1.95, 95% CI: 1.32-2.07).

CONCLUSION

Sex workers should be taught skills to negotiate condom use for oral sex.

A profile of the clients of male sex workers in three Australian cities

OBJECTIVE

This paper describes the profile of clients as reported by 186 male sex workers in three Australian cities.

METHOD

The data were collected using a diary which was completed after each commercial sexual encounter with a male client over a two-week period. The data reported in this study are based on reports from 2,088 sex encounters and a profile of 1,776 clients.

RESULTS

The findings reveal, for example, that the most common source used for recruiting clients was advertisements, followed by escort agencies, although there were differences between the three cities; the majority of the clients were in their 40s but clients of street workers were younger; clients were most often classified as 'middle class', with differences by source of client recruitment; less than half the clients were identified as being gay and a significant number were identified as bisexual or straight; alcohol and drug use took place in a small percentage of the encounters; most workers had some information about their clients, such as occupation and home number; violence was infrequent; and unsafe sex was requested in a minority of the encounters.

CONCLUSION

Overall, the results reveal that clients of male sex workers are a highly heterogeneous group.

IMPLICATIONS

The paper highlights a number of issues which can further promote safety and public accountability in male sex work.