Sex workers and their clients as core groups of high frequency transmitters play a dominant role in the transmission of HIV and other sexually transmitted diseases (STDs). In Surabaya, Indonesia, little is known about the prevalence of STDs in various sex establishments. We conducted an STD prevalence survey of 1873 female sex workers in Surabaya, Indonesia. We did not find any sex workers with HIV infection. Prevalence rates of other STDs (chlamydia, gonorrhoea, serological test for syphilis positive, and/or trichomoniasis) in female sex workers were 48% in brothels (n = 696), 42% on the streets (n = 192), 16% in massage parlours (n = 344), 25% in barber shops (n = 150), 17% at call-girl houses (n = 73), and 10% in nightclubs (n = 418). Sex workers from the brothels had the highest prevalence rates of gonorrhoea (24%) and trichomoniasis (8%), while sex workers from the streets and the barber shop had the highest rates of serological test for syphilis (STS) positive (30%) and chlamydia (18%). STD rates decreased with an increase in age (except for STS positive), an increase in education, a decrease in the number of sex partners, and condom use in the previous week. Condom use in the previous week was universally low among sex workers, especially among sex workers from the brothels (14%). Sex workers from the brothels had STD rates about 4 times higher than sex workers from the nightclubs (adjusted odds ratio of 4.4). Although the HIV seroprevalence rate is currently low, widespread prostitution and high rates of STDs in sex workers warrant programmes to avert a potential explosion of HIV transmission. Because sex workers from the brothels in Surabaya have high rates of STDs and low use of condoms but good cooperation with local authorities, STD preventive measures should focus on this group.
PIP: A sexually transmitted disease (STD) prevalence survey of 1873 female sex workers recruited from six types of sex establishments in Surabaya, Indonesia, in 1992-93 failed to reveal any cases of HIV. The prevalence rates of the other STDs included in the study (chlamydia, gonorrhea, syphilis, and trichomoniasis), by setting, were as follows: brothels (n = 696), 48%; streets (n = 192), 42%; massage parlors (n = 344), 16%; barber shops (n = 150), 25%; call-girl houses (n = 73), 17%; and nightclubs (n = 418), 10%. Sex workers based in brothels and on the streets had the lowest socioeconomic status, while nightclub and call-girl house workers had the highest status. Brothel workers had the highest rates of gonorrhea (24%) and trichomoniasis (8%), while street and barber-shop based workers had the highest prevalences of syphilis (30%) and chlamydia (18%). Condom use in the week preceding the survey ranged from 14% among brothel workers to 67% among call girls. STD rates decreased with increases in age and education and with any condom use. The high rates of STDs documented in this survey, especially among sex workers in brothels, indicate the need for programs aimed at preventing an HIV epidemic. For example, the medical monitoring available from a private physician to workers in most massage parlors, barber shops, call-girl houses, and nightclubs should be made available to brothel-based prostitutes. Also urged are free distribution of condoms to sex establishments, sanctions against establishments where condoms are not used consistently, and a media campaign to encourage men to use condoms with sex workers.