HIV infection and associated risk factors in female prostitutes in Kinshasa, Zaire

In Africa, female prostitutes represent a high risk group for HIV infection. In Kinshasa, Zaire, 101 (27%) out of 377 prostitutes were seropositive to HIV by ELISA and Western blot determination. Seropositivity was significantly associated with the number of life-time partners with a median number of 600 partners, four seropositives and 338 for seronegative individuals (P = 0.02). Seropositivity was also significantly associated with a history of taking oral medications for the prevention of sexually transmitted diseases and/or pregnancy (odds ratio = 2.21, confidence interval = 1.2-4.2), and with the introduction of any product into the vagina for hygiene or other purposes (odds ratio = 2.3, confidence interval = 1.1-4.7). In addition, among 85 prostitutes reporting condom use by their sexual partners during the previous year, the use of condoms by 50% or more of partners was associated with a reduced risk of HIV seropositivity (P = 0.046). An increased risk of HIV seropositivity was not associated with fellatio, anal intercourse, or with any type of kissing. Twenty-nine per cent of prostitutes reported at least one symptom suggestive of HIV infection, and seropositivity was associated with weight loss, either with or without chronic diarrhea or pruritic dermatitis. These data confirm that African prostitutes are at high risk for HIV infection and that the number of lifetime sexual partners, and factors which interfere with the integrity of the vaginal or cervical mucosa, may be associated with an increased risk of HIV infection acquired through heterosexual contact. Prevention of heterosexually transmitted HIV infection will require extensive educational programs aimed specifically at the risk associated with the number and selection of sexual partners and at promoting safer sexual practices.