Objective: To determine the prevalence of HIV infection and risk behaviour among various groups of streetwalkers in Amsterdam and the extent of overlap between different prostitution networks.
Setting: The family room project in the streetwalkers' district in Amsterdam, the Netherlands.
Methods: In November 1996, saliva was taken from 32 female and 25 transsexual/transvestite prostitutes and tested for antibodies against HIV. Besides, prostitutes were interviewed on risk behaviour, history of sexually transmitted diseases and mobility.
Results: Only one of the participants (a female prostitute) had ever injected drugs. None of the female prostitutes, but 6 of the 25 transsexuals/transvestite prostitutes (24%; 95% confidence interval: 7-41) proved seropositive. None of the HIV infected participants was aware of his serostatus. The transsexual/transvestite prostitutes frequently had receptive anal intercourse with their clients. Condom use was high, but most did not use condoms made for anal intercourse. Female prostitutes also reported a high rate of condom use with their clients. Both groups of prostitutes reported few private partners and a low rate of condom use with these partners. According to the transsexual/transvestite prostitutes many of their clients had sexual contacts with women in their private lives. Many prostitutes thought that they shared the same clients in the district.
Conclusion: HIV infections occur quite often among transsexual/transvestite prostitutes in the streetwalkers' district in Amsterdam. The risk of further spread HIV infection to their clients (and through them to other heterosexual populations) is present. AIDS education targeted at this group is important. The use of (special) condoms when having anal intercourse in private as well as in prostitution contacts should be emphatically advised.