Download Katie Panter Biology Lab 1615-025 Larry Jones March 26, 2011

Katie Panter
Biology Lab 1615-025
Larry Jones
March 26, 2011
Scientific Article
PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS
AMONG FEMALE COMMERCIAL SEX WORKERS IN ARGENTINA
Maria A Pando, Carolina Berini, Mariel Bibini, Mauro Fernandez, Elena Reinaga, Sergio
Maulen, Ruben Marone, Mirna Biblione, Silvia M Montano, Christian T Bautista,
Mercedes Weissenbacher, Jose L Sanchez, and Maria M Avila.
Abstract. Sexually transmitted infections (STIs) are associated with a greater risk of
Human immunodeficiency virus (HIV). Female commercial sex workers residing within
different cities in Argentina, and involved in various types of sexual occupations, were
studied in order to determine if certain subpopulations of female sex workers (FSWs)
may be more vulnerable to the contraction of STIs and HIV. Previous studies conducted
in Argentina were only from a population of FSWs who sought assistance and worked
exclusively in brothels. Hence, this is the first study to accurately determine rates of STIs
amongst larger populations of FSWs in Argentina. A cross sectional study was
conducted from 2000-2002 by researching the seroprevalence of various STIs. Certain
risk factors were found in conjunction with sexual behavior to increase the risk of STIs.
Efforts are now being put into effect to reduce the risk of STIs and HIV among these
populations.
INTRODUCTION
STIs are more prevalent among FSWs than any other population. World wide
HIV infections are caused primarily by sexual contact. High risk factors including lack
of condom use, multiple sex partners, and substance abuse are associated with HIV and
other STIs. Argentina has the second highest rate of autoimmune deficiency disease
(AIDS) cases in South America. Heterosexual transmission accounts for 30% of AIDS
cases reported between 1982 and 2004. However, 47% of AIDS cases were contracted
by heterosexual transmission in 2003.
STIs reported include: HIV, a disease that destroys the helper T-cells in the
immune system resulting in AIDS; Syphilis, often a fatal disease if left untreated, which
is caused by the bacterium Treponema pallidum results in small painless sores that may
increase the risk of HIV transmission during intercourse; Human T-Cell Lymphotrophic
Viruses (HTLVs), a family of 4 retroviruses each of which utilizes transcriptase to
produce DNA from RNA infecting the T lymphocytes and often resulting in fatal
leukemia, myelopathy, infectious dermatitis, chronic pulmonary infections, and mild
neurological disorders. HTLV-1 and HTLV-2 are both associated with epidemics yet
HTLV-1 results in the most clinically significant symptoms; Hepatitis B, a DNA virus
that often leads to liver failure, is spread via the same routes of transmission as HIV. It is
often present in persons infected with AIDS; Hepatitis C, a blood borne pathogen that can
often lead to liver cancer and death.
A cross sectional study, more commonly known as a survey, is one that aims to
describe the relationship between specific factors in a population present a particular time
with diseases or health related conditions. These studies are frequently used to identify
the prevalence of conditions and demonstrate associations. In order for the findings to be
valid the studies must be done on representative samples of the population. The
particular cross sectional study was performed to focus on outbreak and prevention
strategies of STIs among populations in Argentina.
MATERIALS AND METHODS
Research was conducted in 6 cities in Argentina; Salta, Buenos Aires, Cordoba,
Mendoza, La Plata and Rosario. A cross section seroprevalence study was conducted in
FSW age 18 years and older. Women who received money or goods for sexual services
rendered participated in the study. FSW working in nightclubs, brothels, bathhouses, and
on the streets were included in the study. Three methods were used to conduct the
survey: Participant interviews, blood samples, and statistical analysis.
One-on-one interviews were conducted by healthcare workers at each location
using a standardized questionnaire. Informed consent was provided to the participants.
Interviews were on a voluntary basis. The questionnaire asked about sexual practices,
alcohol consumption, illegal drug use, history of an STI, and sociodemographic
characteristics.
A blood sample was achieved and diagnosis of an STI was completed on all
participants. All the samples were analyzed in a lab. HIV was diagnosed by performing
an enzyme linked immunosorbent assay (ELISA) and by agglutination techniques.
HTLV-1 and 2 were diagnosed by particle agglutination technique and by ELISA. Hep B
virus was tested by looking for surface antigen markers. Hep C virus was determined by
ELISA. Statistical analysis consisted of a Chi-square and Fisher's exact test to assist in
comparison of categorical variables. Analysis of variance test (ANOVA) compared
differences in the means of variables.
RESULTS
Social behavior and characteristics of participants: A total of 625 FSW were
studied. The average age was 33.8 years. 456 were natives of Argentina. 1 in 5 workers
had another profession. 226 of FSW had a high school education level. 54% of FSW
had a steady sex partner in which 90% did not utilize condoms with during intercourse.
21% had a past history of a STI. The most prevalent infections included syphilis,
urethritis, and gonorrhea. 22% of FSW reported alcohol use. 25% of the participants
used illegal drugs and only 2 reported injection drug use. 51.2% reported sexual contact
with foreigners. The average years involved in sex work was 7.9. The average sexual
partners a week was 14.5. FSW in the city of Salta averaged 28 sex partners a week.
82.1% of the FSW practiced vaginal intercourse, 64.8% practiced oral sex, and 8.5%
practiced anal intercourse. 113 reported irregular condom use. 87% of FSW reported
their client's disinterest in using a condom; 48 of the FSW accepted the client's request.
Irregular condom use with a steady partner was 87.5% compared to that of clients at
18.1%. The most prevalent STIs diagnosed were syphilis, Hep B virus, and Hep C virus
occurring in 14.4% of the participants, followed HIV in 3.2% of participants, and HTLV
1 and 2 occurring in 1.6%.
Risk factors associated with STIs. For syphilis: 30 years of age or older, more
than 10 years of sex work, low wages, illegal drug use, prior history of an STI, alcohol
consumption, and Argentinean. No specific risk factors were found for HIV. Hep B
virus was reduced in those of foreign nationalities. Hep C virus was more prevalent
among Argentinean and among the ages of 40-49 years. The most common co-infections
occurred with Hep B virus and syphilis (7.5%).
DISCUSSION
FSW have a much higher risk of contracting an STI in comparison to non-FSW.
This was the first study done in Argentina that assessed the rates of HIV infection among
FSW. The study concludes that there are potentially subpopulations of FSW that are at
greater risk of contracting STIs. Some of those risk factors include northern cities such
as Salta, poor working conditions associated with low wages, drug use, alcohol use, and
lack of condom use.
In comparison with a similar study performed in Venezuela, Argentina's rates of
syphilis were noticeably higher. This may be due to the routine control of syphilis in
Venezuela, where work licenses are revoked until the infection is no longer present.
Lower rates for Hep C, HIV, and Hep B were also noted in Venezuela. Hep B vaccine
among the adult population is not enforced in Argentina, although it is available. It is
recommended that the vaccine become more readily available to FSW and other members
of the population.
Irregular condom use in steady sex partners suggests that FSW only find
themselves to be at risk with their clients. This study indicates that prevention programs
should incorporate factors that are not viewed as high risk behavior as well.
REFERENCES
1. American Journal of Tropical Medicine. Hygiene, 74(2), 2006 pp. 233-238
Copyright 2006 By the American Society of Tropical Medicine and Hygiene.
http://www.ajtmh.org/cgi/reprint/74/2/233
2. http://www.enotes.com/public-health-encyclopedia/cross-sectional-study
3. http://emedicine.medscape.com/article/219285-overview
4. http://www.bing.com/health/article/medlineplus1000240014/Syphilis?q=syphilis&qpvt=sy...
5. http://www.bing.com/Dictionary/search?q=define+HIV&FORM=DTPDIA&qpvt
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6. Sylvia S. Mader, Human Biology fifth Edition, Copyright 1998 by McGraw-Hill
Companies, Inc.