HIV PREVALENCE AND RISK BEHAVIOR AMONG PROSTITUTES AND CLIENTS IN AMSTERDAM - MIGRANTS AT INCREASED RISK FOR HIV-INFECTION

Objectives-To study groups of prostitutes and clients of prostitutes i n order (i) to determine HIV prevalence and sexual risk behaviour, (ii ) to determine differences between samples recruited within and outsid e a clinic for sexually transmitted diseases (STD) and (iii) to determ ine correlates of inconsistent condom use (ICU) among both groups. Des ign-Participants were interviewed and anonymously tested for HIV-antib ody; approximately half were recruited at a clinic for sexually transm itted diseases (STD) and half at prostitute working places. Setting-An STD clinic and prostitute working places in Amsterdam in 1991. Subjec ts-201 female prostitutes without a history of injecting drugs and 213 male clients of female prostitutes. Main outcome measures-antibodies to HIV, consistency of condom use in commercial vaginal contacts in th e preceding 6 months. Results-HIV prevalence was low: three prostitute s (1.5%; 95% CI 0.5-4.6%) and one client (0.5%; 95% CI 0.1-3-3%) were infected. All three HIV positive prostitutes originated from AIDS-ende mic countries, came to the Netherlands only recently and were recruite d outside the STD clinic. Large differences between subgroups resulted from the two recruitment methods: while clients of prostitutes with r elatively high risk behaviour were strongly represented among the STD clinic sample, high risk prostitutes were underrepresented in this sam ple. Consistent condom use (with 100% of contacts) was reported by 66% of prostitutes and 56% of clients of prostitutes. Inconsistent condom use was found to be high among prostitutes who had migrated from Lati n America and among migrant clients of prostitutes. Conclusions-When m onitoring HIV infection one must take into account imported cases. HIV prevention efforts should be particularly focused at prostitutes from Latin America and at clients of prostitutes who migrated to the Nethe rlands.