Clandestine female sex workers in Lima, Peru: Demographics, epidemiological profile, sex work characteristics, and healthcare seeking behaviors

Background

Little is known about sexual behavioral and health care seeking practices of Peruvian clandestine female sex workers (FSW), and the potential public health impact of these behaviors and practices. Moreover, in the 1990s, the Peruvian government decreased HIV prevention programs for this population due to low HIV prevalence and it also revoked an 80-year policy requiring periodic sexually transmitted infection (STI) clinical examinations.

Objective

Contribute to health promotion and STI/HIV prevention for this population by developing an epidemiological and health care seeking profile of 212 clandestine FSW using cross-sectional survey data (socio-behavioral survey and clinical exam) collected in Lima in 2003.

Results

Eighty-seven percent of FSW were diagnosed with a STI or HIV (Trichomonas vaginalis 2.4%, syphilis 9.4%, HSV-2 79.7%, candidiasis 9.9%, HIV 2.4%). The majority reported abortions (67.8%) and condom use with recent clients (98.3%), but not with partners (7.3%). A minority were familiar with female STI symptoms such as malodorous discharge (35.4%) or genital warts (19.8%). A high percentage had not visited a STI clinic or received an HIV test in the past year (40.6%, 47.1%). In response to STI symptoms, FSW sought care at a pharmacy (54.9%) rather than at public (29.6%) or private (2.5%) clinics.

Conclusion

HIV prevalence among FSW has remained low since the 1990s and condom use with clients high. Prevalence rates of other STI, limited awareness of STI symptoms, inconsistent condom use with partners, and high abortion rates suggest potential interventions needed to improve the health of FSW and promote public health.