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Are registered prostitutes HIV free?
Dec 3, 1996

Some people say the chances are relatively lower to contract HIV disease if they engage sex activaty with registered prostitutes. As far as I know many countries including USA allow some licensed brothels or red light district to do bussiness. All the protitutes there must be registered and have to be screened or checked up periodically by the local government to ensure they are health enough to provide sex services. If they are found having any HIV or STD disease, they will be stopped for working. Does it mean that there are lower risks of contracting HIV or STD if one has sex only with registered prostitute? And by the way, could you estimate the health/disease ratio among registered prostitutes in USA. Thank you.

Response from Mr. Sowadsky

Hi. Thank you for your question.

Some countries do have legalized and regulated prostitution. Because I am not familiar with the rules and regulations of legalized prostitution outside of the USA, I cannot tell you how safe it is. But never assume it's 100% safe, and ALWAYS use condoms for protection. It's impossible to screen for every STD, so to be on the safe side, whether you're having sex with a "registered" prostitute or not, use condoms for protection. And don't assume that they're screened for STD's (including HIV). They may not be. Also, some countries may tolerate prostitution, but it may not be legal, and the prostitutes may not be tested at all. As you will see below, just because a prostitute may have tested negative for HIV and other STD's, does NOT necessarily mean they are not infected.

In the United States, the only legal and regulated prostitution is in the state of Nevada. And even in Nevada, not all prostitution is legal. In Nevada, prostitution is only legal in licensed brothels, and only in certain rural counties. Prostitution is NOT legal in Las Vegas, Reno, Lake Tahoe, Laughlin, and Carson City. Street prostitutes, and prostitution through escort services and massage parlors, are also NOT legal in Nevada. And ALL prostitution is illegal (and unregulated) everywhere else in the USA.

In Nevada's licensed brothels, by law, prostitutes prior to working MUST be screened for Chlamydia, Gonorrhea, Syphilis, and HIV. If they are found positive for Chlamydia, Gonorrhea, or Syphilis, they cannot begin work until they are adequately treated, followed-up, and test negative on a subsequent test. For HIV, they are barred from working for life. There have been brothel applicants who have tested positive for HIV. Because of their HIV positive status, they were prohibited from working at all.

Under Nevada law, once a prostitute begins working in the legal brothels, they are tested weekly for Chlamydia and Gonorrhea, and monthly for Syphilis and HIV. If they are found positive for Chlamydia, Gonorrhea, or Syphilis, they are immediately prohibited from working, and cannot return to work until they are adequately treated, followed-up, and test negative on a subsequent test. For HIV, they would be immediately barred from working for life. To date, no actively working legal brothel prostitute has ever tested HIV positive. However, from time to time, there are cases of Chlamydia, Gonorrhea and rarely Syphilis, among active brothel workers. Chlamydia is the most common STD seen, however this is not a surprise, since Chlamydia is the most common STD in the USA overall.

Nevada law also requires that latex condoms must be used during all sexual activity.

However, even with the mandatory testing, and mandatory condom use, we cannot guarantee that a person won't get HIV or other Sexually Transmitted Diseases (STD's). This is for two reasons. First, although condoms used consistently and correctly will significantly reduce the risk of HIV/STD's, they are not 100% protection. They can sometimes break, slip off, or leak. Also, it's impossible to test for every STD ahead of time. And STD's won't immediately show positive on a test. For example, for diseases like Chlamydia, Gonorrhea and Syphilis, it may take several weeks before the person shows positive on the test. In the case of HIV, it can take as long as 6 months to show positive on the test. So we cannot guarantee that any prostitute will ever be free of HIV/STD's.

However we can say that in Nevada's legal brothels, the risks are MUCH less than going to any other prostitute in the USA. This is because these prostitutes are tested more than any other person for HIV and other STD's. And they cannot work if they are positive. Also, they must use latex condoms during all sexual actitivies. Illegal prostitutes often don't use condoms, and they don't have to get tested for anything. This includes prostitutes working for escort services and massage parlors. Having sex with a legal prostitute can often be safer than having sex with a woman you met in a bar or at a party. This is again because many non-prostitutes don't use protection and don't get tested like legal prostitutes do. But they can still have multiple, even numerous, sexual partners.

In summary, you cannot assume a "registered" prostitute is free of HIV or other STD's. Some may get tested, others not. You still need to ALWAYS use condoms with ALL of them, regardless of their legal status. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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