Rapidly changing conditions in the brothels of Bangladesh: impact on HIV/STD

Bangladesh is a low HIV prevalence country with several well-documented at-risk groups, the most prominent of which is brothel-based sex workers. Using two waves of HIV behavioral surveillance data for a national sample of all operating registered brothels supplemented by historical and observational accounts, this article presents a case study of the changing conditions in the brothels. Between the two waves of surveillance, several brothels were forcibly closed; the number of sex workers dropped; the average number of clients per woman rose; and overall safety, both in terms of violence and protected sex, did not improve. Only treatment-seeking behavior for sexually transmitted diseases was positively changed. Continued surveillance of the possible negative impact of HIV prevention programs is under way. Protective policies are needed to facilitate improved HIV prevention and safety of sex workers, a key to controlling the HIV epidemic.