title: Decline in sexually transmitted disease prevalence in female Bolivian sex workers: impact of an HIV prevention project.
abstract: OBJECTIVE
  To implement an HIV prevention intervention among female commercial sex workers (CSW), and to monitor key outcomes using routinely collected clinical and laboratory data.
  
  
  METHODS
  Cross-sectional and longitudinal analysis of data from an open-enrollment cohort.
  
  
  METHODS
  One public sexually transmitted disease (STD) clinic and about 25 brothels in La Paz, Bolivia.
  
  
  METHODS
  A total of 508 female CSW who work at brothels and attend a public STD clinic.
  
  
  METHODS
  Improved STD clinical care, supported by periodic laboratory testing, and behavioral interventions performed by a local non-governmental organization.
  
  
  METHODS
  Prevalence of gonorrhea, syphilis (reactive plasma reagin titer > or = 1 : 16), genital ulcer disease, chlamydial infection, and trichomoniasis; self-reported condom use in the previous month; and HIV seroprevalence.
  
  
  RESULTS
  From 1992 through 1995, prevalence of gonorrhea among CSW declined from 25.8 to 9.9% (P < 0.001), syphilis from 14.9 to 8.7% (P = 0.02), and genital ulcer disease from 5.7 to 1.3% (P = 0.006); trends in prevalence of chlamydial infection and trichomoniasis were not significant. Self-reported condom use during vaginal sex in the past month increased from 36.3 to 72.5% (P < 0.001). In a multivariate analysis, condom use was inversely associated with gonorrhea [odds ratio (OR), 0.63; 95% confidence interval (Cl), 0.41-0.97], syphilis (OR, 0.39; 95% Cl, 0.23-0.64), and trichomoniasis (OR, 0.44; 95% Cl, 0.32-0.71). In 1995, HIV seroprevalence among CSW was 0.1%.
  
  
  CONCLUSIONS
  Effective prevention interventions for female CSW can be implemented through public services and non-governmental organizations while HIV rates are still low, and key outcomes can be monitored using data obtained from periodic screening examinations.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: Levine
authors.forename: R
authors.initials: R
authors.lastname: Revollo
authors.forename: V
authors.initials: V
authors.lastname: Kaune
authors.forename: J
authors.initials: J
authors.lastname: Vega
authors.forename: F
authors.initials: F
authors.lastname: Tinajeros
authors.forename: M
authors.initials: M
authors.lastname: Garnica
authors.forename: M
authors.initials: M
authors.lastname: Estenssoro
authors.forename: J S
authors.initials: JS
authors.lastname: Lewis
authors.forename: G
authors.initials: G
authors.lastname: Higueras
authors.forename: R
authors.initials: R
authors.lastname: Zurita
authors.forename: L
authors.initials: L
authors.lastname: Wright-De Agüero
authors.forename: R
authors.initials: R
authors.lastname: Pareja
authors.forename: P
authors.initials: P
authors.lastname: Miranda
authors.forename: R L
authors.initials: RL
authors.lastname: Ransom
authors.forename: A A
authors.initials: AA
authors.lastname: Zaidi
authors.forename: M L
authors.initials: ML
authors.lastname: Melgar
authors.forename: J N
authors.initials: JN
authors.lastname: Kuritsky
mesh_terms: D000328:Adult; D001838:Bolivia / Q000453:epidemiology; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015999:Multivariate Analysis; D015995:Prevalence; D016730:Program Development; D012307:Risk Factors; D011477:Sex Work; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D016387:Women's Health