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Indicators

8.3 Commercial sex in last year
Program Area: Sexual behavior 
Definition: The percent of men respondents reporting sex with a sex worker in the last 12 months. 
Numerator: The number of male respondents reporting they had sex with a sex worker in the last 12 months. 
Denominator: Total number of male respondents. 
Measurement Tools: UNAIDS general population survey; DHS AIDS Module; FHI BSS. 
What It Measures: In concentrated epidemics commercial sex is of central interest. In heterosexual concentrated epidemics, the initial focal point of infection is among sex workers and their clients. Those clients then spread infection to their wives and girlfriends in the general population, as well as to other sex workers. In such situations, AIDS programmes often focus on trying to reduce the proportion of men having sex with sex workers, as well as increasing condom use in these encounters. This indicator measures progress towards the first of these goals. 
How to Measure It: This indicator is intended only for countries with well-defined populations of sex workers (see below). In general population surveys or in specialised surveys among groups of men who fit the profile of clients of sex workers (the military, truck drivers, etc.), men are asked directly if they had sex with a sex worker in the previous 12 months.

While there may be several different types of definable sex workers in a given country, each with different perceived levels of risk, all these groups should be combined into an indicator of commercial sex use for monitoring and evaluation purposes.

The indicator is the number of men who report that they have had sex with a sex worker in the past 12 months, divided by all male respondents.

In some countries, this indicator has been collected in the past using only sexually active men (rather than all male respondents) as the denominator. In order to maintain trends over time, it is recommended to continue calculating the indicator using sexually active men, but to collect this new indicator using all men in the denominator for several years in parallel with the former. 

Strengths and Limitations: This indicator is useful in concentrated heterosexual epidemics in countries where commercial sex (and especially brothel-based sex) is common, and where a "prostitute" has a clearly defined role. This means it is most likely to be used in parts of the world where commercial sex has played a dominant role in the epidemiology of HIV, e.g., many countries in Asia.

Attempts to collect and analyse data using a wider definition of commercial sex (questions such as "Have you given or received money or gifts in exchange for sex?") have not yielded useful information. In epidemic terms sex workers are of interest because they have a high turnover of partners and therefore have a high probability of being exposed to infection and passing on infection. In many cultures, this is true of only a fraction of the people who have "received money or gifts in exchange for sex". If there is no locally specific term for prostitution, the chances are that this indicator is not relevant to the programme. It should not be used in these situations.

The indicator is also of limited use in very high prevalence epidemics, since differences in risk associated with sex with a sex worker compared with any other casual partner may not be very substantial.

It is possible to construct a similar indicator for clients of male sex workers in special surveys of men who have sex with men. 

Use of Indicator: Core indicator for concentrated epidemics - Additional indicator for generalised epidemics with defined populations of sex workers 
Tools: Surveys (UNAIDS, DHS, FHI)  
SSO Code: IR 4.1.12 
UNGASS: No 
The President's
Emergency Plan:
Yes 
OVC: No 
MDG: No 

USAID | UNAIDS | UNICEF | WHO | CDC | US Census Bureau
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