Lives of Sex Workers in Ashgabat, Turkmenistan: Their Sexual Practices and Knowledge About STI/HIV

Background: While no reliable data exist on HIV prevalence in Turkmenistan, the high number of drug users, the increasing incidence of STIs in the country, and the documented increase in HIV in neighboring countries suggest that the number of HIV cases may be rising in Turkmenistan. Sex workers are vulnerable both to acquiring and to transmitting HIV/STIs. Although the recent economic transition, high unemployment and poverty rates in Turkmenistan has led to increasing numbers of sex workers, their existence is not recognized by government officials. As a result, data to describe the scope of the problem in this group have been unobtainable; further no interventions exist to reduce HIV/STD risk among Turkmenistan sex workers. Methods: Qualitative research was conducted in two Turkmenistan cities during May-August, 2006. We conducted eight semi-structured interviews with female sex workers working in the streets and bars. Results: Sex workers' perceptions of risk, HIV-related knowledge and perceived HIV prevention needs vary depending on whether they work in the streets or in the bars. Street sex workers are most vulnerable to HIV risk because they have little to no knowledge of HIV and only use condoms when initiated by their clients which is rare. Bar-based sex workers indicated that they do not use condoms with their regular clients, but they do use condoms regularly with casual/one-time clients. Bar-based sex workers were able to more accurately describe HIV transmission and prevention information; however, HIV-related information seems difficult for all sex workers to access. HIV is seen as a problem that exists outside of Turkmenistan, and thus all sex workers had a low perceived risk of HIV. Sex workers indicated that they would be willing and interested in being tested regularly for STIs if free treatment were available. Conclusion: These data show that sex workers were not practicing safe sexual behaviors and also do not have the necessary information for adopting these behaviors. Interventions promoting condom use among sex workers and educating them about HIV and other STIs are needed in Turkmenistan to protect their health. Such interventions could also help to prevent what is now a concentrated epidemic among HIV risk groups from spreading to the general population.