The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics.
BACKGROUND
While female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs), there are limited comparative data with other population groups available. Using routine STI surveillance data, we investigated differences in sexual health between FSWs and other female attendees at genitourinary medicine (GUM) clinics in England.


METHODS
Demographic characteristics, STI prevalence and service usage among FSWs and other attendees in 2011 were compared using logistic regression.


RESULTS
In 2011, 2704 FSWs made 8411 recorded visits to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London). FSWs used a variety of services, however, 10% did not have an STI/HIV test at presentation. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (e.g., gonorrhoea ORadj: 2.76, 95% CI 2.16 to 3.54, p<0.001). Migrant FSWs had better sexual health outcomes than UK-born FSWs (e.g., period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease ORadj: 2.92, 95% CI 1.57 to 5.41, p<0.001).


CONCLUSIONS
FSWs in England have access to high-quality care through the GUM clinic network, but there is evidence of geographical inequality in access to these services. A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees. Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population.
Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
Louise
L
Mc Grath-Lone
Department of HIV & STIs, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Kimberly
K
Marsh
Department of HIV & STIs, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Gwenda
G
Hughes
Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
Helen
H
Ward
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002181:Candidiasis, Vulvovaginal / Q000453:epidemiology; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000453:epidemiology; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D005843:Geography; D006069:Gonorrhea / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology; D015995:Prevalence; D060728:Reproductive Health; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D055815:Young Adult
D017325:Hepatitis B Vaccines
Prostitution; Sexual Health; Surveillance; Women