Characterization of female sex workers in Brazilian state capitals, 2016

Braga, Letícia Penna; Szwarcwald, Célia Landmann; Damacena, Giseli Nogueira

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Brasil

Epidemiologia e Serviços de Saúde

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Brasil

Español English

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Sumário

Original articles • Epidemiol. Serv. Saúde 29 (4) • 2020 • https://doi.org/10.5123/S1679-49742020000400002 copy

Characterization of female sex workers in Brazilian state capitals, 2016^* * Article derived from the Ph.D. thesis project entitled ‘Characteristics of female sex workers recruited by Respondent-Driven Sampling in 12 Brazilian cities, 2016’, submitted by Letícia Penna Braga to the Public Health Epidemiology Postgraduate Program, Sergio Arouca National Public Health School, Oswaldo Cruz Institute Foundation, in 2020. Financial support for the 2nd Biological and Behavioral Surveillance Study was provided by the Brazilian Ministry of Health, via its Health Surveillance Secretariat / Department of Chronic Conditions and Sexually Transmitted Infections: Funding Code LN7901-BR. Letícia Penna Braga received a Full Doctorate grant from the Coordination for the Improvement of Higher Education Personnel (CAPES) / Ministry of Education (MEC): Funding Code 001.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To describe the characteristics of female sex workers (FSW) in 12 Brazilian cities.

Methods

This was a cross-sectional biological and behavioral surveillance study with FSW recruited by respondent-driven sampling (RDS) in 2016. HIV prevalence, sociodemographic, behavioral and sex work profession variables were estimated by city. The chi-square test was used to compare these distributions.

Results

Among 4,328 FSW, HIV prevalence was 5.3% (95%CI 4.5;6.3), ranging from 0.2% (95% CI 0.0;1.2), in Campo Grande, to 18.2 (95%CI 13.2;24.7) in Salvador. In half of the cities, HIV prevalence in the samples was >5.0%, while Campo Grande, Brasília and Belo Horizonte had prevalence rates <1.0%. Significant differences between cities were found in distributions according to educational level, income, workplace, age sex work started, and illicit drug use.

Conclusion

The characteristics of the samples in each city were distinct and have influenced local HIV prevalence.

HIV; Sex Work; Sampling Studies; Social Networking; Vulnerable Populations, Brazil

City	HDI^b	General female population (15-49 years old)	Network characteristics			HIV^a prevalence
			Sample size	Number of seeds	Average number of peer referrals	HIV^a prevalence
			No	No	Average	%	95%CI
Manaus	0.737	542,331	358	5	2.7	3.3	1.5;6.9
Belém	0.746	428,290	351	7	2.7	7.4	4.6;11.8
Fortaleza	0.754	764,773	352	6	2.8	1.2	0.5;2.8
Recife	0.772	462,903	354	5	2.7	6.6	3.7;11.4
Salvador	0.759	854,665	350	10	2.6	18.2	13.2;24.7
Belo Horizonte	0.810	710,835	350	7	2.3	0.8	0.3;2.0
Rio de Janeiro	0.799	1,758,145	429	7	2.6	4.6	2.3;9.3
São Paulo	0.805	3,301,784	368	9	2.4	7.3	4.4;11.8
Curitiba	0.823	521,062	350	9	2.5	8.2	4.9;13.4
Porto Alegre	0.805	395,012	353	6	2.8	5.8	3.7;8.9
Campo Grande	0.784	232,733	352	5	2.7	0.2	0.0;1.2
Brasília	0.824	808,799	361	7	2.5	0.8	0.3;2.1
Total		10,781,322	4,328	83	2.6	5.3	4.5;6.3

City	Age (years)				Race/skin color		Schooling				Monthly income (R$)
	18-29	30-39	40-49	>50	White	Non-White	A	B	C	D	≤500	501-1,000	1,001-2,000	>2,000
	%	%	%	%	%	%	%	%	%	%	%	%	%	%
	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI
Manaus	40.7	31.6	18.7	9.1	6.3	93.7	21.9	40.8	23.9	13.5	33.4	32.0	20.8	13.9
Manaus	34.3;47.4	26.6;37.0	14.4;23.8	6.3;12.9	4.2;9.4	90.6;95.8	16.9;27.8	35.0;46.9	19.3;29.2	10.0;18.0	26.5;41.0	25.8;38.8	15.3;27.6	9.3;20.3
Belém	54.6	26.2	12.5	6.7	12.5	87.5	13.8	27.3	45.4	13.5	32.0	41.7	22.2	4.1
Belém	46.5;62.5	19.5;34.3	8.7;17.8	3.6;12.1	9.0;17.0	83.0;91.0	9.5;19.6	22.0;33.3	39.2;51.7	9.6;8.7	25.9;38.7	35.6;48.2	17.1;28.3	2.1;7.7
Fortaleza	52.8	25.6	14.7	6.9	10.7	89.3	13.4	24.6	48.4	13.6	43.2	35.1	19.2	2.6
Fortaleza	45.6;59.8	19.7;32.6	10.2;20.6	4.1;11.6	7.0;16.1	83.9;93.0	9.4;18.8	19.2;30.8	41.0;55.8	9.5;19.3	36.0;50.7	28.5;42.2	15.0;24.2	1.0;6.5
Recife	46.4	22.4	22.1	9.0	18.5	81.5	6.9	17.5	43.6	31.9	56.6	33.6	7.7	2.0
Recife	38.7;54.3	17.0;29.0	16.3;29.3	6.0;13.5	14.0;24.1	75.9;86.0	4.5;10.6	13.0;23.3	36.8;50.7	25.3;39.3	49.1;63.8	27.9;39.9	4.8;12.0	0.8;5.20
Salvador	49.0	30.1	13.1	7.9	8.9	91.1	11.6	10.8	45.0	32.7	62.6	27.0	6.7	3.7
Salvador	41.8;56.2	24.6;36.2	9.1;18.5	5.1;11.9	5.0;15.4	84.6;95.0	7.6;17.2	7.6;15.1	37.9;52.3	26.2;39.8	54.6;69.9	20.9;34.1	4.0;11.1	1.9;7.1
Belo Horizonte	50.8	27.9	13.5	7.8	20.4	79.6	46.7	29.0	20.1	4.2	7.5	13.2	29.6	49.7
Belo Horizonte	42.5;59.1	21.7;35.0	9.2;19.5	4.9;12.2	14.8;27.6	72.4;85.2	38.1;55.5	22.3;36.8	14.5;27.3	1.9;9.0	3.8;14.4	8.5;19.9	22.6;37.7	40.9;58.5
Rio de Janeiro	49.0	27.1	15.2	8.6	14.6	85.4	19.0	29.0	34.9	17.1	21.1	29.4	29.1	20.4
Rio de Janeiro	41.9;56.2	21.5;33.5	11.2;20.3	5.6;13.2	10.8;19.4	80.6;89.2	14.6;24.4	23.5;31.5	28.7;41.6	12.5;23.0	15.6;28.0	23.3;36.3	23.2;35.7	15.4;26.5
São Paulo	31.3	23.9	23.2	21.6	28.1	71.9	29.7	23.3	37.3	9.7	19.2	34.1	34.9	11.7
São Paulo	24.3;39.2	18.5;30.4	17.6;29.9	16.2;28.2	22.2;34.8	65.2;77.8	23.7;36.4	17.4;30.5	30.3;44.9	6.2;14.8	13.4;26.8	27.3;41.7	27.6;43.0	8.0;16.9
Curitiba	35.2	25.1	24.6	15.2	52.8	47.2	32.4	22.1	26.6	18.9	19.8	32.8	31.1	16.4
Curitiba	28.2;42.8	19.8;31.2	18.8;31.4	10.5;21.4	45.7;59.7	40.3;54.3	26.1;39.6	17.4;27.6	20.1;34.2	13.9;25.3	14.1;27.0	25.3;41.3	24.6;38.4	11.9;22.1
Porto Alegre	60.1	26.5	10.5	2.8	32.5	67.5	31.0	28.3	26.1	14.6	25.5	32.1	34.6	7.9
Porto Alegre	53.0;66.9	21.4;32.5	6.7;16.3	1.5;5.2	25.5;40.5	59.5;74.5	24.5;38.3	22.3;35.2	20.7;32.3	9.9;21.1	19.2;33.0	25.9;38.9	28.1;41.7	4.9;12.4
Campo Grande	65.1	22.2	9.1	3.6	34.7	65.3	48.4	32.3	18.0	1.3	3.7	15.0	43.9	37.4
Campo Grande	58.2;71.4	17.4;28.0	6.4;12.9	1.8;7.0	28.6;41.4	58.6;71.4	48.9;55.1	26.7;38.4	13.2;23.9	0.5;3.2	1.9;7.1	10.8;20.5	38.0;49.9	31.2;44.2
Brasília	62.2	27.3	6.5	4.1	22.2	77.8	40.6	26.1	25.5	7.7	7.6	20.8	40.2	31.3
Brasília	55.5;68.4	22.1;33.1	4.1;10.2	2.1;7.7	17.1;28.3	71.7;82.9	34.2;47.5	20.8;32.2	20.2;31.7	4.9;12.1	4.5;12.5	16.0;26.6	33.9;46.9	26.2;37.7
Total	49.7	26.3	15.3	8.6	21.7	78.3	26.2	26.0	32.9	14.9	27.4	28.8	26.9	16.9
X² p-value^a	<0.001				<0.001		<0.001				<0.001

City	Workplace		Price per sexual encounter (R$)			Age began sex work (years)
	Street points	Other places	<50	50-99	≥100	≤13	14-17	≥18
	%	%	%	%	%	%	%	%
	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI
Manaus	58.2	41.8	37.2	57.2	5.6	7.7	37.4	54.9
Manaus	50.9;65.1	34.9;49.1	31.4 ;43.4	51.0;63.2	3.0;10.0	5.2;11.1	31.7;43.5	48.8;60.9
Belém	54.0	46.0	28.7	59.1	12.2	12.8	47.8	39.4
Belém	47.1;60.7	39.3;52.9	22.3;36.0	52.2;65.7	8.6;17.0	9.2;17.5	41.0;54.8	32.1;47.2
Fortaleza	42.6	57.4	26.4	61.9	11.7	11.9	42.7	45.4
Fortaleza	35.9;49.5	50.5;64.1	20.0;33.9	54.4;68.9	7.8;17.2	8.2;16.9	36.3;49.5	38.5;52.4
Recife	84.4	15.6	51.5	44.9	3.6	26.0	36.6	37.5
Recife	78.4;89.0	11.0;21.6	44.2;58.7	37.9;52.2	1.9;6.6	19.6;33.5	29.8;43.9	30.7;44.8
Salvador	61.0	39.0	39.9	52.4	7.7	13.7	36.9	49.5
Salvador	53.0;68.4	31.6;47.0	32.6;47.6	45.0;59.7	4.6;12.5	8.9;20.4	29.6;44.8	41.8;57.2
Belo Horizonte	7.4	92.6	74.2	19.2	6.6	0.4	10.9	88.7
Belo Horizonte	3.4;15.7	84.3;96.6	65.4;81.4	13.4;26.7	3.6;11.7	0.2;1.2	6.4;17.8	81.6;93.3
Rio de Janeiro	39.0	61.0	21.1	72.3	6.7	5.5	34.5	60.0
Rio de Janeiro	32.2;46.2	53.8;67.8	15.8;27.6	65.8;77.9	4.1;10.8	3.5;8.5	28.3;41.3	53.2;66.5
São Paulo	75.3	24.7	76.5	19.9	3.6	2.5	18.9	78.6
São Paulo	67.5;81.7	18.3;32.5	69.7;82.2	14.5;26.70	1.6;7.9	1.4;4.4	14.0;25.0	72.2;83.9
Curitiba	44.6	55.4	42.6	46.2	11.2	4.8	18.9	76.3
Curitiba	36.7;52.9	47.1;63.3	35.0;50.6	38.7;53.8	7.5;16.3	2.3;9.6	13.6;25.6	69.0;82.4
Porto Alegre	36.0	64.0	26.1	53.5	20.4	4.6	30.4	65.0
Porto Alegre	28.6;44.3	55.7;71.4	20.1;33.0	45.8;61.1	14.9;27.2	2.5;8.1	24.0;37.7	57.6;71.8
Campo Grande	11.2	88.8	6.9	48.8	44.2	2.2	15.3	82.5
Campo Grande	6.7;18.1	81.9;93.3	3.9;12.0	41.8;55.9	36.9;51.8	0.9;5.6	11.4;20.2	77.3;86.7
Brasília	46.0	54.0	9.0	59.4	31.7	4.4	37.1	58.5
Brasília	39.2;52.8	47.2;60.8	5.8;13.8	53.1;65.3	26.1;37.8	2.3;8.3	30.9;43.9	51.6;65.0
Total	46.6	53.4	36.4	50.0	13.7	8.0	30.7	61.3
X² p-value^a	<0.001		<0.001			<0.001

City	Condom use in vaginal sex with clients			Would not use condom for some reason
	Never	Sometimes	Always	Would not use condom for some reason
	%	%	%	%
	95%CI	95%CI	95%CI	95%CI
Manaus	2.3	6.3	91.4	14.9
Manaus	1.0;4.9	4.0;10.0	87.4;94.2	11.1;19.8
Belém	3.1	25.7	71.2	50.3
Belém		20.4;31.9	65.0;76.7	43.7;57.2
Fortaleza	3.3	29.4	67.3	48.7
Fortaleza	1.4;7.8	23.5;36.1	60.0;73.9	40.9;56.5
Recife	3.2	10.1	86.7	36.7
Recife	1.6;6.3	6.8;14.7	81.7;90.5	30.1;43.8
Salvador	0.3	27.6	72.10	48.8
Salvador	0.0;2.1	21.5;34.5	65.2;78.2	41.7;56.2
Belo Horizonte	0.7	7.8	91.60	19.1
Belo Horizonte	0.1;4.6	4.4;13.3	85.9;95.1	13.5;26.2
Rio de Janeiro	4.0	16.8	79.2	36.3
Rio de Janeiro	2.3;7.0	12.2;22.7	73.1;84.2	30.3;42.7
São Paulo	2.5	16.3	81.3	29.4
São Paulo	0.8;7.0	11.4;22.8	74.5;86.5	23.2;36.6
Curitiba	8.6	17.3	74.0	46.5
Curitiba	4.9;14.8	12.1;24.2	66.1;80.7	38.6;54.5
Porto Alegre	8.8	29.4	71.8	61.2
Porto Alegre	5.2;14.3	23.5;36.1	65.0;77.7	54.1;68.0
Campo Grande	0.7	3.3	96.0	14.5
Campo Grande	0.2;2.8	1.8;6.1	93.0;97.7	10.6;19.5
Brasília	0.7	16.5	82.8	45.4
Brasília	0.1;4.2	11.9;22.4	76.8;87.5	38.6;52.5
Total	3.2	16.4	80.5	37.4
X² p-value^a	<0.001			<0.001

Cidade	Use of crack^a	Use of cocaine	Use of drugs^b	Frequent use of alcohol^c	Use of alcohol during sex	Use of drugs during sex	Sex without condom – alcohol or drugs
	%	%	%	%	%	%	%
	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI	95%CI
Manaus	2.8	5.0	7.6	3.1	13.7	6.7	2.2
Manaus	1.4;5.7	3.1;7.9	5.1;11.2	1.7;5.8	10.4;18.0	4.0;10.8	1.1;4.7
Belém	4.6	10.4	18.5	8.6	27.8	18.2	18.4
Belém	2.2;9.3	7.1;15.0	13.2;25.2	5.3;13.7	22.7;33.5	13.2;24.6	13.3;24.9
Fortaleza	8.8	7.9	14.0	5.3	30.8	16.5	20.4
Fortaleza	5.9;13.0	5.1;12.1	10.1;19.1	2.7;10.0	24.8;37.5	12.4;21.7	15.7;26.2
Recife	9.9	3.2	16.3	9.1	28.8	25.9	14.5
Recife	6.5;14.7	1.6;6.3	11.5;22.7	5.5;14.5	23.2;35.1	19.8;33.1	10.8;19.3
Salvador	13.9	13.5	22.8	19.3	54.3	24.6	21.8
Salvador	9.4;19.9	9.3;19.1	17.5;29.2	14.1;25.9	47.1;61.3	19.0;31.3	16.1;28.7
Belo Horizonte	0.7	5.1	5.1	5.1	14.1	6.9	4.4
Belo Horizonte	0.2;2.8	2.7;9.4	2.7;9.4	2.6;9.8	9.7;20.0	4.0;11.5	2.1;9.1
Rio de Janeiro	2.8	19.6	22.7	21.6	45.3	30.0	14.8
Rio de Janeiro	1.3;5.8	14.7;25.5	17.5;28.9	16.5;27.8	38.6;52.1	24.1;36.7	10.8;19.9
São Paulo	21.5	15.2	29.7	12.7	28.9	29.1	11.9
São Paulo	15.1;29.6	10.4;21.6	22.3;38.3	9.1;17.6	22.4;36.3	22.3;36.9	7.7;17.9
Curitiba	5.1	2.9	6.8	16.7	30.2	7.6	8.7
Curitiba	2.5;10.2	1.5;5.4	3.8;11.9	12.2;22.4	23.8;37.5	4.9;11.6	5.0;14.6
Porto Alegre	8.8	7.4	16.2	24.1	44.4	17.5	15.4
Porto Alegre	5.0;15.1	5.0;10.7	11.4;22.4	18.7;30.4	37.1;52.1	13.3;22.6	11.2;20.9
Campo Grande	3.2	6.8	10.7	47.5	68.0	12.2	9.3
Campo Grande	1.4;6.9	4.2-10.7	7.4;15.3	40.9;54.1	60.8;74.5	8.6;17.0	6.3;13.5
Brasília	3.3	6.6	8.0	7.2	41.9	18.3	22.3
Brasília	1.5;7.1	4.0;10.7	5.2;12.3	4.4;11.3	35.8;48.3	13.5;24.4	16.9-28.7
Total	7.1	8.8	15.0	15.1	35.8	18.0	13.7
X² p-value^d	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Letícia Penna Braga – Biblioteca de Manguinhos, Av. Brasil, No. 4365, sala 225, Manguinhos, Rio de Janeiro, RJ, Brazil. Postcode: 21040-360 E-mail: leticiapbraga@gmail.com