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Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention.

Identifieur interne : 000109 ( Main/Exploration ); précédent : 000108; suivant : 000110

Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention.

Auteurs : Valentine Becquet [France] ; Marcellin Nouaman [Côte d'Ivoire] ; Mélanie Plazy [France] ; Jean-Marie Masumbuko [Côte d'Ivoire] ; Camille Anoma [Côte d'Ivoire] ; Soh Kouame [Côte d'Ivoire] ; Christine Danel [Côte d'Ivoire] ; Serge Paul Eholie [Côte d'Ivoire] ; Joseph Larmarange [France]

Source :

RBID : pubmed:31919122

Descripteurs français

English descriptors

Abstract

OBJECTIVE

To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.

DESIGN AND SETTING

The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire.

PARTICIPANTS

A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.

RESULTS

Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.

CONCLUSIONS

Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.


DOI: 10.1136/bmjopen-2018-028508
PubMed: 31919122
PubMed Central: PMC6955511


Affiliations:


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<term>Adult (MeSH)</term>
<term>Cote d'Ivoire (epidemiology)</term>
<term>Cross-Sectional Studies (MeSH)</term>
<term>Female (MeSH)</term>
<term>Follow-Up Studies (MeSH)</term>
<term>HIV (MeSH)</term>
<term>HIV Infections (epidemiology)</term>
<term>HIV Infections (prevention & control)</term>
<term>HIV Infections (psychology)</term>
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<term>Male (MeSH)</term>
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<term>Sexually Transmitted Diseases (prevention & control)</term>
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<term>Adulte (MeSH)</term>
<term>Comportement sexuel (statistiques et données numériques)</term>
<term>Côte d'Ivoire (épidémiologie)</term>
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<term>Humains (MeSH)</term>
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<term>Infections à VIH (psychologie)</term>
<term>Infections à VIH (épidémiologie)</term>
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<term>Maladies sexuellement transmissibles (épidémiologie)</term>
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<term>Travailleurs du sexe (statistiques et données numériques)</term>
<term>VIH (Virus de l'Immunodéficience Humaine) (MeSH)</term>
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<term>Maladies sexuellement transmissibles</term>
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<term>Comportement sexuel</term>
<term>Rapports sexuels protégés</term>
<term>Travailleurs du sexe</term>
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<term>Infections à VIH</term>
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<term>Cross-Sectional Studies</term>
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<term>Femelle</term>
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<term>Partenaire sexuel</term>
<term>VIH (Virus de l'Immunodéficience Humaine)</term>
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<p>
<b>OBJECTIVE</b>
</p>
<p>To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>DESIGN AND SETTING</b>
</p>
<p>The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>PARTICIPANTS</b>
</p>
<p>A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.</p>
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<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.</p>
</div>
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<AbstractText Label="OBJECTIVE">To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.</AbstractText>
<AbstractText Label="DESIGN AND SETTING">The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire.</AbstractText>
<AbstractText Label="PARTICIPANTS">A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.</AbstractText>
<AbstractText Label="RESULTS">Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.</AbstractText>
<AbstractText Label="CONCLUSIONS">Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.</AbstractText>
<CopyrightInformation>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.</CopyrightInformation>
</Abstract>
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<LastName>Becquet</LastName>
<ForeName>Valentine</ForeName>
<Initials>V</Initials>
<Identifier Source="ORCID">0000-0002-3599-5445</Identifier>
<AffiliationInfo>
<Affiliation>INED (French Institute for Demographic Studies), Paris, France valentine.becquet@ined.fr.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France.</Affiliation>
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</AffiliationInfo>
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<Initials>J</Initials>
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<Affiliation>CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France.</Affiliation>
</AffiliationInfo>
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<CollectiveName>ANRS 12361 PrEP-CI Study group</CollectiveName>
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<Month>01</Month>
<Day>08</Day>
</ArticleDate>
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<Country>England</Country>
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<CoiStatement>Competing interests: None declared.</CoiStatement>
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