HIV Seroprevalence Study Among 729 Female Prostitutes in Italy
1996; Lippincott Williams & Wilkins; Volume: 11; Issue: 2 Linguagem: Inglês
10.1097/00042560-199602010-00018
ISSN2331-6993
AutoresUmberto Tirelli, Michele Spina, Salvatrice Mancuso, Cristina Lh Traina, Alessandro Sinicco,
Tópico(s)HIV Research and Treatment
ResumoTo the Editor: It is well known that prostitutes constitute an HIV reservoir in Africa and Southeast Asia (1,2). In Italy, previous reports have shown that HIV seroprevalence was low (2%) among professional Italian prostitutes generally and high (37%) among Italian intravenous drug-using (IVDU) prostitutes (3-5). In the past few years, an increasing number of female prostitutes arrived from high-risk areas such as central African countries and began working in Italy. We want to report the overall HIV seroprevalence among female prostitutes working in Italy, in particular before and after the massive arrival of foreign prostitutes. From January 1988 to November 1994, we collected data through questionnaires filled out by physicians of several Italian institutions regarding HIV serological testing of 729 female prostitutes who were working in 13 Italian towns: Milan, Rome, Naples, Pordenone, Palermo, Turin, Florence, Reggio Emilia, Lecco, Bologna, Genova, Ravenna, and Udine. This study was carried out on prostitutes who voluntarily attended Italian medical facilities for HIV; the results of this seroprevalence study therefore could be biased by this selection. Five hundred and nineteen out of 729 prostitutes (71%) were professional prostitutes; the remaining 210 were IVDU. Overall, 111/729 (15%) were HIV positive: 25 out of 519 professionals (5%) and 86 out of 210 IVDU prostitutes (41%). Regarding the geographic origin of these prostitutes: 593/729 (81%) were Italians, and 136/729 (19%) were foreigners (of these foreigners, 107 came from South America, 22 from Africa, and seven from Eastern Europe. Among the foreign prostitutes, 17/136 (12.5%) were HIV positive; three of then were from the 107 (3%) from South America (two from Brasil and one from Colombia). Two of the seven from Eastern Europe (both from ex-Yugoslavia) were HIV positive (28%). Twelve of the 22 from Africa (five from Nigeria, three from Ghana, three from Zaire, and one from Senegal) were HIV positive (54%). We have also split the results according to when the seroprevalence study was conducted. From 1988 to 1990, i.e., before the arrival of most foreign prostitutes, the seroprevalence study carried out among 403 Italian prostitutes showed that HIV seroprevalence was 2% among professional prostitutes and 37% among IVDU prostitutes (p < 0.001) (5). From 1991 to 1994, the seroprevalence study carried out among 326 Italian and foreign prostitutes showed that HIV infection was present in 8% among professional prostitutes and in 46% among IVDU prostitutes (p < 0.001). In the first study no foreign prostitutes were present, whereas in the second study 136 foreign prostitutes were included in the professional prostitute group of 234. There is a significant increase of seroprevalence among professional prostitutes between 1988-90 and 1991-94 (2% vs. 8%; p < 0.001), whereas among the IVDU prostitutes the increase was not significant (37% vs. 46%; p = 0.22). Table 1 summarizes our data. Moreover, on a confidential basis, all prostitutes were interviewed about condom use with clients. The Italian prostitutes regularly used condoms (6), but, among the 17 HIV positive foreign prostitutes, all but one reported not regularly using condoms, especially when the client offered more money for sex without a condom. This unfortunately is a common request. Therefore, our data show a significant increase of seroprevalence among professional prostitutes in the recent years, whereas the high seroprevalence among IVDU prostitutes is constant. It is reasonable to think that IVDU prostitutes still drive the epidemic, but in the future, if the population of African prostitutes continues to grow, these women may also significantly contribute to increase the infection rates. Acknowledgment: This work was supported in part by grants of ISS. *U. Tirelli; *M. Spina; †S. Mancuso; ‡C. Traina; §A. Sinicco *Division of Medical Oncology and AIDS, Cancer; Center; Aviano, Italy †AIDS Center, Policlinico Giaccone ‡AIDS Center, USL 58; Palermo, Italy §Institute of Infectious Diseases, Hospital Amedeo di; Savoia; Turin, Italy
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