Official websites use. Share sensitive information only on official, secure websites. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. German sex workers have illegally established a prevention strategy, which consists of testing potential sexual partners with human immunodeficiency virus HIV -specific rapid diagnostic tests RDTs prior to engaging in unprotected sexual intercourse eventually performed in case of a negative test result.
Based on a recently established modeling approach, the effectiveness of this strategy regarding the risk of HIV exposure was compared with protection provided by condom use. A notable weakness of the strategy is the RDTs' poor sensitivity in spite of a high transmission risk during the seroconversion stage. Keywords: HIV, rapid testing, exposure risk, prevention, sex worker, risk assessment. Recently, we have introduced a mathematical model for the comparison of prevention strategies against sexual transmission of the human immunodeficiency virus HIV [ 1 ] with a focus also on exposition prevention.
Furthermore, condom use of men having sex with men MSM is not represented [ 2 ], and studies assessing condom effectiveness are affected by numerous sources of bias [ 4β8 ]. However, the main limitation is not technical failure of condom use, but rather its lacking acceptance in high-risk groups as extensively discussed elsewhere [ 1 , 9 ]. In Germany, sex workers have illegally invented a strategy to protect themselves from exposure to HIV while avoiding condom use, which is rather unpopular or even rejected by many of their clients.
As this approach is illegal and largely restricted either to the demimonde or private hedonistic parties, systematic scientific assessment of its effects and long-term consequences for both, the sex workers and their clientele, is yet missing.
In detail, by modern 4th-generation serological HIV tests, p24 as the main viral marker protein can be detected not earlier than between the second or third week after infection. After 3 weeks or more, HIV-specific antibodies usually become measurable [ 11 ]. The use of 4th-generation RDT systems can narrow the diagnostic gap but cannot completely resolve this problem. In summary, positive reactions of HIV RDTs in case of early HIV infections are delayed by approximately 1 week compared to serological 4th-generation bench-top devices in the laboratory as demonstrated by comparing the principles using a seroconverter panel [ 13 ].
