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 (≥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.Fil: Bautista, Christian T.. Walter Reed Army Institute Of Research; Estados UnidosFil: Sanchez, J. L.. Walter Reed Army Institute Of Research; Estados UnidosFil: Montano, S. M.. Naval Medical Research Unit No. 6; PerúFil: Laguna Torres, A.. Naval Medical Research Unit No. 6; PerúFil: Suarez, L.. Dirección General de Epidemiología; PerúFil: Sanchez, J.. Asociación Civil Impacta Salud y Educación; PerúFil: Campos, P.. Ministerio de Salud, Lima; PerúFil: Gallardo, C.. Fundacion Esperanza; EcuadorFil: Mosquera, C.. Instituto Nacional de Salud Pública E Investigación Leopoldo Izquieta Pérez; EcuadorFil: Villafane, M.. Ministerio de Salud Pública; ParaguayFil: Aguayo, N.. Ministerio de Salud Pública; ParaguayFil: Ávila, María Mercedes. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia para el Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Weissenbacher, Mercedes Crecencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia para el Sida; ArgentinaFil: Ramirez, E.. Instituto de Salud Publica de Chile; ChileFil: Child, R.. Comisión Nacional de Acreditación; ChileFil: Serra, M.. Ministerio de Salud; UruguayFil: Aponte, C.. Instituto Nacional de Higiene Rafael Rangel; VenezuelaFil: Mejia, A.. Instituto Nacional de Salud; ColombiaFil: Velazques, N.. Centro Nacional de Enfermedades Tropicales; BoliviaFil: Gianella, A.. Centro Nacional de Enfermedades Tropicales; BoliviaFil: Perez, J.. Naval Medical Research Unit No. 6; PerúFil: Olson, J. G.. Naval Medical Research Unit No. 6; PerúFil: Carr, J. K.. Walter Reed Army Institute Of Research; Estados Unido