Risky business: health and safety in the sex industry over a 9 year period.
OBJECTIVE
To assess whether a previously established low sexually transmitted infection/HIV risk in prostitutes in London has been sustained, and to measure other occupational risks, including mortality.


METHODS
9 year prospective study in west London.


METHODS
402 prostitutes recruited from 1985 to 1991, 320 were followed up for 675 person years to 1994.


METHODS
Condom use in commercial and non-commercial sex; viral and bacterial sexually transmitted infection at initial and follow up visits; death.


RESULTS
Condom use increased significantly from 1986 to 1993 and protected the majority of commercial sexual contacts. Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Viral infections were associated with injecting drug use and non-British nationality; bacterial infections were associated with numbers of non-commercial partners but not with sexual contacts at work. Four women died during the course of the study; two had AIDS, two were murdered. This mortality of 5.93 per 1000 person years was 12 times the expected rate for women of a similar age.


CONCLUSIONS
This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently: there has been a sustained increase in condom use in the sex industry. None the less, prostitutes are at increased risk of sexually transmitted infections, primarily through non-commercial sexual partnerships. Infectious diseases are only one of the risks facing prostitutes, as illustrated by the mortality from violence as well as from HIV infection.
Ward
H
H
Department of Epidemiology and Public Health, Imperial College School of Medicine, St Mary's Hospital, London.
Day
S
S
Weber
J
J
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000635:transmission; D015331:Cohort Studies; D017280:Condoms; D005260:Female; D006069:Gonorrhea / Q000635:transmission; D006708:Homicide; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000401:mortality / Q000517:prevention & control / Q000635:transmission*; D015819:Substance Abuse, Intravenous / Q000150:complications; D013587:Syphilis / Q000635:transmission; D014777:Virus Diseases / Q000401:mortality / Q000635:transmission