Clients of Female Sex Workers as a Bridging Population in Vietnam
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Understanding bridging behaviors of clients of female sex workers (FSWs) is important for projecting and intervening in the spread of sexually transmitted infections in Vietnam. The goals of the study were to determine HIV/STI prevalence amongst different bridging groups, identify factors associated with being potential and active bridgers, and assess the association of drug use and unsafe sex with HIV and/or STI prevalence. In April, 2007, 292 clients were anonymously interviewed at sex venues in a two-stage time-location cluster sampling survey, followed by HIV, syphilis, and HSV-2 testing. Based on condom use with both high-risk (FSWs) and low-risk (wives/girlfriends) sexual partners, clients were classified as unlikely, potential, or active bridgers. The majority of clients were potential or active bridgers (55.8%) who had a significantly higher prevalence of herpes simplex type 2 (HSV-2) (21% and 33%, respectively) than unlikely bridgers (8.7%). HIV seropositivity was 4.4-fold (95% CI 1.1-17.1) higher among those who were HSV-2-positive. Clients of FSWs may be playing a major bridging role in transmitting HIV and sexually transmitted infections (STIs) in Vietnam. An observed synergistic interaction between drug use and condom slippage/breakage emphasizes the importance of proper condom use, particularly among drug users.
KeywordsSexual behaviors Condoms Bridging Drug use Male clients Female sex workers (FSWs) Risk factors Sexually transmitted infections (STIs) HIV
This study was funded by a grant from the National Institute of Health/Fogarty International Center (D43 TW000013). We especially thank Drs. Ralph Frerichs, Donald Morisky, and Pamina Gorbach, who reviewed manuscript and provided thoughtful suggestions and relevant literature. Special thanks to Family Health International colleagues for advice and support for the conduct of the study. We are grateful to the research team members and staff of the Vietnam Administration of Preventive Medicine of the Ministry of Health, Hai Phong Health Services, the Hai Phong HIV/AIDS Prevention Center, the Hoa Phuong Club, and the World Vision project in Hai Phong for their contributions to the success of the study. Sincere thanks to Dr. Tran Quang Vinh for field work organization, and to Wendy Aft for assistance in preparing this manuscript.
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