Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America.
OBJECTIVE
Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America.


METHODS
Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests.


RESULTS
The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries.


CONCLUSIONS
Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.
Bautista
C T
CT
U.S. Military HIV Research Program at the Walter Reed Army Institute of Research, and the Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., 1 Taft Court, Suite 250, Rockville, MD 20850, USA. cbautista@hivresearch.org
Sanchez
J L
JL
Montano
S M
SM
Laguna-Torres
A
A
Suarez
L
L
Sanchez
J
J
Campos
P
P
Gallardo
C
C
Mosquera
C
C
Villafane
M
M
Aguayo
N
N
Avila
M M
MM
Weissenbacher
M
M
Ramirez
E
E
Child
R
R
Serra
M
M
Aponte
C
C
Mejia
A
A
Velazques
N
N
Gianella
A
A
Perez
J
J
Olson
J G
JG
Carr
J K
JK
D000328:Adult; D015153:Blotting, Western; D004797:Enzyme-Linked Immunosorbent Assay; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D013020:South America / Q000453:epidemiology