HIV infection among sex workers in Accra: Need to target new recruits entering the trade

Objective: Description of the epidemiology of HIV infection among sex worke rs (SW) in Accra, Ghana. Methods: In all, 1013 SW working out of their homes (seaters) or finding cu stomers in bars, hotels, brothels or on the street (roamers) were interview ed and tested for HIV. Results: Overall, prevalence of HIV infection was nearly 50% (506 of 1013), varying from 26% (133 of 507) among the roamers to 74% (368 of 496) among the sealers. Profound differences were noted between these two categories o f SW with regard to age, number of clients per day, price per instance of i ntercourse, condom use, and other characteristics. Respectively, 27% and 58 % of roamers and seaters were infected with HIV within their first 6 months of sex work, despite a limited number of unprotected sex acts with seropos itive clients. Independent risk factors fur HIV infection varied between ty pes of SW: age among the roamers; region of origin and duration of sex work among the sealers; number of clients per day, and presence of current or p ast genital ulcer and gonococcal cervicitis in both groups. Conclusion: In Accra, considerable heterogeneity exists in the population o f SWs. In both categories of SW, new recruits become rapidly infected with HIV after entering the trade. The 25-fold higher prevalence of HIV among SW s than in the general adult population suggests that in Accra, as in many c ities of West Africa, a high fraction of new cases of HIV infection continu e to be acquired from SWs. Intervention programs targeting SW should be an essential component of national AIDS control strategies. Special efforts sh ould be made to identify and offer preventive services to new sex workers.