Factors associated with HIV-1 infection among sex workers of Addis Ababa, Ethiopia

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Abstract
To study the prevalence and risk factors for HIV infection among sex workers of Addis Ababa, Ethiopia. Cross-sectional survey on socio-demographic characteristics, behaviours, and HIV serological status of sex workers attending two health centres of Addis Ababa. HIV prevalence among sex workers was 274 of 372 (73.7%). Several factors were significantly associated with an increased risk of being HIV-infected [among others, working in ‘shared rooms', high number of clients, use of injectable hormones, and positive Treponema pallidum particle agglutination (TPPA) serology], and others with a decreased risk (being born in Addis Ababa, high level of education, peer education on sex work, condom use, use of oral pill, and use of condoms for contraception). Of interest, sex workers who were using condoms for contraception were, compared with others, more likely to use condoms consistently (65 versus 24%, respectively;P < 0.001), and less likely to be HIV-infected (55 versus 86%, respectively;P < 0.001). In multivariate analysis [log-binomial model, giving estimates of the prevalence ratio (PR)], being born in Addis Ababa (PR = 0.74; 95% confidence interval (CI), 0.61–0.91), using condoms for contraception (PR = 0.73; 95% CI, 0.64–0.85), and a positive TPPA serology (PR = 1.21; 95% CI, 1.09–1.36), remained significantly associated with HIV infection. HIV prevalence was remarkably high among sex workers of Addis Ababa. Condom use was higher, and HIV prevalence lower, in sex workers using condoms not only for prevention of HIV and sexually transmitted diseases, but also for contraceptive purpose. This finding is of particular interest for its implications for prevention strategies among sex workers in the developing world.