Introduction: Older age is strong predictor of human immunodeficiency vi-rus (HIV), syphilis, and risk behaviours among female sex workers (FSWs). Prior re-search suggests that age differences are very variable; HIV was higher among older FSWs. This study compares HIV, syphilis, and risk behaviours among younger and older FSWs of Nepal.
Material and methods: We conducted secondary analysis of Integrated Bi-ological and Behavioural Surveillance (IBBS) surveys among FSWs from 2004 to 2016. Bivariate analysis using χ2 tests and multi­variate logistic regression models were used to assess differences of HIV, syphilis, and risk behaviours among younger and older FSWs.
Results: The study comprised 17.6% FSWs aged 35 years or older. HIV prevalence was 1.7% for the entire group of FSWs, with 2.3% among older FSWs and 1.5% among younger FSWs. The older FSWs were married and separated, had lower education levels, had longer duration of sex work, worked on the streets, and had inconsistent condom used with clients than younger FSWs (p < 0.05). Younger FSWs were also at high risk because of a higher number of sexual partners and working days, pervasive alcohol consumption, and use of drugs (p < 0.05). The multivariate analysis revealed that older FSWs were more street-based (aOR = 2.1, 95% CI = 1.8-2.4), have inconsistent condom use with clients (aOR = 1.8, 95% CI = 1.4-2.1) and had higher syphilis rates (aOR = 1.8, 95% CI = 1.3-2.5) than younger FSWs.
Conclusions: Older FSWs practice higher risk behaviour and have higher syphilis prevalence. HIV and STI prevention interventions among targeting FSWs should consider risks and vulnerability of older FSWs.