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  • Title: Prostitution and risk of HIV: male partners of female prostitutes.
    Author: Day S, Ward H, Perrotta L.
    Journal: BMJ; 1993 Aug 07; 307(6900):359-61. PubMed ID: 8374418.
    Abstract:
    OBJECTIVE: To describe risk behaviours for infection with HIV in male sexual partners of female prostitutes. DESIGN: A cross sectional study. SETTING: Genitourinary medicine clinic, St Mary's Hospital, London. SUBJECTS: 112 self identified male sexual partners of female prostitutes: 101 who reported commercial sexual relationships only, five who reported non-commercial relationships only, and six who reported both commercial and non-commercial relationships. MAIN OUTCOME MEASURES: Reported risk behaviours for infection with HIV. RESULTS: Of the 40 men who had had previous HIV tests or were tested during the study, two (5%) were infected with HIV. Of the men who would answer the questions, 34/94 reported having sex with other men, 2/105 reported using injected drugs, 8/105 had a history of blood transfusion, 14/108 reported a past history of gonorrhoea, 44/102 reported paying for sex abroad, and 8/92 said that they had also been paid for sex. Of the 55 men who reported paying for vaginal intercourse in the past year, 45 (82%) said that they had always used a condom. In contrast, of the 11 non-paying partners of prostitutes, only two (18%) reported ever using a condom with their partners. CONCLUSIONS: Men who have sex with female prostitutes cannot be assumed to be at risk of infection with HIV only by this route: homosexual contact may place them at greater risk. Despite the heterogeneity among male sexual partners of prostitutes, patterns of use of condoms were uniform when they were considered as a reflection of the type of relationship a man had with a female prostitute rather than a consequence of an individual's level of risk. A cross sectional study of prostitutes was complemented by interviewing both paying (clients) and non paying (boyfriends or husbands) partners of female prostitutes to describe known risk factors and different sexual behaviors for infection with HIV. Altogether 112 men participated in the study during 1990-91: 107 were clients of female prostitutes and 11 were non paying members. 75 men had responded to advertisements, 24 were recruited through the genitourinary medicine clinic, and 13 through other methods. 47 interviews were conducted face-to-face and 65 by telephone. 24 men reported having had HIV tests; a further 16 men were tested during the study. The results yielded an overall prevalence of infection with HIV of 5% (2/40). Of the men who replied, 2% reported past use of injected drugs; 8% (8/105) had a history of blood transfusion; 13% (14/108) reported a history of gonorrhea; and 36% (34/94) reported ever having had sex with another man. 15 reported having sex with other men in the past year, and 6 reported taking part in anal intercourse. During their most recent contacts, all 6 men had used condoms, and 1 reported a condom failure. Of the 84 men who reported paying for sex in the past year, 55 had vaginal sex and 45 of these always used a condom. 79 clients reported some use of condoms using sex with prostitutes in the past year, of whom 23 said that 1 or more had failed. Condoms were used in commercial sex primarily to prevent sexually transmitted infections and HIV. Most men always used a condom with a prostitute; most used a condom sometimes with causal, non commercial partners; but few used a condom with regular non commercial partners (wife or steady girlfriend). Among the 11 men who reported noncommercial relationships with prostitutes, 6 who also had paid for sexual intercourse during the past year reported always using a condom in those encounters. In contrast, of the 11 non paying partners, only 2 (18%) reported ever using a condom with their partners.
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