title: Injection drug use, sexual risk, violence and STI/HIV among Moscow female sex workers.
abstract: OBJECTIVE
  The HIV prevalence in Eastern Europe and Central Asia continues to increase. While injection drug use (IDU) is leading factor, heterosexual transmission is on the rise. Little is known about female sex workers (FSWs) in the region despite the central role of commercial sex in heterosexual sexually transmitted infection (STI)/HIV transmission globally. The authors evaluated the prevalence of STI/HIV among Moscow-based FSWs and potential risk factors including IDU, sexual risks and violence victimisation.
  
  
  METHODS
  Moscow-based FSWs (n=147) completed a clinic-based survey and STI/HIV testing over an 8-month period in 2005.
  
  
  RESULTS
  HIV prevalence was 4.8%, and 31.3% were infected with at least one STI including HIV. Sexual behaviours significantly associated with STI/HIV included anal sex (adjusted odds ratio (AOR) 3.48), high client volume (three or more clients daily, AOR 2.71), recent subbotnik (sex demanded by police; AOR 2.50) and regularly being presented with more clients than initially agreed to (AOR 2.45). Past year experiences of physical violence from clients and threats of violence from pimps were associated with STI/HIV (AOR 3.14 and AOR 3.65, respectively). IDU was not significantly associated with STI/HIV. Anal sex and high client volume partially mediated the associations of abuse with STI/HIV.
  
  
  CONCLUSIONS
  Findings illustrate substantial potential for heterosexual STI/HIV transmission in a setting better known for IDU-related risk. Many of the STI/HIV risks observed are not modifiable by FSWs alone. STI/HIV prevention efforts for this vulnerable population will benefit from reducing coercion and abuse perpetrated by pimps and clients.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., E4142, Baltimore, MD 21212, USA. mdecker@jhsph.edu
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Baral
authors.forename: Alena
authors.initials: A
authors.lastname: Peryshkina
authors.forename: Vladmir
authors.initials: V
authors.lastname: Mogilnyi
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Weber
authors.forename: Julie
authors.initials: J
authors.lastname: Stachowiak
authors.forename: Vivian
authors.initials: V
authors.lastname: Go
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D009031:Moscow / Q000453:epidemiology; D015995:Prevalence; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D047568:Unsafe Sex / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult