Sex Workers Face Sexual and Non-Sexual HIV Risks

A survey into HIV/AIDS among female sex workers (FSW), injecting drug users (IDU) and men who have sex with men (MSM) in Lebanon has found that prevalence was 3.7% among MSM but that no members of the other two groups were HIV positive. Whatever about IDUs, it is not too surprising that no FSWs were infected. In many countries where HIV prevalence has been monitored over a long period of time, prevalence among FSWs has been found to be low, even zero, unless they also face other risks such as injecting drugs.

This is what makes it so surprising that HIV prevalence can be extremely high among sex workers in some African countries. It has been claimed that prevalence reached over 80% among sex workers in Nairobi in the 1980s and over 70% in one region in Tanzania in the 1990s. It is often said that high rates of sexually transmitted infections STI make sex workers more susceptible to HIV. This is undoubtedly true, but rates of some STIs, which are an indication that those infected could have been engaging in unsafe sex, don't seem to correlate with HIV rates.

Programs that aimed to reduce STI rates have often been successful, but they have not usually resulted in any reduction in HIV incidence. Indeed, long before HIV was identified, STI prevalence among the entire male population of Leopoldville in the former Zaire in the late 1950s was extremely low. And it was in the years following this that HIV transmission rates were said to have increased as a result of extraordinary levels of 'unsafe' sexual behavior. What seems more plausible is that FSWs in Kenya and Tanzania were rounded up, perhaps routinely, to receive sexual healthcare that may not have been too sterile.

Sex workers everywhere can engage in high levels of 'unsafe' sex, but only in a few countries have sex workers been found to have such massive rates of HIV infection. And only in a few countries have up to 50% of the female heterosexual population in certain age groups been infected with a virus that can be transmitted sexually, but is far more efficiently transmitted through unsafe healthcare. Why should high levels of 'risky' sexual behavior among Lebanese sex workers result in no HIV infections when relatively low levels in some African countries result in high rates of HIV infection?