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Objectives: To study groups of prostitutes and clients of prostitutes in order (i) to determine HIV prevalence and sexual risk behaviour, (ii) to determine differences between samples recruited within and outside a clinic for sexually transmitted diseases (STD) and (iii) to determine correlates of inconsistent condom use (ICU) among both groups., Design: Participants were interviewed and anonymously tested for HIV-antibody; approximately half were recruited at a clinic for sexually transmitted diseases (STD) and half at prostitute working places., Setting: An STD clinic and prostitute working places in Amsterdam in 1991., Subjects: 201 female prostitutes without a history of injecting drugs and 213 male clients of female prostitutes., Main Outcome Measures: antibodies to HIV, consistency of condom use in commercial vaginal contacts in the preceding 6 months., Results: HIV prevalence was low: three prostitutes (1.5%; 95% CI 0.5-4.6%) and one client (0.5%; 95% CI 0.1-3.3%) were infected. All three HIV positive prostitutes originated from AIDS-endemic countries, came to the Netherlands only recently and were recruited outside the STD clinic. Large differences between subgroups resulted from the two recruitment methods: while clients of prostitutes with relatively high risk behaviour were strongly represented among the STD clinic sample, high risk prostitutes were underrepresented in this sample. Consistent condom use (with 100% of contacts) was reported by 66% of prostitutes and 56% of clients of prostitutes. Inconsistent condom use was found to be high among prostitutes who had migrated from Latin America and among migrant clients of prostitutes., Conclusions: When monitoring HIV infection one must take into account imported cases. HIV prevention efforts should be particularly focused at prostitutes from Latin America and at clients of prostitutes who migrated to the Netherlands.

Objective: to assess whether male prostitution is an independent risk factor for HIV infection among male (intravenous and nonintravenous) drug users., Design: a cross-sectional study., Setting: various low-threshold methadone clinics and the sexually transmitted diseases clinic of the Municipal Health Service in Amsterdam and a drug-treatment centre in The Hague., Participants: 343 male intravenous drug users and 106 male non-intravenous drug users., Main Outcome Measures: characteristics concerning drug use behaviour, sexual behaviour, and sociodemography, related to prostitution and HIV-antibodies., Results: of the 449 study participants, 88 (20%) reported a history of prostitution; no differences were found between intravenous and non-intravenous drug users. Younger age, West German nationality, and having had private homosexual sex contacts, were independent predictors of a history of prostitution. Independent predictors of HIV infection were (1) longer residency in Amsterdam; (2) having had predominantly homosexual private sex contacts; (3) longer duration of intravenous drug use; and (4) frequent needle sharing., Conclusion: no evidence was found to suggest that male prostitution in itself contributed to the risk of HIV infection.

In determining the effectiveness of AIDS preventive measures among heterosexuals, trends in visits to two clinics for sexually transmitted diseases (STD) in Amsterdam between 1982 and 1989 are described. Also, data on sexual behaviour are presented that were collected in a sample of 635 heterosexual women and 947 heterosexual men at one of the clinics between September 1986 and December 1988. In 1987, when in The Netherlands for the first time extensive publicity was given to the risk of heterosexual transmission of the human immunodeficiency virus, the numbers of male and female heterosexual attenders started to decline. Exceptions to this general decline were men of Turkish nationality and foreign prostitutes, each group showing a continuing increase. At the same time, the numbers of customers reported by prostitutes in the sample declined markedly between 1986 and 1988, from a median of 35 to 15 per month (p = 0.001). Condom use with casual contacts generally increased in the sample period. We conclude that the publicity given to "heterosexual AIDS"--contributed to by the national AIDS prevention campaign--apparently led to a considerable decrease in the number of risky contacts of heterosexuals in Amsterdam in 1987 and 1988. This does not seem to apply to men with Turkish nationality. In 1989 a change appeared in several subgroups when the number of visitors started to rise. Also, the probability of an STD diagnosis increased in male attenders. This may indicate a change in the tendency towards safer sexual behaviour.

To assess the potential role of drug using prostitutes in the heterosexual transmission of human immunodeficiency virus (HIV), 117 prostitutes, recruited from December 1985 to November 1987 at a weekly evening sexually transmitted diseases (STD) clinic for drug using prostitutes only, were studied for the prevalence of HIV and STD. Intravenous drug use was reported by 96 (82%) of the women. Antibody to HIV was found in 35/117 (30%) women, all but one of whom had been using drugs intravenously. Most (73, 62%) of the prostitutes reported having had more than 2000 clients each in the preceding five years. In the six months preceding enrollment to the study they had practised mainly vaginal (106/117) and orogenital (82/117) intercourse; 90% (105/117) reported frequent use of condoms in vaginal intercourse and 65% (68/105) in orogenital intercourse. Despite frequent condom use, 81% (84/104) contracted one or more STD in this period. Considering the high incidence of HIV and STD and the finding by others that the presence of STD may facilitate transmission of HIV, we conclude that the potential for HIV transmission from these prostitutes to their clients (and vice versa) was clearly present.