Sexual Behavior and Awareness of Sexually Transmitted Diseases Among Street-Based Female Sex Workers in the Florence Area, Central Italy

Objective: Street-based female sex workers are more likely to practice unprotected sex with multiple partners increases their risk of infection with sexually transmitted diseases. This study was performed to evaluate the understanding of and risk factors for sexually transmitted diseases among street-based female sex workers. Methods: A survey consisted of a sociodemographic section and a health section was conducted from June to August in two consecutive years (2012-2013) using an anonymous questionnaire compiled by street-based female sex workers in the area of Florence (Central Italy). A descriptive analysis of sociodemographic, epidemiological, and anamnestic variables was performed using common methods for proportions; associations between variables were assessed using univariate and bivariate logistic regression. Results: Totally 122 street-based female sex workers (mean age, 24.1 years; age range, 17–45 years) were enrolled, and were from Europe (63.1%) (mainly from Romania [48.4%] and Albania [13.1%]), Africa (31.2%) (specifically Nigeria), and South America (5.7%). Of the 122 street-based female sex workers, 63% were married/engaged and 37% were single. More than half had been living in Italy and Florence for more than 1 year; 72.8% stated that they possessed a residence permit and the others were illegal migrants. Eighteen (15%) street-based female sex workers also worked in the industry in neighboring European countries. Their level of education was generally high: 58.1% had completed secondary school (lower secondary school and upper secondary school). A total of 81.4% stated that they perceived an actual fear of contracting human immunodeficiency virus; in fact, 43.3% had never been tested for any sexually transmitted diseases except for human immunodeficiency virus. Conclusion: Despite the long-time involvement of street-based female sex workers in the commercial sex industry, the large numbers of clients and a strong perception of concerns about sexually transmitted diseases. This study confirms a low rate of condom use and blood screening, and corresponding science education and health screening efforts need to be strengthened in this high risk population.