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Introduction
Nevada is the only US state in which commercial sex is legal. Since 1971, counties of fewer than 400 000 people have been able to elect to legalize brothels. At present, there are 32 legal brothels employing about 300 licensed prostitutes.
Licensed brothel sex workers undergo weekly state-mandated medical examinations for gonorrhea, herpes, and venereal warts and monthly blood tests for syphilis. In March 1986, the Nevada Board of Health began requiring a negative initial human immunodeficiency virus (HIV) antibody test and negative monthly tests thereafter as a condition of employment. If a brothel worker or applicant is found to be seropositive, her employment is immediately terminated or denied.(1-3) Between July 1, 1988, and December 31, 1993, more than 20 000 HIV tests were conducted. None of the women employed at any of the Nevada brothels tested positive.(1,4) In the same period, however, 19 brothel applicants tested HIV seropositive.(4) These data are in sharp contrast to HIV seroprevalence rates among other female prostitutes in the United States.(5-7)
Data indicate a negligible incidence of other sexually transmitted diseases among these women. A 1988 study found 5000 cases of gonorrhea in Nevada, only 9 of which were detected in legal brothels.(8) More than 7000 sexually transmitted disease tests conducted between 1982 and 1989 on 246 prostitutes in one brothel revealed only 2 cases of syphilis and 19 cases of gonorrhea, all reportedly contracted before implementation of Nevada's mandatory condom law.(9,1O)
Although the actual exposure level of brothel workers to clients with HIV and other sexually transmitted disease infections is not known,(11) the absence of HIV and other sexually transmitted diseases may be explained by the fact that clients are required to use condoms during every sexual act. In January 1987, the brothel industry voluntarily adopted a compulsory condom policy in response to a 30% to 40% decline in business following reports that HIV could be spread through heterosexual contact.(2,1O) This policy was ratified by the state as a mandatory condom law in March 1988.
While latex condoms can substantially reduce the risk of transmission of HIV and other sexually transmitted diseases when used consistently and correctly,(11-14) condoms may still break or slip off and thereby expose users to potential infection and risk of pregnancy.(15,16) Summaries of...