Low seroincidence and decrease in seroprevalence of HIV among female prostitutes in Madrid

Pilot study assessing HIV vaccine trial readiness among female sex workers, injection and non-injection drug users, and men who have sex with men in Spain

The purpose of this study was to assess HIV risk and willingness to participate in HIV vaccine trials in three high risk populations in Spain. Eight hundred and forty-four participants, comprising female sex workers, injection and non-injection drug users (IDUs and NIDUs, respectively), and men who have sex with men were tested for HIV and surveyed for risk and willingness to participate in future preventive HIV vaccine trials. HIV seroprevalence was 3.8% (95% CI: 2-11). HIV infection was associated with transgender identification, IDU in the past year, and sex with an IDU or other drug-using partner. The majority (82%) expressed their willingness to participate in HIV vaccine trials. Substantial sexual and parenteral risk in all groups and concomitant willingness to participate in vaccine trials was found, particularly among women and IDUs. Additional longitudinal cohort studies in Spain are needed to plan future vaccine efficacy trials.

Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain

OBJECTIVES

To determine the prevalence of human immunodeficiency virus (HIV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among immigrant female sex workers (FSW) according to their geographic area of origin and identify possible risk factors independently associated with current infection with CT and/or NG.

STUDY DESIGN

Cross-sectional study of 357 FSW in Catalonia in 2005. Information on sociodemographic and sex work characteristics, use of alcohol and drugs, sexual practices, and the use of social and health care services was collected. Oral fluid and urine samples were collected to determine the prevalence of HIV and CT/NG, respectively. Factors independently associated with CT/NG were assessed using multivariate logistic regression models.

RESULTS

A total of 36.4% of women were from Eastern Europe, 34.5% from Latin America, and 29.1% from Africa. Overall CT and NG prevalence were 5.9% [95% confidence interval (CI): 3.7-8.9] and 0.6% (95% CI: 0.1-2.0), respectively. No differences were observed by geographic origin. Three African women were HIV positive (overall HIV prevalence was 0.8%, 95% CI: 0.2-2.4). In multivariate analysis, younger age and unprotected sex with clients were associated with the presence of CT/NG.

CONCLUSIONS

The prevalence of sexually transmitted infections among FSW in Catalonia was lower than in other European countries. Even though the prevalence of HIV was only 0.8%, it could increase in the future given the high vulnerability of these women and their wide geographic mobility. It is necessary to continue with the work carried out by nongovernmental organizations (harm reduction programs, outreach programs, and safe sex workshops) as well as to facilitate the access to health centers, especially for the youngest women.

Epidemiología de la infección por virus de la inmunodeficiencia humana (VIH) en la provincia de Salamanca (1985-2002)

INTRODUCTION

Since effective treatment against HIV has become available, HIV infection surveillance is focussed not only on AIDS cases, but also on new cases of HIV infection. One of the methods used for this task is compilation of case records. We report the results of 18 years of recording information on new diagnoses of HIV (1985-2002) in the area of Salamanca (Spain).

METHODS

Our report system is based on active monitoring of results from the microbiology laboratory of the Salamanca Health Area. All patients testing positive in HIV analytical studies and who had not been previously diagnosed as HIV-infected are included in the report system.

RESULTS

A total of 188 579 analytical results were studied. We found 16,772 (9.23%) HIV-positive results, 1984 of which were new HIV infection diagnoses. The incidence for the entire period was 556 cases/100,000 inhabitants. The highest incidence was found in 1992 (62.2 cases/100,000), with a progressive decrease thereafter to 2002 (5.18/100,000). Among the total, 75.3% of patients were men between 20 and 39 years old and more than half (62.2%) were intravenous drug users. Over the period studied, there has been an increase in the age of patients at the time of diagnosis, a trend to increases in the number of cases acquired through heterosexual transmission and a reduction in the number of drug users. During the study period, 312 AIDS cases were declared.

CONCLUSIONS

Epidemiological information systems for HIV surveillance are essential to know the features, magnitude and evolution of the epidemic. Creation of a national HIV infection surveillance system to compile the information from smaller regional or local organisms would contribute substantially to our understanding of the epidemiology and evolution of HIV infection.

HIV infection among foreign transsexual sex workers in Rome: prevalence, behavior patterns, and seroconversion rates

BACKGROUND

The Azienda Sanitaria Locale Roma E (ASL-RME) outpatient clinic is the main reference center in Rome for HIV testing of foreign people.

GOAL

To define the prevalence and incidence of HIV infection among foreign transsexual sex workers attending the center.

STUDY DESIGN

A cross-sectional, follow-up study was conducted.

RESULTS

Between 1993 and 1999, 353 transsexuals attended the ASL-RME. They were from Colombia (n = 208), Brazil (n = 122), and other countries (n = 23). Most of these transsexuals reported having 5 to 10 partners per day. The overall HIV prevalence was 38.2%, which multivariate analysis found to be associated with origin from Brazil and a higher number of sex partners. The observed HIV seroconversion rate was 4.1 per 100 person-years, and non-regular condom use was the only factor related to seroconversion.

CONCLUSIONS

The data from this study suggest that promotion of safer sex practices and regular condom use still is the main priority among marginalized population subgroups, such as foreign prostitutes, involved in sex activities that put them at risk for HIV infection.

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution]

OBJECTIVE

To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes.

METHODS

Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected.

RESULTS

132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had).

CONCLUSIONS

HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

[Trends in the number of human immunodeficiency virus infected persons and AIDS cases in Spain: 1980-1998]

BACKGROUND

To describe the trend in the number of HIV-infected persons and the number of AIDS cases in Spain between 1980 and 1998.

SUBJECTS AND METHODS

The following information was used: annual incidence of AIDS taken from the National Registry, AIDS deaths taken from the same registry and from the Registry of Vital Statistics, HIV seroprevalence in studies in sentinel populations, HIV incidence in cohorts of exposed persons, and reports of HIV infections in the registries existing in the autonomous communities. We considered three events of interest--HIV infection, AIDS and death--which were related using back-projection and compartmental models.

RESULTS

HIV spread rapidly in Spain during the years 1980. Transmission subsequently declined by more than 50% to figures that probably do not exceed 6,000 new infections in 1998. The incidence of AIDS increased to more than 7,000 new cases in 1994 and has since declined to some 4,000 cases in 1998. The level of AIDS mortality has always been lower than the incidence; it increased up to 1995 and then dropped to less than half in subsequent years. The number of living persons infected with HIV, including AIDS cases, arose until the early years 1990 and has since remained steady at about 125,000 persons. The number of cases of living persons with AIDS has increased continuously, and is estimated at about 19,000 through the end of 1998.

CONCLUSIONS

The recent trend in new infections, AIDS cases and deaths is favourable, while the number of infected living persons remains very high.