Hiv och STI-prevention riktad mot sexköpare

Sedan vi skrev Osynliga Synliga Aktörer så har jag tänkt mycket på hivprevention till sexköpare. De är idag en av de prioriterade grupperna i de nationella riktlinjerna för hivprevention men nästan inga insatser utförs. När det sker osäkra sexuella praktiker vid sex mot ersättning så handlar det oftast om att köparen inte vill använda kondom och är beredd att öka priset för att få detta. I samband med (Natsal-3, se förra blogginlägget) kunde de få fram uppgifter från en population som annars är mycket svår att nå.

Här följer en rad intressanta citat från The role of men who pay for sex in STI transmission: current knowledge and future directions. The contribution of the third UK National Survey of Sexual Attitudes and Lifestyles (Natsal-3), Sónia Dias published in Sex Transm Infect November 17, 2014;

Much more must be done to comprehensively understand this area of research and to intervene successfully in sexual health.

As currently discussed, men who pay for sex and their paid partners can act as a potential bridge for STI transmission to lower-risk populations. Critical components of bridging include high rate of partner change, concurrency, patterns of sexual mixing with different types of partners (paid, non-paid, regular, casual, etc), inconsistent condom use and high rates of STI prevalence. Some of these characteristics have been documented in men who pay for sex, as illustrated in previous studies.

Furthermore, most clients had a regular partner or other casual non-female SW partners.

Likewise, in a sexual health clinic survey in UK with 2665 men, 10% reported paid sex. The majority had paid

for sex in the previous 12 months, and nearly a third on five or more occasions. Almost half the men paid for sex while in another relationship. In this light, it has been largely acknowledged that the spreadof STIs among men who pay for sex is likely to be linked to their high rates ofsexual partner change (commercial and

non-commercial partners). Additionally, a number of studies report noteworthy findings showing a proportion of bisexual concurrency, with men having both female and male sexual partners, which may further increase the risk of STI transmission in high-risk sexual networks. Another key aspect that has emerged as a risk factor is the mobility/migration. here is evidence of the rising proportion of men paying for sex with links to travel, sex tourism and high-risk sexual behaviours abroad.

Furthermore, there is a marked growth in the proportion of migrants involved in sex work. This is extremely important

considering the recognised close link between migration and heightened risk of STI acquisition, but also the documented high prevalence rates of HIV among immigrant SWs from countries with generalised epidemics.

Overall, it has been widely agreed that there is an increasing diversity of commercial sex, which entails different risk levels of STI infection.

There is a clear need for a more in-depth understanding of the extent of the paid sex phenomenonand the patterns and trends in the key behaviours that influence STI/HIV transmission dynamics. Crucial information includes: characteristics of men paying for sex and paid partners (age, origin, travel habits); commercial sex patterns (prevalence across regions, mobility, sex work settings, same-sex contact, changes of contact with SWs over time); experience of sexual violence, particularly in a context of drug use; usage of STI clinic services, among others. This evidence would be valuable to inform about how these parameters influence the trajectory of the epidemic and support the HIV prevention programmes in effectively allocatng resources and interventions to where they will have the greatest impact.

The evidence found that men paying for sex report high number of partners, including foreign partners outside the UK, and are more likely to report STI diagnoses strongly supports that they are key populations to be targeted.

Natsal-3 illustrates a relevant effort to generate evidence of the role of men who pay for sex in STI transmission.