Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016

Abstract

Background:The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016.Methods:The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate.Results:Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%).Discussion:Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.

Prevalence of syphilis in female sex workers in three countryside cities of the state of Pará, Brazilian Amazon

“…Studies have shown epidemiological heterogeneity on the prevalence of STIs among different regions of Brazil [7,8]. A survey conducted in 10 different state capital cities in Brazil (the seat of a state government, in this case with an average large metropolitan area > 1.5 million inhabitants) showed an increase from 2.4% in 2009 to 8.5% in 2016 on the prevalence of syphilis among FSWs, which demonstrates that beside all health public policies and access to information available, the prevalence of syphilis is rising [9]. Another study carried out in three southern cities of Brazil (Tubarão, Laguna and Imbituba), showed an even higher prevalence of syphilis among FSWs (19.7%) [8].…”

“…These cities can be characterized as small urban areas (population is between 50,000 and 200,000), showing about 100,000 inhabitants, have human development indexes around 0.55 (low) and have as their main economic activities: fishing, agriculture, extraction and processing of natural resources, such as crabs, shrimps and kaolin (used in the production of alumina and aluminium). All these cities have an intense flow of people and product trade, mainly by highways and seaports [9]. The following inclusion criteria were used: women (biologically determined at birth) older than 15 years who reported commercial sex at least once in the last 3 months that agreed to participate in the study and signed the free consent form.…”

HIV testing coverage among female sex workers, Brazil, 2016

“…The comparison of biological and behavioral studies performed in 2009 and 2016 in the group of FSWs showed an important increase of the HIV testing coverage in Brazil. The proportion of FSWs tested for HIV at least once in life grew from 64.4% to 77.3%, while the testing coverage in the 12 months prior to the researches increased from 20.3% to 39.3% 15 .…”

“…The combined prevalence was estimated in 5.1%. In a biological and behavioral survey conducted in 10 Brazilian cities, in 2009, the prevalence of HIV was estimated in 5% 14 , and in a survey of 2016, performed with similar methodology, the prevalence of HIV remained in the same level 15 .…”

A More Understanding about AIDS: Design and Assessment of Validity and Reliability of Several New Scales

“…5 Assessing one's knowledge, attitudes and performance are necessary prior to AIDS preventive planning. 6 we decided that knowledge would be addressed in a construct called 'health literacy.' In fact, health literacy refers to one's capacity to receive, perceive and interpret primary information and health services, which are required for appropriate decision-making.…”