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

2020

Article référencé dans le Web of Science WOS:000519306600185

Becquet Valentine, Nouaman M., Plazy M., Masumbuko J. M., Anoma C., Kouame S., Danel C., Eholie S. P., Larmarange Joseph, ANRS 12361 PrEP-CI Study Group

BMJ Open, 2020, 10 (1), e028508 [12 p.] ISSN 2044-6055

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 Cote 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 Cote 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.

Santé : aspects socioculturels, économiques et politiques [056] ; Démographie [108]

COTE D'IVOIRE

Fonds IRD [F B010078925]

fdi:010078925