SOCIOECONOMIC-STATUS AND RISK OF HIV-1, SYPHILIS AND HEPATITIS-B INFECTION AMONG SEX WORKERS IN SAO-PAULO STATE, BRAZIL

Objectives: To determine how HIV risk behavior and the prevalences of sexually transmitted diseases vary according to socioeconomic status a nd city among sex workers in Sao Paulo State, Brazil. Subjects and met hods: A cross-sectional study of 600 female sex workers (100 of a high er socioeconomic status and 100 of a lower socioeconomic status in eac h city) was conducted in the cities of Sao Paulo, Campinas and Santos. HIV risk behavior was assessed by questionnaire; serological tests we re administered to assess prior exposure to HIV-1, syphilis and hepati tis B. Results: Only statistically significant (P < 0.05) findings are reported here. Compared to those with a higher socioeconomic status, sex workers with a lower socioeconomic status worked longer hours each day (9.6 versus 7.9), had more clients per day (5.4 versus 2.6) and h ad fewer episodes of intercourse per client per encounter (1.1 versus 1.4). Levels of condom use for vaginal, anal and oral sex were signifi cantly higher in Santos than in Sao Paulo or Campinas. Twenty-three pe r cent of the women said they feared violence if they insisted that th eir clients wear condoms; 74% voiced similar fears regarding their non -client sexual partners. Overall, 11% of sex workers were positive for exposure to HIV-1, 45% for syphilis and 39% for hepatitis B. Those wi th a lower socioeconomic status were more likely than those with a hig her socioeconomic status to be infected with HIV-1 (17 versus 4%), syp hilis (66 versus 24%) and hepatitis B (52 versus 26%), but there were no differences in prevalence rates by city. Conclusions: These data de monstrate substantial heterogeneity in HIV risk behavior and the preva lence of HIV-1 and other sexually transmitted diseases among sex worke rs in Sao Paulo State, many of which were related to differences in so cioeconomic status. Interventions to prevent HIV transmission among se x workers must be tailored to the local environment and, in particular , to the socioeconomic status of these workers.