Although it is well known and accepted that FSW are a highly vulnerable group in the scope of the HIV epidemic, most countries in the world do not know the size of this population group. The estimates of the prevalence of FSW presented in this paper show how important this hard-to-reach population group is in all parts of the world.

Background Uganda has long been successful in controlling the HIV epidemic but there is evidence that HIV prevalence and incidence are increasing again. Data on the HIV/STI epidemic among sex workers are so far lacking from Uganda. This paper describes the baseline epidemiology of HIV/STI in a newly-established cohort of women involved in high risk sexual behaviour in Kampala, Uganda. Methods Women were recruited from red-light-areas in Kampala. Between April 2008-May 2009, 1027 eligible women were enrolled. Socio-demographic and behavioural information was collected; blood and genital samples were tested for HIV/STI. Risk factors for HIV-infection were examined using multivariable logistic regression. Results HIV seroprevalence was 37%. The prevalence of N. gonorrhoea (NG) was 13%, C. trachomatis (CT) 9%, T. vaginalis (TV) 17%, bacterial vaginosis (BV) 56% and 11% had candida infection. 80% had HSV-2 antibodies, 21% were TPHA -positive and 10% had active syphilis (RPR+TPHA+). In 3% of the genital ulcers, T. pallidum (TP) was identified, H. ducreyi (HD) in 6% and HSV-2 in 35%. Prevalent HIV was independently associated with older age, being widowed, lack of education, sex work as sole income, street based sex work, not knowing HIV-status, using alcohol and intravaginal cleansing with soap. HIV-infection was associated with NG, TV, BV, HSV-2 seropositivity and active syphilis. Conclusions Prevalence of HIV/STI is high among women involved in high risk sexual behaviour in Kampala. Targeted HIV prevention interventions including regular STI screening, VCT, condom promotion and counselling for reducing alcohol use are urgently needed in this population.

M. genitalium is likely to persist and recur in the female genital tract. Because of the urogenital tract morbidity caused by the infection and the observed association with HIV acquisition, further research is needed to define screening modalities, especially in populations at high risk for HIV, and to optimize effective and affordable treatment options.

BackgroundEffective interventions among female sex workers require a thorough knowledge of the context of local sex industries. We explore the organisation of female sex work in a low socio-economic setting in Kampala, Uganda.MethodsWe conducted a qualitative study with 101 participants selected from an epidemiological cohort of 1027 women at high risk of HIV in Kampala. Repeat in-depth life history and work practice interviews were conducted from March 2010 to June 2011. Context specific factors of female sex workers’ day-to-day lives were captured. Reported themes were identified and categorised inductively.ResultsOf the 101 women, 58 were active self-identified sex workers operating in different locations within the area of study and nine had quit sex work. This paper focuses on these 67 women who gave information about their involvement in sex work. The majority had not gone beyond primary level of education and all had at least one child. Thirty one voluntarily disclosed that they were HIV-positive. Common sex work locations were streets/roadsides, bars and night clubs. Typically sex occurred in lodges near bars/night clubs, dark alleyways or car parking lots. Overall, women experienced sex work-related challenges at their work locations but these were more apparent in outdoor settings. These settings exposed women to violence, visibility to police, a stigmatising public as well as competition for clients, while bars provided some protection from these challenges. Older sex workers tended to prefer bars while the younger ones were mostly based on the streets. Alcohol consumption was a feature in all locations and women said it gave them courage and helped them to withstand the night chill. Condom use was determined by clients’ willingness, a woman’s level of sobriety or price offered.ConclusionsSex work operates across a variety of locations in the study area in Kampala, with each presenting different strategies and challenges for those operating there. Risky practices are present in all locations although they are higher on the streets compared to other locations. Location specific interventions are required to address the complex challenges in sex work environments.