In Eastern Europe and Central Asia, the prevalence of HIV continues to rise. And although injection drug use (IDU) remains a leading risk factor, transmission via heterosexual sex is increasing. While commercial sex work plays a central role globally in the heterosexual transmission of HIV and STI, little is known about female sex workers (FSWs) in this region.
The authors of the current study evaluated STI and HIV prevalence among FSWs in Moscow and potential risk factors, including IDU, sexual risks, and violence victimization. During an eight-month period in 2005, 147 Moscow FSWs completed a clinic-based survey and were tested for STI and HIV.
The results indicated that HIV prevalence was 4.8 percent, and 31.3 percent of the women were infected with at least one STI including HIV. Sexual behaviors found to be significantly associated with STI/HIV included anal sex (adjusted odds ratio 3.48), high volume of clients (AOR 2.71 for three or more clients daily), recent "subbotnik" (sex demanded by police, AOR 2.50), and regularly being presented with more clients than was originally agreed to (AOR 2.45).
Also associated with STI/HIV were past-year experiences of physical violence from clients (AOR 3.14) and threats of violence by pimps (AOR 3.65). "IDU was not significantly associated with STI/HIV," the researchers reported. "Anal sex and high client volume partially mediated the associations of abuse with STI/HIV."
"Findings illustrate substantial potential for heterosexual STI/HIV transmission in a setting better known for IDU-related risk," the authors concluded. "Many of the STI/HIV risks observed are not modifiable by FSWs alone. STI/HIV prevention efforts for this vulnerable population will benefit from reducing coercion and abuse perpetrated by pimps and clients."
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