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At least 19 recordsLinked to original sources
PubMed1989

Sex worker, client sex behaviour and condom use in Harare, Zimbabwe.

One-hundred sex workers and 100 clients were interviewed at a bar/disco complex in Harare, Zimbabwe in 1989. Sociodemographic characteristics of sex workers and clients were examined. Almost a third of sex workers and nearly 90% of clients had engaged in commercial sex over 5 or more years. Sex workers reported that they worked an average of 4.6 nights a week, averaged 2.2 clients a night and charged a mean of Z$8.7 per session and Z$19.8 per night. Clients reported that they averaged 7.4 visits a month to a sex worker and paid a mean of Z$6.2 per session and Z$17.2 per night. Over half the sex workers said their last client was drunk and nearly two-thirds said he was a repeat client. Sex workers and clients were asked about the sex behaviours completed in their last paid sex act. Vaginal intercourse was reported by 98% of sex workers and clients alike. Manual stimulation of the sex worker's and client's genitalia was reported by roughly 80% of sex workers and clients. Oral and anal sex were rarely reported. Fifty-four percent of sex workers and 44% of clients reported using a condom in their last paid sex act. Client reports thus suggest that sex worker reports of sex acts and condom use with the last client possess considerable validity. Ethnographic approaches were used to study the social and work environment of sex workers. Ethnographic analysis demonstrated a lack of organisation among sex workers and a need to develop cohesive groups for successful health interventions. The study also highlighted the need to include clients in health interventions, the possible role of alcohol as an impediment to health interventions and the feasibility of using bar/disco security and the bar personnel as health educators.

Adolescent↗
PubMed2006

Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study.

BACKGROUND: Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. METHODS: All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. RESULTS: Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. CONCLUSION: Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU.

Journal Article↗
PubMed2004

The use of the Internet by gay and bisexual male escorts: sex workers as sex educators.

While prior studies have targeted street-based male sex workers as potential vectors of disease transmission, the number of men who work independently through Internet chat-rooms and other online endeavors has steadily increased. It is likely that these men differ substantially from their street-based counterparts in terms of sexual risk behaviors with their clients. The purpose of this study was to explore the ways in which the Internet has impacted the work of male escorts and their sexual practices with clients. Semi-structured qualitative interviews and quantitative surveys were administered to 46 such men. Less than half the men reported unprotected anal sex with clients. The qualitative data lend support to this finding, in that the majority talked about refusing any unsafe sex with clients, and many reported taking the extra step of educating their clients about the dangers of risky sex. Some of the escorts described the methods used to incorporate safer sex practices into sessions with their clients. Internet-based male escorts can play an important role as potential sex educators on the front lines of the fight against HIV and other sexually transmitted infections.

Adult↗
PubMed2005

Drug use and risk behaviours among injecting drug users: a comparison between sex workers and non-sex workers in Sydney, Australia.

BACKGROUND: This paper examines the differences in demographics, drug use patterns and self reported risk behaviours between regular injecting drug users (IDU) who report engaging in sex work for money or drugs and regular injecting drug users who do not. METHODS: Cross sectional data collected from regular IDU interviewed as part of the New South Wales (NSW) Illicit Drug Reporting System (IDRS) in 2003 were analysed. RESULTS: IDU who reported engaging in sex work were more likely to be female, and identify as being of Aboriginal and/or Torres Strait Islander descent. They initiated injecting drug use at a significantly younger age and were more likely to report injection related problems than IDU who had not engaged in sex work. There were no differences in the drug classes used, but findings suggested that the sex workers tended to be more frequent users of crystalline methamphetamine (ice) and benzodiazepines. CONCLUSION: The similarities between these groups were more striking than the differences. Further research, examining a larger sample is needed to clarify whether injecting drug users who are sex workers have heavier use patterns.

Journal Article↗
PubMed2001

HIV surveillance among female sex workers.

Female sex workers are at high risk for infection with HIV, and their clients may act as a bridging population by spreading HIV to the general population. Comprehensive HIV surveillance among sex workers includes surveillance of HIV infection, of sexually transmitted infections and of risk behavior. Surveillance of HIV infection among sex workers is critical for countries with low-level or concentrated HIV epidemics, and can help in monitoring the response to the HIV epidemic in countries with a generalized epidemic. Sex workers are a vulnerable population, and particular attention needs to be paid to human rights issues including consent, confidentiality and stigma. Collaborations with key players in the local sex work scene--sex workers themselves in the first place--and alliances with salient institutions and groups are key to the success of surveillance among sex workers. Surveillance activities should have a strong link to interventions targeted at sex workers. Surveillance for HIV infection among sex workers can be institution- or community-based. Institutional settings include screening programs for registered sex workers, of sexually transmitted diseases clinics, and re-education camps. Specific sources of bias need to be considered in different settings, and must be measured--through the collection of socio-demographic and behavioral data--to allow a correct interpretation of prevalence data and time trends. Community-based HIV infection surveillance can be conducted in a probability sample of the sex worker population, thereby reducing selection bias. This requires the mapping of sex workers' contact venues, and drawing a random sample from the resulting sampling frame.

Cross-Sectional Studies↗
PubMed2006

Exploring barriers to 'respondent driven sampling' in sex worker and drug-injecting sex worker populations in Eastern Europe.

Respondent driven sampling (RDS) has been used in several counties to sample injecting drug users, sex workers (SWs) and men who have sex with men and as a means of collecting behavioural and biological health data. We report on the use of RDS in three separate studies conducted among SWs between 2004 and 2005 in the Russian Federation, Serbia, and Montenegro. Findings suggest that there are limitations associated with the use of RDS in SW populations in these regions. Findings highlight three main factors that merit further investigation as a means of assessing the feasibility and appropriateness of RDS in this high risk population: the network characteristics of SWs; the appropriate level of participant incentives; and lack of service contact. The highly controlled and hidden nature of SW organizations and weak SW social networks in the region can combine to undermine assumptions underpinning the feasibility of RDS approaches and potentially severely limit recruitment. We discuss the implications of these findings for recruitment and the use of monetary and non-monetary incentives in future RDS studies of SW populations in Eastern Europe.

Data Collection↗
PubMed2004

Cervical smears and human papillomavirus typing in sex workers.

OBJECTIVES: Sex workers are at increased risk for sexually transmitted infections (STI), human papillomavirus (HPV) and hence cervical cancer. In Belgium screening for cervical cancer starts at the age of 25, and is at 3 yearly intervals. The aim of this study is to assess risks for abnormal cervical smears and HPV in sex workers and decide whether the current screening policy is sufficient for them. METHODS: In an outreach programme for sex workers results of 653 smears sampled between 1992 and 2001 were analysed, and compared to a control group matched for age from the general population in 2001. Separately, 99 consecutive samples were typed for HPV and compared to an equal control group, matched for age. Smears and typing were performed according to current techniques. RESULTS: In the sex worker group 2.6% were diagnosed with atypical glandular cells of undetermined significance (AGUS)/atypical squamous cells of undetermined significance (ASCUS), 15.6% with low grade squamous intraepithelial lesion (LSIL), and 2.9% with high grade squamous intraepithelial lesion (HSIL), and in the control group results were 1.4%, 2.9% (p<0.001) and 0.6% (p<0.001) respectively. When considering only those under 25 years, 24.4% should have further follow up. Of the sex workers, 77.4% were positive for one or more types of HPV (55.9% for high risk HPV), in comparison with 27.6% of the control group (14.3% for high risk HPV) (p<0.001). In high risk HPV samples more LSIL and HSIL were found. CONCLUSION: Abnormal smears and high risk HPV were significantly more prevalent in sex workers than in controls. Current screening policy would miss many sex workers with an abnormal smear who should be referred for further follow up. It is proposed to screen sex workers when they enter prostitution regardless of their age.

Adolescent↗
PubMed2003

The Bali STD/AIDS study: human papillomavirus infection among female sex workers.

Female sex workers in low priced brothel areas in Denpasar, Bali, Indonesia participated in an intervention study designed to promote condom use and sexually transmitted disease (STD)/AIDS prevention. The intervention provided educational sessions for sex workers, STD treatment for sex workers, condom distribution, and media for clients. The brothel areas were divided into high and low areas for programme effort. The high effort areas received a more intensive behavioural intervention than the low effort areas. A clinic was available for STD treatment in both areas. Behavioural surveys and STD testing were used to evaluate the programmes. About 600 were evaluated for several STDs and completed personal interviews at enrolment and at six-month intervals during the 18-month study. About 50% of women were new to the study at each round. Human papillomavirus (HPV) testing of cervical swabbed specimens, using polymerase chain reaction methodology, was performed at the beginning of the study and 18 months later. Human papillomavirus infection was initially high in these women (38.3%) and declined to 29.7% after 18 months (P <0.01). The prevalence of HPV infection declined with age (P <0.01). HPV infection was associated with a number of STD symptoms that were reported in personal interviews. These associations were stronger in the first time period. Infection with Neisseria gonorrhoeae was associated with HPV infection at baseline (P =0.03). HPV infection declined in the study area with the more intensive educational programme (P <0.01). The prevalence of HPV infection declined over time and was associated with study area and age of woman.

Adolescent↗
PubMed2003

A study of HIV/STD infections amongst commercial sex workers in Kolkata (India). Part-I: some socio-demographic features of commercial sex workers.

A community-based survey of Human Immunodeficiency Virus (HIV) and sexually transmitted diseases (STD) was carried out among commercial sex worker's (CSW) in different red light areas of Kolkata. By multistage random sampling technique 867 female sex workers (FSW) studied who were belonging to Sonagachi 77.28%, Metiabruz 14.07%, Rampurgali and Khidderpore 8.65% red light areas. Among sex workers surveyed 58.94% were Hindu and 33.33% Muslims. There were 22.07% CSW of foreign origin, out of which 17.99% from Bangladesh and 4.04% from Nepal. Majority of CSW 74.28% were under thirty years of age. The lowest age was 13 years and mean age was 26.55 years. There were 22.26% sex workers under twenty years and 6.92% above forty years of age. About 79.0% of sex workers were illiterate. The average number of clients visiting each sex workers was 2.67, with a range between 1 to 8 clients per day. The average duration for which sex workers remain in the trade was 6 to 7 years. Around 60.09% sex workers were in the trade for five years, while 2.64% were for more than twenty years. Average monthly income of sex workers was around Rs. 500-1000. History of pregnancy was present in 84.66% with one child in 24.91 % to maximum eight in 0.23% sex workers. The mean number of pregnancies was 1.9 per female sex workers. About 36.2% had history of abortion and 65.51 % had living children.

Adolescent↗
PubMed2006

STI declines among sex workers and clients following outreach, one time presumptive treatment, and regular screening of sex workers in the Philippines.

OBJECTIVES: This intervention linked research aimed to reduce prevalence of Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct) among female sex workers by means of one round of presumptive treatment (PT), and improved prevention and screening services. METHODS: A single round of PT (azithromycin 1 g) was given to all female sex workers reached during a 1 month period of enhanced outreach activity. Routine sexually transmitted infection (STI) screening services were successfully introduced for two groups of unregistered sex workers who work in brothels (BSWs) and on the street (SSWs). No changes were made to existing screening methods for registered sex workers (RSWs) or lower risk guest relations officers (GROs). Cross sectional prevalence of Ng and Ct was measured by PCR on three occasions, and stratified by type of sex work. Ng/Ct prevalence was assessed twice in clients of BSWs. RESULTS: Prevalence of Ng and/or Ct at baseline, 1 month post-PT, and 7 months post-PT was BSWs: 52%, 27%, 23%; SSWs: 41%, 25%, 28%; RSWs: 36%, 26%, 34%; GROs: 20%, 6%, 24%, respectively. Ng/Ct declines 1 month post-PT were significant for all groups. 6 months later prevalence remained low for BSWs (p<0.001), and SSWs (p = 0.05), but had returned to pre-intervention levels for the other groups. Prevalence of Ng/Ct among clients of BSWs declined from 28% early in the intervention to 15% (p = 0.03) 6 months later. CONCLUSIONS: In this commercial sex setting, one round of PT had a short term impact on Ng/Ct prevalence. Longer term maintenance of STI control requires ongoing access to effective preventive and curative services.

Adolescent↗
PubMed2004

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia.

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.

Adult↗
PubMed2006

Assessment of respondent driven sampling for recruiting female sex workers in two Vietnamese cities: reaching the unseen sex worker.

Respondent driven sampling (RDS) is a relatively new method to sample hard-to-reach populations. Until this study, female sex workers (FSWs) in Vietnam were sampled using a variety of methods, including time location sampling (TLS), which may not access the more hidden types of FSWs. This paper presents an analysis from an HIV biological and behavioral surveillance survey to assess the feasibility and effectiveness of RDS to sample FSWs, to determine if RDS can reach otherwise inaccessible FSWs in Vietnam and to compare RDS findings of HIV risk factors with a theoretical TLS. Through face-to-face interviews with FSWs in Ho Chi Minh City (HCMC) and Hai Phong (HP), data were collected about the venues where they most often solicit their clients. These data were used to create three variables to assess whether FSWs solicit their clients in locations that are visible, semi-visible and non-visible. For this analysis, the visible group simulates a sample captured using TLS. Survey results in HIV prevalence and related risk factors and service utilization, adjusted for sampling methodology, were compared across each of the three FSW visibility groups to assess potential bias in TLS relative to RDS. The number of self-reported visible FSWs (HCMC: n=311; HP: n=162) was much larger than those of the semi-visible (HCMC: n=65; HP: n=43) and non-visible (HCMC: n=37; HP: n=10) FSWs in HCMC and HP. Non-visible FSWs in both cities were just as likely as visible and semi-visible FSWs to be HIV positive (HCMC: visible 14.5%, semi-visible 13.8%, non-visible 13.5%, p value = 0.982; HP: visible 35.2%, semi-visible 30.2%, non-visible 30.0%, p value = 0.801), to practice behaviors that put them at risk for contracting and transmitting HIV (injecting drug use-HCMC: visible 13.8%, semi-visible 12.3%, non-visible 5.4%, p value = 0.347; HP: visible 38.9%, semi-visible 23.3%, non-visible 30.0%, p value = 0.378, to have no condom use in the past month -HCMC only: visible 52.7%, semi-visible 63.1%, non-visible 48.6%, p value = 0.249) and to have symptoms of a sexually transmitted infection (STI) in the past year (HCMC: visible 16.1%, semi-visible 12.3%, non-visible 16.2%, p value = 0.742; HP: visible 13.6%, semi-visible 18.6%, non-visible 20.0%, p value = 0.640). There was a difference found among the visible, semi-visible and non-visible groups in HP for no past month condom use (visible 53.1%, semi-visible 79.1%, non-visible 60.0%, p value = 0.009). This study found that RDS was successful at recruiting hidden types of FSWs in Vietnam. Past reports of FSWs in Vietnam have assessed the more visible FSWs as being the most vulnerable and at risk for HIV. Although the number of visible FSWs is much higher than those of the semi and non-visible groups, this study found that the non-visible FSWs are very vulnerable to HIV infection. If prevention programs are targeting and responding to those who are most likely to be assessed (e.g., more visible types of FSWs) then this analysis indicates that a significant proportion of the FSW population at risk for HIV may not be receiving optimal HIV information and services.

Data Collection↗
PubMed2003

Male sex workers in Córdoba, Argentina: sociodemographic characteristics and sex work experiences.

OBJECTIVE: To report on the sociodemographic characteristics and work experiences of 31 male sex workers (MSWs) in the city of Córdoba, Argentina. METHODS: Information on each of the MSWs was collected using a questionnaire that covered his personal characteristics and his work background, self-assessed general health status, and use of health and social services. Scales were included in order to assess attitudes towards condom use, knowledge about safe sex, perceptions about the risk of getting HIV, individual self-efficacy, and locus of control. The questionnaire also asked each respondent to rank his level of agreement with interactive strategies for gaining client compliance with safe sex practices. RESULTS: In terms of their self-identity, out of the 30 MSWs who answered the question, 10 of them (33.3%) self-identified as heterosexual and 9 (30%) as bisexual. Alcohol and drug consumption and unsafe sexual practices were relatively low among the MSWs. Of the 31 MSWs responding, 21 of them (67.7%) reported that they had been tested for HIV, but only 13 of them (41.9%) said they had been vaccinated for either hepatitis A or hepatitis B. A variety of differences were found between the study's 17 street sex workers (sex workers who offer their services in public places such as streets and parks) and the 14 independent sex workers (sex workers who are self-employed, advertise and manage their own business, and have an exclusive location for their commercial sex work). The street MSWs were younger and had less formal education. Independent MSWs were economically more settled, had been working longer in the sex industry, and were more comfortable about having sex with men. Independent MSWs were also more likely to report a gay sexual orientation and less likely to report using alcohol, marijuana, or other substances. CONCLUSIONS: The differences between street MSWs and independent MSWs are important since they could influence the negotiating of safer sex practices with clients. Programs aimed at preventing the spread of HIV and other sexually transmitted infections and promoting responsible self-care among MSWs in Córdoba should be introduced. Such programs could increase the proportion of MSWs who know their HIV serostatus and could make MSWs more aware of the risk of different sex acts performed in commercial sex encounters. Given the differences that we found between street MSWs and independent MSWs, specific strategies and educational materials should be developed for those two subgroups within the MSW population.

Adolescent↗
PubMed2003

Evidence-based treatment guidelines for sexually transmitted infections developed with and for female sex workers.

BACKGROUND: Sex work is frequently one of the few options women in low-income countries have to generate income for themselves and their families. Treating and preventing sexually transmitted infections (STIs) among sex workers (SWs) is critical to protect the health of the women and their communities; it is also a cost-effective way to slow the spread of HIV. Outside occasional research settings however, SWs in low-income countries rarely have access to effective STI diagnosis. OBJECTIVES: To develop adequate, affordable, and acceptable STI control strategies for SWs. METHODS: In collaboration with SWs we evaluated STIs and associated demographic, behavioural, and clinical characteristics in SWs living in two cities in Madagascar. Two months post-treatment and counselling, incident STIs and associated factors were determined. Evidence-based STI management guidelines were developed with SW representatives. RESULTS: At baseline, two of 986 SWs were HIV+; 77.5% of the SWs in Antananarivo and 73.5% in Tamatave had at least one curable STI. Two months post-treatment, 64.9% of 458 SWs in Antananarivo and 57.4% of 481 women in Tamatave had at least one STI. The selected guidelines include speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk-based treatment during 3-monthly follow-up visits. SWs were enthusiastic, productive partners. CONCLUSIONS: A major HIV epidemic can still be averted in Madagascar but effective STI control is needed nationwide. SWs and health professionals valued the participatory research and decision-making process. Similar approaches should be pursued in other resource-poor settings where sex work and STIs are common and appropriate STI diagnostics lacking.

Adolescent↗
PubMed1997

Patterns of sexually transmitted diseases in female sex workers in Surabaya, Indonesia.

Sex workers and their clients as core groups of high frequency transmitters play a dominant role in the transmission of HIV and other sexually transmitted diseases (STDs). In Surabaya, Indonesia, little is known about the prevalence of STDs in various sex establishments. We conducted an STD prevalence survey of 1873 female sex workers in Surabaya, Indonesia. We did not find any sex workers with HIV infection. Prevalence rates of other STDs (chlamydia, gonorrhoea, serological test for syphilis positive, and/or trichomoniasis) in female sex workers were 48% in brothels (n = 696), 42% on the streets (n = 192), 16% in massage parlours (n = 344), 25% in barber shops (n = 150), 17% at call-girl houses (n = 73), and 10% in nightclubs (n = 418). Sex workers from the brothels had the highest prevalence rates of gonorrhoea (24%) and trichomoniasis (8%), while sex workers from the streets and the barber shop had the highest rates of serological test for syphilis (STS) positive (30%) and chlamydia (18%). STD rates decreased with an increase in age (except for STS positive), an increase in education, a decrease in the number of sex partners, and condom use in the previous week. Condom use in the previous week was universally low among sex workers, especially among sex workers from the brothels (14%). Sex workers from the brothels had STD rates about 4 times higher than sex workers from the nightclubs (adjusted odds ratio of 4.4). Although the HIV seroprevalence rate is currently low, widespread prostitution and high rates of STDs in sex workers warrant programmes to avert a potential explosion of HIV transmission. Because sex workers from the brothels in Surabaya have high rates of STDs and low use of condoms but good cooperation with local authorities, STD preventive measures should focus on this group.

Adolescent↗
PubMedDate not supplied

The motivation and mental health of sex workers.

Commercial sex work presents specific mental health concerns. We aimed to study motivation for sex work and mental health issues in a sample of such women. We contacted 55 consenting women through organized brothels and interviewed them using the Farley questionnaire and screening items for posttraumatic stress disorder (PTSD) and depression. Eighty-two percent of the women had arrived illegally and had been "trafficked." All but 2 were engaged voluntarily in sex work. Seventeen percent met criteria for PTSD, and 19% were likely to be clinically depressed. We present representative case histories. Availability of mental health treatment for workers in the sex industry could improve compliance with HIV prevention programs and enlarge options for women to leave the sex industry. We observed that stereotypes of sex workers as either always having histories of childhood abuse or as being always "happy hookers" were incorrect.

Depressive Disorder↗
PubMed1996

Healthy and unhealthy life styles of female brothel workers and call girls (private sex workers) in Sydney.

Two groups of female sex workers were compared with respect to their healthy or unhealthy life styles. Both 'call girls' (private sex workers) and brothel workers were infected with sexually transmitted diseases as often in their noncommercial sexual relations as in their work, smoking was a serious problem for both, and each group endured problems from clients specific to their work sites. However, overall, the call girls had healthier life styles, but were more vulnerable to pressures from clients for unsafe sex and to potential violence.

Adolescent↗