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Systematic Differences in HIV, Syphilis and Risk Behaviors among Street Based and Establishment Based Female Sex Workers in Kathmandu Valley of Nepal

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      Female Sex Workers (FSWs) are main drivers of the HIV epidemic in Nepal. The work environment of sex work in Nepal is differentiated into establishment based (e.g. massage parlors, dance restaurants, hotels and lodges) and street based (e.g. streets, parks and markets). The study compares HIV, syphilis and risk behaviours among establishment-based FSWs and street-based FSWs in Kathmandu Valley of Nepal.

      Materials and Methods:

      Cross-sectional bio-behavioral surveys in 2006, 2008, 2011 and 2015 aimed to sample 2093 FSWs using two stage cluster sampling in the Kathmandu valley. Statistical analysis used chi-squared tests and logistic regression models to assess differences of HIV, syphilis and risk behaviors among street-based FSWs and establishment-based FSWs.


      The study included 39.7% street-based FSWs and 60.3% establishment-based FSWs. The street-based FSWs had lower education levels, older age groups, separated, longer duration of sex work and inconsistent condom used with clients than establishment-based FSWs (p<0.05). Establishment-based FSWs were lower exposure to HIV intervention programs and pervasive alcohol consumption and use of drugs (p<0.05). The multivariate analysis showed that street-based FSWs were more likely of HIV test (aOR=1.25, 95%CI=1.04, 1.49), HIV (aOR=4.72, 95%CI=2.19, 10.15) and syphilis (aOR=7.96, 95%CI=3.49, 18.15) than establishment-based FSWs.


      Street-based FSWs possessed higher risk behaviour and have higher HIV and syphilis prevalence. HIV prevention interventions targeting FSWs should consider risks and vulnerability of street-based FSWs. .

      Related collections

      Most cited references 13

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      Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.

      Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99,878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6-12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0-18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2-31·3; 8627 of 28,075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1-14·8). Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. The World Bank, UN Population Fund. Copyright © 2012 Elsevier Ltd. All rights reserved.
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        Bridge populations in the spread of HIV/AIDS in Thailand.

        To determine the extent to which men provide a bridge population between commercial sex workers (CSW) and the general female population in Thailand. Sexual network and serological data were collected from a systematic quota sample of low income men and truckers during 1992 in three Thailand provinces. Completed sample size was 1075 men aged 17-45 years and 330 truckers. Sexual network information was used to identify those men who have sex with both female CSW and non-CSW partners (the 'bridge population'). A new method was used for calculating the partner acquisition rate and to establish the potential number of women exposed to HIV via inconsistent condom use among the bridge population. Approximately 17% of men and 25% of truckers can be included in the bridge population. These men are more likely to be HIV-positive and to have had at least one other sexually transmitted infection in the past year (odds ratio, 2.2 and 3.4, respectively). Consistent condom use with CSW is less than 30%, and is less than 1% with non-CSW partners. As a result, 30 women in the general population were potentially exposed to HIV per 100 sexually active men in the last year:nine women each additional year. Younger men and truckers expose almost twice as many women to HIV; more female peers than wives are exposed. Bridge populations may be as important as "core groups' for the spread of HIV into the general Thai population. Young men and women are strategic intervention targets because they have more partners, are more likely to be in bridging networks, and are more receptive to condom use.
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          Risk factors associated with HIV prevalence among female sex workers in 10 Brazilian cities.

          HIV prevalence is 15 times higher among female sex workers (FSWs) than in the overall Brazilian female population. In this article, we investigated factors associated to HIV infection among FSW, recruited by Respondent-driven sampling (RDS), in 10 Brazilian cities in 2008-2009. The total sampling was 2523 FSWs. The variables considered in the study included sociodemographic characteristics and those related to profession, knowledge, and source of information on sexually transmitted infection/AIDS, access to condoms, sexual behavior, health care and sexually transmitted infection signs, discrimination and violence, and the use of alcohol and drugs. Sampling weights were proportional to the inverse of network size and for the generation of global results for the 10 cities, data were calibrated by the population size. Multivariate logistic regression models were used, taking into account the dependency structure of observations. The longest period of prostitution (odds ratio [OR], 1.040; 95% confidence interval [CI], 1.013-1.067), the lowest price charged for sex (OR, 0.713; 95% CI, 0.522-0.970), the association with other sexually transmitted infections such as syphilis (OR, 2.186; 95% CI, 1.064-4.488), and the fact of would waive the use of condom on client's request (OR, 3.735; 95% CI, 1.449-9.661) were the most important associated risk factors to HIV infection among FSWs. Purchase of condoms (OR, 0.503; 95% CI, 0.304-0.833) was a relevant preventive factor. The use of RDS proved to be appropriate for the recruitment of FSWs as long as the statistical analysis takes into account the dependency structure of observations. The HIV infection predictors here depicted can support public health policies focused on this population group in Brazil.

            Author and article information

            [1 ] Post-doctoral Research Scientist, Department of Computer Science and Mathematics, Faculty of Science and Technology Prince of Songkla University, Pattani, Thailand.
            [2 ] Director, National Centre for AIDS and STD Control, Kathmandu Nepal
            [3 ] Research Officer, CREHPA, Kathmandu Nepal
            [4 ] Assistant Professor, Program in Research Methodology, Department of Computer Science and Mathematics Prince of Songkla University, Pattani, Thailand.
            Author notes
            Dr. Sampurna Kakchapati, Post-doctoral Research Scientist, Department of Computer Science and Mathematics, Faculty of Science and Technology, Prince of Songkla University, Pattani, Thailand. kck_sampurna@

            Author’s Contribution: Author's Contribution SK designed the concept, analysed the data, drafted the manuscript, and revised it. TP designed the concept and provide the data. MM help in data collection and revising the manuscript and AL revised the manuscript. .

            Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

            Source of Support: Nil

            Nepal J Epidemiol
            Nepal J Epidemiol
            Nepal Journal of Epidemiology
            International Nepal Epidemiological Association
            December 2016
            31 December 2016
            : 6
            : 4
            : 620-630
            5506387 10.3126/nje.v6i4.17256
            Copyright © 2016 CEA& INEA Published online by NepJOL-INASP.

            This work is licensed under a Creative Commons Attribution 4.0 International License

            Figures: 0, Tables: 5, Equations: 1, References: 20, Pages: 11
            Research Article


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