The Centre for Epidemiological Studies into Sexually-Transmitted Diseases and AIDS in Catalonia (CEEISCAT) started a pioneering study in Spain in 2005 to look into the prevalence of sexually-transmitted diseases (STDs) among female sex workers (SWs). The objective was to monitor the rates of infection with both HIV and other diseases over time, as well as the prevalence of risky behavior. 

"The phenomenon of prostitution has changed over recent years in Spain, going from prostitution as an activity carried out by Spanish women, often injecting drug users, to a situation where it is carried out by women from other countries, which has led to behavioural and social changes," Cinta Folch, lead author of the study and a researcher at CEEISCAT, told Servicio de Información y Noticias Científicas (SINC).

Only 10.8% of the 400 women interviewed were native Spaniards, and these tended to be older women who were injecting drug users. The rest came from Latin America (30.7%), eastern Europe (32.5%) and Africa (26%). The researchers found that 95.5% of these sex workers use condoms during vaginal sex with clients, but that they do not ordinarily use them with their regular partners (only 12.4%). 

"A significant finding is that the Spanish women are the least likely to use a condom with their clients. The reason could be the age of these working women. Their clients may be more stable and they may trust them more. In addition, the IV drug users among the SWs are the Spanish women (9.3%), and this fact could lead them to have unprotected sex," stresses the CEEISCAT expert. 

The conclusions of this study, published recently in the journal Sexually Transmitted Diseases, show the rate of HIV infection to be 1.8%, that of Chlamydia trachomatis 5.5% and Neisseria gonorrhoeae 0.5%. The only differences were observed in the HIV infection rates, which were significantly higher among the Spanish SWs, at 9.3%. In addition, 49.7% of the women interviewed reported incidences when condoms had split over the past six months.

Even so, the researchers remain cautious about the figures obtained. STD infection rates appear to be lower in Catalonia than in the rest of Europe, but it is hard to generalize.

"Our studies are quantitative and have their limitations, so we cannot extrapolate from them, although one can observe trends", points out Folch.

Once the 2009 figures are available it will be possible to compare the data.

Guaranteeing public health care 

The research shows that sex workers working in Catalonia have highly defined social and cultural traits, according to where they come from. "We must pay special attention to the section of Spanish SWs who, although they are in the minority, have the highest rates of HIV infection and drug use, as well as taking the lowest level of precautions during commercial sex", explain the researchers. 

According to the study, a key issue in the prevention and control of HIV/STDs is to provide access to health centres, as well as diagnosing and treating STDs as a means of helping to prevent the spread of HIV. "This means understanding the prevalence of these infections and the behaviours related to them, in order to be able to design suitable prevention strategies", concludes Folch. 

Reference literature: 

Folch C, Sanclemente C, Esteve A, Martró E, Molinos S, Casabona J y grupo de trabajo HIVITS-TS. Diferencias en las características sociales, conductas de riesgo y prevalencia de VIH/infecciones de transmisión sexual entre trabajadoras del sexo españolas e inmigrantes en Cataluña. Med Clin (Barc). 2009 Mar 21;132(10):385-388.

Folch C, Esteve A, Sanclemente C, Martró E, Lugo R, Molinos S, Gonzalez V, Auxina V, Casabona J. Prevalence of HIV, Chlamydia trachomatis and Neisseria gonorrhoeae, and risk factors for Sexually Transmitted Infections among immigrant female sex workers in Catalonia, Spain. Sex Transm Dis. 2008 Feb;35(2):178-183.