HIV/AIDS risk among female sex workers who use crack in Southern Brazil.
OBJECTIVE
To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study.


RESULTS
Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care.


CONCLUSIONS
Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.
Malta
Monica
M
Departamento de Ciências Sociais, Escola Nacional de Saúde Pública SérgioArouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. mmalta@jhsph.edu
Monteiro
Simone
S
Lima
Rosa Maria Jeronymo
RM
Bauken
Suzana
S
Marco
Aliamar de
Ad
Zuim
Gleisse Cristine
GC
Bastos
Francisco Inacio
FI
Singer
Merrill
M
Strathdee
Steffanie Anne
SA
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D016578:Crack Cocaine; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D036301:Qualitative Research; D018570:Risk Assessment; D012309:Risk-Taking; D012649:Self Concept; D012742:Sex Offenses; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D035862:Vulnerable Populations; D055815:Young Adult
D016578:Crack Cocaine