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Lack of HIV Infection and Condom Use in Licensed Prostitutes--The Lancet Dec.13, 1986

SIR,--Licensed prostitutes in West Germany have a human immunodeficiency virus (HIV) antibody prevalence rate of 1% and unlicensed prostitutes have a prevalence of 20%.^1,2 This difference has not been explained although intravenous drug usage is more common in unlicensed prostitutes. Any data on variable rates may provide useful information to limit the spread of HIV infection.³

448 licensed female prostitutes in Nuremburg, West Germany, were studied in March and April, 1986. The city has a population of about 500,000 with 25,000 US Army personnel. 1% of US soldiers presenting to the sexually transmitted disease clinic are western blot positive and about 1.6 per 1000 US soldiers are western blot positive.

89% of the licensed prostitutes were tested for HIV antibody by enzyme-linked immunosorbent assay and positives were confirmed by immunofluoresence test. 50% of the prostitutes completed an anonymous questionnaire, providing demographic data and details on sexual practices.

No prostitute tested was anti-HIV positive by immunofluoresence. All prostitutes were German or other Western European. Their mean age was 30 years (range 18-62) adn they had been prostitutes for 77 months on average (range 1-480). The mean number of clients was 13 per week (range 1-50). 21% regularly had military clients and 2% of the prostitutes regularly had African clients. 1 was an intravenous drug user, 10% had tattoos, and 1.8% had had intimate contact with a person in an AIDS high risk group.

13% practise open-mouth kissing with clients. 74% occasionally to always masturbate clients, 80% with condoms; 63% occasionally to always perform oral sex, 90% with condoms; 92% occasionally to always have vaginal sex with clients, 97.5% do this with condoms; and 5% occasionally to always have rectal sex, 55.5% with condoms.

This heterosexually very active group of women has remained free from HIV infection. The demographic mix of their clients, the absence of intravenous drug abuse and the frequency with which condoms are used for all sexual practices may be protecting these prostitutes from infection.