prevention and care for both HIV and sexually transmitted infections.

Sex work

Shinde S, Setia MS, Row-Kavi A, Anand V, Jerajani H. Male sex workers: are we ignoring a risk group in Mumbai, India? Indian J Dermatol Venereol Leprol. 2009;75:41-6.

Male sex workers have recently been recognized as an important risk group for sexually transmitted infections including human immunodeficiency virus infection. Although there are global studies on male sex workers, few such studies describe the behavioural patterns and sexually transmitted infections among this population in India. Male sex workers were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. Shinde and colleagues report on the demographics, sexual behaviours, and sexually transmitted infections including HIV of these sex workers. Of the 75 male sex workers, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9) years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex). About 13% of male sex workers had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04). The sexually transmitted infection prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8). Syphilis was the most common sexually transmitted infection (28%) in these male sex workers. HIV was associated with being a transgender (41 vs 17%, P = 0.04), age > 26 years (57 vs 28%, P = 0.04), more than one year of sex work (38 vs 8%, P = 0.05), and income P = 0.02). These male sex workers have high-risk behaviours, low consistent condom use, and high prevalence of sexually transmitted infections and HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and prevention and care for both HIV and sexually transmitted infections.

Editors’ note: This study did not recruit any male sex workers involved solely in the heterosexual sex trade possibly because such men are less likely to attend this clinic treating sexually transmitted infections (STI). Among the sex worker participants were kothis, effeminate men who have sex with men but may also have sex with women, and hijras, male-to-female transgendered people who are primarily the receptive partners because of their female gender identity. Overall, only one-third reported always using condoms, with the most common reasons for non-use being non-availability (43%) and refusal of condom use by the partner (20%). Social marginalization of sex workers in India, as elsewhere, hampers the development of effective programmes to help them avoid HIV infection and obtain treatment for STI and HIV. They appear to be considerably more at risk of acquiring HIV infection than do women who sell sexual services and are particularly likely to benefit from improved access to condoms and skills training to enhance condom negotiation.