HIV in Karnataka, south India disproportionately burdens female sex workers (FSWs) and men who have sex with men (MSM). The best long-term strategy for managing the global HIV epidemic might involve a preventive vaccine; however, vaccine availability cannot guarantee its acceptability. An exploratory, cross-sectional study was conducted among frontline health service providers (HSPs) working with MSM/FSWs in relation to HIV-related health services in Karnataka. Face-to-face structured interviews were performed to better understand potential barriers/facilitators to acceptability/uptake of a future HIV vaccine among MSM/FSW communities. Descriptive analyses explored HSPs’ perceptions of vaccine acceptability/uptake and likelihood to recommend an HIV vaccine. Although HSPs mentioned numerous potential barriers to future HIV vaccine acceptability/uptake, most believed that MSM/FSWs would be willing to receive the vaccine to protect their health and avoid HIV. HSPs reported being very likely to recommend the vaccine, however young age of potential vaccine recipients negatively affected likelihood to recommend.

While female sex workers (FSWs) are often the focus of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other sexually transmitted infections (STIs) research in Kenya, little else is known about their lives, including their intimate relationships. This thesis explores the relationships between FSWs and their intimate partners in Kibera, an urban informal settlement in Nairobi, Kenya. As part of the Kenya Free of AIDS (KeFA) project, previous field research found that FSWs with an intimate partner saw over 50% fewer clients per week and were statistically more likely to use a condom with clients. These findings suggested that FSWs' intimate relationships might act as a form of harm and/or use reduction. Sex work harm reduction aims to diminish the occupational harms associated with sex work, such as discrimination, violence and disease, through strategies such as empowerment and education. Use reduction aims to reduce FSWs' frequency of exposure to these occupational risks through a reduction in clients. Specifically, it is proposed that FSW intimate relationships promote harm and/or use reduction in three ways: 1) by reducing the number of clients on a weekly basis, 2) by reducing harm from the virus through adherence to antiretroviral drugs (ARV), and 3) by offering a supportive environment financially, emotionally, and in terms of health and/or childcare. To test these theories this thesis analyzed interviews with 27 HIV positive FSWs from Kibera. Results showed that HIV was normalized in intimate relationships, whereas sex work was stigmatized. As a result, FSWs in this study were more likely to tell their partners that they were HIV positive than disclose their involvement in sex work. Therefore, rather than genuine use reduction, client reduction was unintentional and, in reality associated with sex work stigmatization that prevents women from disclosing their occupation. Some intimate partnerships were found to be a source of emotional and health-related support for Kibera FSWs. Intimate partners provided support for participants' HIV status and adherence to ARV. They also provided emotional support in the form of advice and comfort. Overall, this study suggested it would be difficult to include intimate partners in interventions with HIV positive Kibera FSWs because of the considerable, continued stigma surrounding sex work but that intimate partners can have a positive and/or protective role to play in HIV positive Kibera FSWs’ lives. / Graduate / 0573 / 0327 / 0626 / kimberly.m.sharpe@gmail.com

This project draws on aspects of research into the plight of women prostitutes working in Lal Batti areas of India. The project considers historical, contemporary and personal texts that form the basis of a creative synthesis. This synthesis is manifest in the design of five fabric-based artworks that seek to interpret issues of manipulation, entrapment, belonging, spirituality and demise. The project is located beyond the boundaries of fashion design. However, it involves an artistic fusion of garment construction, fabric and surface treatment. In doing this, the thesis seeks to give ‘voice’ to a political commentary that reaches beyond commercial uses of garments for display and protection.

Interpersonal violence and abuse in New Zealand is so widespread it is considered a normative experience. Mental health nurses witnessing the inscribed effects of abuse on service users are lead to consider whether we are dealing with a breakdown of the mind or a breakdown in social or cultural connection (Stuhlmiller, 2003). The purpose of this research is to examine the cultural context which makes violence and abuse against women and children possible. In 2003, the public debate on prostitution law reform promised to open a space in which discourses on sexuality and violence, practices usually private or hidden, would publicly emerge. Everyday discourses relating to prostitution law reform reported in the New Zealand Herald newspaper in the year 2003 were analysed using Foucauldian and feminist post-structural methodological approaches. Foucauldian discourse analysis emphasises the ways in which power is enmeshed in discourse, enabling power relations and hegemonic practices to be made visible. The research aims were to develop a complex, comprehensive analysis of the media discourses, to examine the construction of harm in the media debate, to examine the ways in which the cultural hegemony of dominant groups was secured and contested and to consider the role of mental health nurses as agents of emancipatory political change. Mental health promotion is mainly a socio-political practice and the findings suggest that mental health nurses could reconsider their professional role, to participate politically as social activists, challenging the social order thereby reducing the human suffering which interpersonal violence and abuse carries in its wake.

Submitted by Diogo Misoguti (diogo.misoguti@gmail.com) on 2018-04-26T13:19:25Z No. of bitstreams: 1 Tese-15278.pdf: 1972023 bytes, checksum: 78202b7c664ccd82fe643533af6e484f (MD5) / Approved for entry into archive by Vera Lúcia Guimarães de Mendonça (vlgmendonca@unifesp.br) on 2018-04-26T13:23:38Z (GMT) No. of bitstreams: 1 Tese-15278.pdf: 1972023 bytes, checksum: 78202b7c664ccd82fe643533af6e484f (MD5) / Made available in DSpace on 2018-04-26T13:23:38Z (GMT). No. of bitstreams: 1 Tese-15278.pdf: 1972023 bytes, checksum: 78202b7c664ccd82fe643533af6e484f (MD5) Previous issue date: 2015 / Estudo epidemiológico com desenho transversal e objetivo de analisar as associações da situação sociodemográficas e condições de trabalho dos profissionais do sexo (PS) e a sua percepção da qualidade de vida, na região central do Município de São Paulo. A amostra foi de 96 indivíduos que se auto identificaram como mulheres, homens ou travestis. Instrumentos: questionário sóciodemográfico e de condições de trabalho e o WHOQOL-Bref. Resultados: os PS tinham em média 31 anos (±7,3); maior parte do Estado e Município de São Paulo; maioria do sexo masculino, heterossexual, branco, solteiro, não possuía filhos e tinha ensino médio incompleto. Proporcionalmente, os homens praticavam mais atividade física regularmente e fumavam mais; enquanto as mulheres consumiam mais álcool e os travestis mais drogas. A maioria procurou os serviços públicos de saúde e apresentou problemas de saúde nos últimos 5 anos. Os travestis foram os que mais procuraram os serviços de saúde e no setor público. A maioria dos motivos que levaram os PS a procurar esses serviços foram os exames de rotina e aqueles para DST/HIV. A média de horas trabalhadas por dia foi de 7,8h (±3,8) e o atendimento foi de 6 (±4,1) clientes por dia. As mulheres atendiam mais clientes; os travestis informaram rendimento médio mensal maior provavelmente por cobrarem mais pelo atendimento. A idade média da primeira relação sexual enquanto PS foi 16,8 anos (±3,8). A prática sexual anal era a mais utilizada pelos homens e travestis; relataram uso de preservativo masculino em todas as relações e a maioria das mulheres não faziam uso de anticoncepcional. A maioria não era contribuinte do INSS. Quase metade dos entrevistados já havia sofrido algum tipo de violência e os travestis eram as maiores vítimas. Quanto à percepção de qualidade de vida, o escore mais alto foi para o domínio psicológico para as três categorias. Os travestis apresentaram pontuação mais alta para QV geral e os homens para a satisfação com a saúde. Verificou-se associação estatisticamente significante (p<0,05) em todos os domínios e em QV geral com horas de trabalho. E a melhor pontuação de QV geral dos PS foram as variáveis ensino médio completo, ausência de filhos e 5 a 10 horas diárias de trabalho (p<0,05). A média de clientes apresentou associação significativa em todos os domínios exceto na QV geral. Tiveram melhores escores os PS que atendiam menos de cinco clientes por dia. Diante desses resultados, identificou-se a necessidade de políticas públicas de saúde voltadas ao desenvolvimento de medidas preventivas visando à promoção da saúde do profissional do sexo; e trabalhistas, como qualquer ocupação com direitos e deveres. / Epidemiological study with cross design and purpose of analyzing the socio-demographic situation and associations working conditions of sex workers (SW) and their perception of the quality of life in the central region of São Paulo. The sampling of 96 individuals who identified themselves as women, men or transvestites. Instruments: sociodemographic questionnaire and working conditions and the WHOQOL-Bref. Results: the SW had on average 31 years (± 7.3); most from the State and city of São Paulo; most male, heterosexual, white, unmarried, with no children and incomplete high school education. Proportionally, men practiced more physical activity regularly and smoked more; while women consumed more alcohol and the transvestites more drugs. The majority searched public health services and health problems in the last 5 years. Among those who sought the public health service, the majority did not present health problems over the past five years. The transvestites were the most searched health services and in the public sector. Most of the reasons that led the SW to seek these services were routine examinations and those for STD/HIV. The average number of hours worked per day was 7.8h (± 3.8) and the service was of 6 (± 4.1) clients per day. Women attended more customers; however, the average monthly income informed by transvestites was greater probably by charging more for servicing. The medium age of first sexual intercourse while being SW was 16.8 years (± 3.8). The anal intercourse was the most used, and they reported the use of male condom in all relationships, and women did not made use of any birth control. The majority was not taxpayer by social security. Nearly half of those surveyed had already suffered some type of violence and the transvestites were the main victim. As for the perception of quality of life, the highest score was for the psychological domain for the three categories. The transvestites had better quality of life and men better health satisfaction. It was found a statistically significant association (p<0.05) in all areas and in general working hours with QOL. And the best overall quality of life index belonged to the SW who worked between 5 and 10 (p<0.05) hours per day compared to the others. Average customers presented significant associations in all areas except General QOL. SW who attended fewer than five clients a day had better scores. Based on those results, it was identified the need for public health policies aimed at the development of preventive measures focusing health promotion for sex workers; and labor policies as well as for any other occupation with rights and duties.

Contexte: Les travailleuses du sexe (TS) sont un groupe à risque de l’infection à VIH, jouant un rôle majeur dans la dynamique de l’épidémie en Afrique de l’Ouest. Les interventions de prévention et de prise en charge du VIH ciblant ces femmes sont donc indispensables, mais leur contenu reste à définir. Nous avons conçu un paquet d’intervention qui combinait la prévention et les soins, et estimé son impact sur l’incidence du VIH. Méthodes: Entre septembre 2009 et septembre 2010, nous avons réalisé une étude transversale à Ouagadougou (Burkina Faso) suivie d’une étude de cohorte interventionnelle chez des jeunes TS âgées de 18 à 25 ans, avec un suivi trimestriel pendant 21 mois maximum. Le paquet d’intervention de la cohorte combinait des activités de prévention effectuées par des pairs (sessions de communication pour un changement de comportement) et de soins (IST, VIH, soins généraux, santé sexuelle et reproductive, soutien psychologique).A chaque visite, les comportements sexuels étaient collectés par un questionnaire ; des tests VIH, HSV-2 et de grossesses étaient réalisés. L’incidence de l’infection à VIH observée dans la cohorte a été comparée à l’incidence attendue en absence d’intervention. Cette dernière a été estimée grâce à un modèle mathématique de Bernouilli utilisant les données collectées chez les clients des TS, et des estimations de paramètres clés issus de la littérature.Durant le suivi, nous avons défini un comportement à risque comme le premier épisode d’un évènement biologique résultant d’un rapport sexuel non-protégé : grossesse non-désirée, primo-infection HSV-2 ou à T. vaginalis. Nous avons utilisé un modèle logistique à effet aléatoire pour identifier les déterminants de ces comportements à risque durant le suivi.Résultats: Parmi les 609 travailleuses du sexe pré-sélectionnées dont 188 (30,9%) professionnelles, la prévalence du VIH était de 10,3% chez les professionnelles et 6,5% chez les non-professionnelles l’âge médian était de 21 ans. Au total, 41,2% des professionnelles et 47,5% des non-professionnelles rapportaient une utilisation non systématique du préservatif, principalement avec leurs partenaires réguliers.Dans cette étude transversale, l’infection à VIH était associée à l’âge (aOR=1,44; IC95%: 1,22-1,71), la vie en couple (AOR=2,70; IC95%: 1,21-6,04), et l’infection à T. vaginalis (aOR=9,63; IC95%: 2,93-31,59), tandis que la réalisation antérieure d’un test VIH réduisait nettement ce risque (AOR=0,18; IC95%: 0,08-0,40). Les 321 TS non-infectées par le VIH incluses dans la cohorte ont effectué un suivi total de 409 personne-années (p-a). Aucune participante n’a fait une séroconversion au VIH durant le suivi (0/409 p-a) alors que l’incidence attendue modélisée était de 5,05/409 p-a (IC95%, 5,01-5,08) soit 1,23 infection/100 p-a (p=0,005). Cette incidence nulle était associée à une réduction du nombre de partenaires réguliers et de clients réguliers ainsi qu’à une augmentation du taux d’utilisation constante du préservatif avec les nouveaux clients (aOR =2,19; IC95%, 1,16-4,14) et avec les clients réguliers (aOR=2,18; IC95%, 1,26-3,76). Cependant, les comportements à risque restaient élevés durant l’intervention : 26,7/100 p-a (IC95%, 24,1-33,7). Ce risque résiduel était plus élevé chez les TS vivant en couple (aOR =7,47, IC95%, 1,70-30,80) et chez les non-professionnelles (AOR =5,53, IC95%, 1,75-16,84). Ces dernières avaient le plus tendance à ne pas déclarer les comportements à risque lors des interviews. Conclusions: Notre étude a démontré la nécessité de cibler les jeunes TS par des interventions adaptées.Notre paquet d’intervention combinant la prévention du VIH et les soins a permis de réduire l’incidence du VIH chez les jeunes travailleuses du sexe au Burkina Faso. Les interventions devront se focaliser sur le dépistage du VIH, les TS non-professionnelles et les partenaires réguliers. / Background: In West Africa, interventions targeting female sex workers (FSW) are crucial to impact on the HIV dynamics. However, the contents and efficacy of these interventions are unclear, and identifying the most at risk FSW in order to adapt these interventions remain challenging, partly because of the limitations of self-reported sexual behaviours. We therefore designed a comprehensive dedicated intervention targeting young female sex workers, and assessed its impact on HIV incidence in Burkina Faso and the reliability of interview data. Methods: From September 2009 to September 2010 we conducted a cross sectional study in Ouagadougou, Burkina Faso. Then HIV-uninfected FSW aged 18-25 years were enrolled in a prospective interventional cohort. The participants were followed quarterly for a maximum of 21 months. The intervention group received a package which combined prevention and care within the same setting, and consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care, and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. High-risk behaviour was defined as the first occurrence of any biological event resulting from unsafe sex, including unexpected pregnancy or HSV-2 or T. vaginalis infection. We used random logistic models to assess the relationship between socio-demographic characteristics and the residual high risk behaviours during the intervention.We compared the cohort HIV incidence with a Bernoulli modelled expected incidence in the absence of intervention, using data collected at the same time from FSW clients and key parameters from the litterature. Results: We screened 609 FSW including 188 (30.9%) professionals. Their median age was 21 years [IQR, 19-23], and the prevalence of HIV was 10.3% among professionals and 6.5% among non-professionals. Overall, 277 (45.6%) women reported high-risk behaviours (41.2% among professionals and 47.5% among non-professionals), which were driven mainly by non-consistent condom use with regular partners. In multivariable analysis, before the intervention, HIV infection was associated with older age (AOR=1.44; 95%CI: 1.22-1.71), with being married/cohabiting (AOR=2.70; 95%CI: 1.21-6.04), and with T. vaginalis infection (AOR=9.63; 95%CI: 2.93-31.59), while previous HIV testing was associated with a decreased risk (AOR=0.18; 95%CI: 0.08-0.40).The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study while the expected modelled number of HIV infections were 5.05 (95%CI, 5.01-5.08) during the same follow-up (409 person-years) or 1.23 infection per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and to an increase in consistent condom use with casual clients (AOR =2.19; 95%CI, 1.16-4.14, p=0.01) and with regular clients (AOR=2.18; 95%CI, 1.26-3.76, p=0.005). However, the incidence of residual risk was high, at 26.7/100 person-years (95% CI, 24.1-33.7). The residual risk was higher among FSW living in couple (adjusted odd ratio [AOR] =7.47, 95% CI, 1.70-30.80) and among those for whom sex work was not the main source of income (AOR =5.53, 95% CI, 1.75-16.84). The latter also tended not to report high-risk behaviours during face –to–face interview. Conclusions: This study highlights the need for targeted interventions among young FSW focusing particularly on non-professionals, sexual behaviours with regular partners and regular HIV testing. The ANRS 1222 study intervention package which combined peer-based prevention and care within the same setting markedly reduced HIV incidence among young female sex workers in Burkina Faso, through reduced risky behaviours.

Philosophiae Doctor - PhD / This thesis presents research on the use of modified respondent driven sampling (mRDS) methodology to enhance identification and recruitment of key populations (KP) into an HIV prevention trial in Kisumu, western Kenya through a three phase mixed method study. The study was carried out in Kisumu, western Kenya within the Kenya Medical Research Institute (KEMRI) and the US Centers for Disease Control and Prevention (CDC) Research and Public Health Collaboration platform. The three phases included: 1. PHASE I: Identification and determination of categories of KPs and techniques of locating and motivating them to participate in HIV prevention trials.2. PHASE II: Design and Implementation of a mRDS methodology in recruiting Ks into HIV prevention trials.3. PHASE III: Evaluation of the mRDS in recruitment of KPs into an HIV incidence cohort study. Methods Phase I of the study included the conduct of in depth interviews which were used to identify different categories of persons considered to be KPs within Kisumu, identify strategies of locating the KPs and determine motivators and inhibitors of KPs participation in HIV prevention trials. Phase II on the other hand included the administration of a survey that had been refined in Phase I. The survey was used to design a mRDS methodology which was then implemented to recruit KPs into the survey. Phase III evaluated the success of the mRDS in recruiting KPs into an HIV prevention study by assessing the risk profiles for participants screened and enrolled into the Phase III study. Ethical approval for the study was sought from the ethics committee of the Kenya Medical Research Institute, the US CDC and the University of the Western Cape.The study recruited 53 individuals into phase I and was able to 8 identify different categories of people considered to be KPs and the 4 salient strategies that could be used to recruit them into HIV prevention studies. The phase also identified 8 potential motivators and 9 potential inhibitors to participation in HIV prevention research. These categories and salient strategies were used in phase II to develop and pilot a mRDS methodology in recruiting 203 individuals into a survey. The survey was used as a validation tool for the risk levels of persons recruited by the mRDS using the variables of inconsistent condom use and having multiple partners. The validated mRDS was then applied in the recruitment of 1,292 participants in phase III of thestudy. These study participants had characteristics similar to those seen in similar studies and elucidated from phases I and II of the study. HIV seropositivity was used as the variable for validating risk levels of participants in this study and this was found to be higher that that seen in general population and comparable to that seen in other KPs groups in the region. Results: Overall the study was able to identify different categories of people considered to be at high riskof HIV acquisition. The groups identified included people who frequent bars (e.g. bar workers, drunkards, sex workers, businessmen), people who work in transportation (e.g. truck drivers, matatu drivers, motorcycle drivers, taxi drivers, bicycle taxi drivers), fishermen/fishmongers, MSM and hair salon workers. The study also identified using personal contact, link persons, peer mobilisers and leaders as strategies of identifying and locating KPs. The study used the mRDS successfully in recruiting participants with evaluation of inconsistent condom use and multiple sexual partnerships showing the participants to be of high risk behaviour. Of all the females in the study, only 3.3% were pregnant. The prevalence of Chlamydia was 2.9%, gonorrhoea was 5.0%, syphilis was 0.4% and HSV-2 was 46.0%. Those who tested positive for HIV were 26.2% with 42.3% of the HIV positive participants having CD4 counts of between 250 – 500 cells/ml. Recommendations and Conclusion:The mRDS was successful in recruiting KPs in an HIV prevention trial. Majority of the participants reported inconsistent condom use and having multiple sex partners. In addition to MSM, SW and transport industry workers, fisherfolk, discordant couples, widowers, street youth, car washers and police also form part of KPs groups. The HIV prevalence was higher amongst these groups compared to general population with discordant couples having the highest HIV prevalence. The study recommends that mRDS should be used to identify and recruit KPs as it not only allows for faster recruitment of KPs, it also reduces the expense and complexity associated with coupon management in the standard RDS.

Prostitution, sex in exchange for consideration, has never been illegal in Canada; however, activities surrounding prostitution have been criminalized in the Criminal Code. These prohibited activities include: working indoors (s. 210 keeping a common bawdy house), providing services to sex workers (s. 212(1)(j) living off of the avails of prostitution), and communicating in public for the purposes of prostitution (s. 213). In 2007 two former and one current sex worker, Terri Jean Bedford, Valerie Scott and Amy Lebovitch challenged the constitutionality of the above laws, arguing that they increased sex workers’ vulnerability to harm. Six years later on June 13th, 2013 the Supreme Court of Canada heard the landmark case Canada (Attorney General) v. Bedford. Prior to hearing the case, the Supreme Court Justices read the submitted factums outlining the arguments of the appellants, respondents, and their interveners. The final decision was released on December 22nd, 2013 and the unanimous decision to strike down all three laws was made. Using a discourse analysis inspired by Michel Foucault, this study ‘unpacks’ the meanings that are constituted within the factums submitted to the Supreme Court regarding the people who engage in sex work and the institution of prostitution. The convergences and divergences within the discourses are presented. Drawing on these findings, while applying the work of Wedeking’s (2010) strategic legal framing alongside the governmentality perspective of risk, the tensions surrounding risk and choice are further explored. In doing so, the relationship between risk (taking/avoiding) and choice (making) is teased out. In this thesis I argue that risk and choice are strategically framed in the submitted factums to demonstrate the (un)constitutionality of Canada’s prostitution laws. Furthermore, I argue that both the appellants and respondents agree that risk avoidance is an acceptable self-governance strategy for sex workers, however they diverge on what they consider to be acceptable risk avoidance measures. The conclusion of this study discusses the decision of Canada (Attorney General) v. Bedford to strike down the three prostitution laws and the subsequent introduction of the Protection of Communities and Exploited Persons Act.

In 2020, COVID-19 spread worldwide, and a state of pandemic was declared by the World Health Organization. Female sex workers are in many ways dependant on the social conditions of society and have, throughout time, been considered as a highly victimized group. This study aims to gain insight into the changes and consequences the COVID-19 pandemic has had on female sex workers in Sweden by conducting semi-structured interviews with individuals who, through their employment, have connections to female sex workers. The collected data were analyzed using thematic analysis. The results revealed four themes that describe the changes and consequences witnessed by the participants. The first theme entails the vulnerabilities and circumstances that female sex workers are conditioned by in society. The second theme demonstrates the economic consequences which the pandemic outbreak caused. Not only in relation to expenses and difficulties traveling but also in terms of an increased market due to unemployment and lockdowns in Central Europe. This theme also includes a subgroup of physical consequences as a result of the competition created by the increased market of female sex workers in Sweden. This has caused the women to have to take additional risks and abuse. The third theme includes the bureaucratic and social complications caused by the social restrictions enforced to hinder the spread of the COVID-19. The fourth and last theme presents the participants' post-pandemic predictions.

Individuals infected with HIV through heterosexual contact made up 24% (9,578) of all new infections in the United States. Female sex workers are at increased risk of getting HIV and other sexually transmitted infections (STI) because they may be more likely to participate in risky sexual behaviors including sex with multiple partners and condom-less anal/vaginal sex. Guided by the syndemic theory, the purpose of this study was to explore the relationships between social and structural factors (homelessness, substance use, immigration status, and use of healthcare) and risky sexual behaviors (condom-less vaginal sex and multiple sex partners) among female sex workers while controlling for age and sexual violence. This study was conducted using a quantitative research approach with a correlational method. Multiple linear regression statistical testing was performed using data from 534 participants from the National HIV Behavioral Surveillance study. Immigration status was not significantly associated with condom-less vaginal sex or multiple sex partners. However, homelessness and substance use were positively associated with condom-less vaginal sex and multiple sex partners. In addition, utilization of healthcare was negatively associated with condom-less vaginal sex. The results from this study can increase awareness and knowledge of challenges and barriers among female sex workers living in Illinois. In addition, the results of this study may contribute to establishing baseline epidemiology of this population and guidelines on addressing the factors associated with unsafe sexual behaviors that can potentially lead to HIV and other STIs.