Indicator 9.10: "Sex with commercial sex workers among young people."
The proportion of young people who have had sex with a commercial sex worker (CSW) in the preceding 12 months.
A nationally representative general population survey.
What It Measures
In places where CSWs are important sources of new HIV infections it is a priority to reduce the number of young people having sex with them. This indicator measures the prevalence of commercial sex in the preceding year which, although not a good estimate of the lifetime prevalence of this behaviour, is more able to detect changes in such behaviour over time.
Attempts to collect and analyse data on the basis of a wider definition of commercial sex, with the use of questions such as “Have you given or received money or gifts in exchange for sex?”, have not yielded useful information. In the context of the HIV/AIDS epidemic, sex workers are of interest because they have a high turnover of partners and are therefore at high risk of being exposed to infection, becoming infected and passing on the infection to others. In many cultures, this is true of only a fraction of those who have “received money or gifts in exchange for sex”. If there is no locally specific term for prostitution, this indicator is unlikely to be relevant to the programme and should not be used.
The inclusion in the denominator of all young people makes it simple to describe and monitor the size of a group of young people who may be especially vulnerable to HIV infection. If the denominator were the number of sexually active young people, a shift in the number sexually active could affect the proportion visiting commercial sex workers. This would complicate the analysis of the indicator.
How to Measure It
Respondents are first asked if they have ever had sex. Those who reply in the affirmative are asked about their last three partners in the preceding 12 months. Information on the type of partner (e.g. spouse, live-in partner, boyfriend/girlfriend, acquaintance or commercial sex worker) is requested in respect of each of the last three partners.
The indicator should be given as the percentages of all males who report this behaviour in the age groups 15–19, 20–24 and 15–24 years. If appropriate it should also be presented for women.
Strengths and Limitations
This indicator assumes that condom use is not consistent among sex workers. The inequality of power between sex workers and their clients suggests that this is often true. The indicator also assumes that any sex with sex workers is unsafe. However, in countries where condom promotion has been successful among sex workers, an alternative indicator on the use of a condom on the occasion of the last commercial sexual encounter might be more appropriate.
In concentrated and low-level epidemics, sex work can play a major part in spreading HIV infection. However, it is very difficult to define commercial sex in a way that translates from one place to another. This is the principal limitation of the indicator. Once commercial sex has been described for a country, however, this is unlikely to change much with the passage of time. Once a question has been satisfactorily phrased the indicator can be used to track trends in the prevalence of this behaviour over time.
This indicator is of limited use in very high-level epidemics, since the differences in risk associated with sex with a sex worker compared with any other casual partner may not be very substantial.