HIV Infection among immigrant sex workers in Rome: comparing men, women and transgenders
Issues: To calculate prevalence of HIV infection among immigrants reporting to be involved in sex-working; to assess gender differences in prevalence and sexual behavior; to estimate effectiveness of risk-reduction intervention.
Description: The reference test facilities generally receives immigrants from services and outreach-units of the municipal HIV-prevention program. Patients are asked to answer a behavioral questionnaire with strong counseling provided, including condom and leaflets in foreign languages distribution.
Out of 3860 immigrants voluntarily HIV-tested between 1992-2007, 896 (23.2%) self-reported sex-working: 65 (3.7%) men, 229 (18.4%) women and 602 (99.2%) M-to-F transgenders; most from South-America (80% men/women, 96% transgenders).
Among sex workers, HIV-prevalence at enrollment was 21.3% (vs 2.2%) with striking gender differences: 27.4% transgenders, 23.1% men, 4.8% women. Women also more frequently reported regular condom use with clients (89.0% vs 76.0% transgenders and 69.2% men). Twenty-two new HIV infections were observed during follow-up, 20 among transgenders and 16 in subjects who did not report regular condom use (p<0.001 vs regular-users). Cocaine-use was reported by 8.9% of subjects with no gender difference; alcohol-abuse, particularly during the night, was also diffused: both negatively impacted on condom use.
Lessons learned: The demand for street prostitution is generally decreasing in the 2000s in Rome, prices are also dropping. As consequence, sex workers more likely accept non-use of condom to avoid to lose clients. New populations of sex workers (i.e: men/women from East-Europe) are rising, refractory to condom use. Promoting condom remains the main target for prevention. During follow-up, the repeated counseling has been demonstrated effective in maintaining high level of regular condom use in men and women, while an increase among transgenders was observed (76.0% to 81.9%).
Next steps: The program is ongoing with new topics of interest: dealing with problem of stigmatization, managing substances abuse, skill building with psychological support; HIV-testing and counseling male partners of sex workers.
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