The ecology of sex work and drug use in Saratov Oblast, Russia.
BACKGROUND
The Russian Federation is experiencing epidemics of drug-injection-associated HIV infection and high rates of syphilis and other sexually transmitted infections (STIs).


OBJECTIVE
The goal of the study was to present the results of a rapid assessment focusing on sex workers (SWs) and drug users that was conducted in the Saratov Oblast in May 2000.


METHODS
We used four data-collection techniques during this rapid assessment: review of available literature; in-depth interviews; naturalistic observations; and focus group discussions.


RESULTS
Sex work in Saratov/Engels is more differentiated, with more categories of SWs, pimps with well-defined functions, and clearly formed escort services. In Balakovo, sex work is confined to individual women who are working as freelancers, most of whom are drug users. In the past 2 years, the drug of choice has shifted to heroin. The potential epidemiologic impact of sex work on the general population is defined in terms of the number of SW contacts per 100,000 population per year, which ranges from 32,800 to 730,000. Further elaboration of this simple measure is discussed.


CONCLUSIONS
Our understanding of core group structure and characteristics, core-periphery contacts, and the impact of these on the spread of STI needs to be enhanced; comparative empirical data on such parameters need to be collected across societies.
Aral
Sevgi O
SO
Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, M/S-E02, Atlanta, GA 30333, USA.
St  Lawrence
Janet S
JS
D003625:Data Collection; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D012426:Russia / Q000453:epidemiology; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D019966:Substance-Related Disorders / Q000453:epidemiology*