HIV vulnerability of adolescent sex workers in Romania
J. Busza1, M. Preda2, D. Buzducea2, V. Grigoras2, F. Lazar2
1London School of Hygiene & Tropical Medicine, Centre for Population Studies, London, United Kingdom, 2University of Bucharest, Faculty of Sociology and Social Work, Bucharest, Romania
Background: Evidence from a range of settings suggests that
younger sex workers are more vulnerable to HIV than adults, due to inexperience
and poor access to services. A survey of sex workers in three Romanian cities
explored injecting drug and sexual risk behaviours among both adolescents and
Methods: We recruited 295 sex workers aged 15-24 in Bucharest, Constanta and Timisoara, using key informants and snowball sampling. A
standardised questionnaire included questions on injecting drug use, equipment
sharing, condom use, and use of harm reduction or other health services.
Analysis compared sex workers aged 15-17 with those 18-24 to assess the
specific needs of legal minors.
Results: Close to one fifth of the sample were younger
than 18 (19.7%) and about one third were of Roma ethnicity. Overall, 22.2% had
ever injected drugs, and this varied significantly by age. A quarter of 18-24
year olds had ever injected compared to 8.9% of adolescents. Among both age
groups, 29.0% of injectors reported sharing injecting equipment in the past
month. Condom use varied significantly by age: compared to adults, adolescent
sex workers reported a lower rate of consistent use with commercial partners
(46.5% vs. 70.0%) as well as at last sex with a casual partner (38.5% vs.
83.9%). Adolescents also exhibited poorer knowledge about HIV transmission, and
were less likely to have ever had an HIV test (33.9% vs. 57.6%).
Conclusions: As found in other settings, younger sex
workers in Romania appear to be less well informed about HIV and less
able to negotiate preventive measures during commercial and casual sex compared
with older peers. They are also less likely to consider themselves at risk for
HIV, as demonstrated by low testing rates. On the other hand, they display a
lower prevalence of injecting drug use, providing a window of opportunity for prevention
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