Decker, M.R., Wirtz, A.L., Moguilnyi, V., et al. AIDS and Behavior (August 2013), E-publication ahead of print.
The authors conducted a mixed methods assessment in Kazan, Krasnoyarsk, and Tomsk, Russia, to understand the environment of female sex workers (FSWs); determine HIV prevalence and risk factors; and review the acceptability of the Globus Consortium’s FSW-targeted HIV prevention services. Analysis confirmed high HIV risk among FSWs, and the need for increased HIV prevention and services to address their key risk factors: injecting drug use (IDU) and sexual violence. FSWs found the FSW-targeted prevention services highly acceptable, valuable, and non-stigmatizing. The authors conducted secondary analysis of the program evaluation; 35 in-depth interviews; 11 focus group discussions with 81 FSWs; and a survey and HIV screening with 754 FSWs. HIV prevalence was 3.9 percent across the sample of FSWs, and lifetime IDU, client violence, and physical violence from a pimp, or momka, were common and significantly associated with HIV. Sexual risk behaviors were also identified (e.g., more than three clients per day [46 percent] and inconsistent condom use [17 percent]). FSWs cited protection as the primary benefit of working with pimps, although many found the protection limited; and reported experiencing violence or exploitation. The acceptability of FSW-targeted services was reflected in high uptake of HIV testing and free condoms, and greater HIV knowledge. While further research is necessary, Russian FSWs should be considered a key high-risk population.