Trends in sexual behaviour and the incidence of sexually transmitted diseases and HIV among drug-using prostitutes, Amsterdam 1986-1992.
OBJECTIVE
To determine trends in commercial sexual risk behaviour among drug-using prostitutes in Amsterdam after local and national prevention campaigns began in 1987.


METHODS
A subgroup of 281 drug-using prostitutes was selected from a comprehensive, open cohort study of drug users in Amsterdam.


METHODS
Cross-sectional (at intake) and within-person trends in sexual behaviour were evaluated. Person-time analysis was used to determine trends in incidence of sexually transmitted disease (STD).


RESULTS
From 1986 to 1992, 'always' use of condoms in the 6 months preceding intake increased from 21 to 58% (P < 0.001) and the number of commercial contacts declined from 84 to 64 per month (P = 0.06). Consequently, the mean number of unprotected commercial contacts declined from 26 to nine per month (P < 0.001). Temporal trends within individual prostitutes from visits 1 to 8 (mean interval between visits, 4 months) showed a somewhat larger risk reduction than the cross-sectional trends. From 1989 to 1992, the STD incidence declined from 61 to 40 episodes per 100 person-years (P = 0.06). Prostitutes residing in Amsterdam for shorter time periods reported more STD and a relatively small core group reported the majority of STD episodes. At intake, when < 10% of all participants knew their HIV serostatus, HIV-positive prostitutes reported significantly lower levels of condom use and more STD than HIV-negatives, while, after learning their serostatus, levels of condom use and the STD-incidence were comparable. Prevalent and incident HIV infections were not observed among non-injecting prostitutes.


CONCLUSIONS
Drug-using prostitutes have reduced sexual risk behaviour. There is evidence for the effectiveness of HIV testing and counseling. At present, new infections among clients of drug-using prostitutes are expected to occur, although not on a large scale. Since the incidence of STD continues to be high, it is important to monitor the spread of HIV among heterosexuals, including prostitutes and their clients, closely.
van Ameijden
E J
EJ
Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.
van den Hoek
A J
AJ
van Haastrecht
H J
HJ
Coutinho
R A
RA
D000328:Adult; D003042:Cocaine; D015331:Cohort Studies; D015897:Comorbidity; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000208:ethnology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence; D006556:Heroin Dependence / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D009426:Netherlands / Q000453:epidemiology; D015397:Program Evaluation; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D016320:Substance Abuse Treatment Centers; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population
D003042:Cocaine