HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney

Objectives: To assess prevalence of HIV and sexually transmitted infections (STIs), risk behaviours, and demographics in male commercial sex workers ( CSWs)/prostitutes in Sydney. Methods: Retrospective, cross sectional study with two comparison groups. D emographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydn ey between January 1991 and March 1998. Two comparison groups were used: fe male CSWs and non-CSW working homosexual men who attended over the same tim e. Results: 94 male CSWs, 1671 female CSWs, and 3541 non-CSW working homosexua l men were included. The prevalence of HIV in male CSWs tested (6.5%) was s ignificantly greater than in female CSWs (0.4%, p=0.0001), but less than in non-CSW homosexual men (23.9%, p<0.0001). Genital warts occurred significa ntly more frequently in male CSWs than in comparison groups. Prevalence of other STIs was similar in all groups. Male CSWs saw significantly fewer cli ents per week than female CSWs and male and female CSWs used condoms with a lmost all clients. Male CSWs reported significantly more non-work sexual pa rtners than female CSWs and non-CSW homosexual men and were significantly m ore likely to have unprotected penetrative sex with their non-work partners than non-CSW homosexual men. Injecting drug use was significantly more fre quent in male CSWs than in both comparison groups. Conclusions: Although male CSWs use condoms with clients, they are more lik ely to practise unsafe sex with non-work partners (especially women) and in ject drugs than female CSWs and non-CSW homosexual men. Some men with HIV a re working within the commercial sex industry. Targeted health education to encourage safer drug use and safer sex outside work is needed.