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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
  1. Valentine Becquet1,2,
  2. Marcellin Nouaman3,
  3. Mélanie Plazy4,
  4. Jean-Marie Masumbuko3,
  5. Camille Anoma5,
  6. Soh Kouame6,
  7. Christine Danel3,
  8. Serge Paul Eholie3,
  9. Joseph Larmarange2
  10. for the ANRS 12361 PrEP-CI Study group
    1. 1 INED (French Institute for Demographic Studies), Paris, France
    2. 2 CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France
    3. 3 Programme PAC-CI/ANRS Research Site, Abidjan, Côte d'Ivoire
    4. 4 ISPED, Inserm Research Center 1219 (Bordeaux Population Health), Université de Bordeaux, Bordeaux, France
    5. 5 Espace Confiance, Abidjan, Côte d'Ivoire
    6. 6 Aprosam, San Pedro, Côte d'Ivoire
    1. Correspondence to Dr Valentine Becquet; valentine.becquet{at}


    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.

    • qualitative research
    • HIV & AIDS
    • public health
    • demography
    • epidemiology

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    • Collaborators Members of the ANRS 12361 PrEP-CI study group: Aboubakar Sangaré (Aprosam, San Pedro, Côte d’Ivoire), Anglaret Xavier (PAC-CI, Abidjan, Côte d’Ivoire / Inserm, Bordeaux, France), Anoma Camille (Espace Confiance, Abidjan, Côte d’Ivoire), Barin Francis (Université François Rabelais, Tours, France), Bazin Brigitte (ANRS, Paris, France), Becquet Valentine (Ceped/IRD, Paris, France), Dabis François (ISPED/Inserm, Bordeaux, France), Danel Christine (PAC-CI, Abidjan, Côte d’Ivoire / Inserm, Bordeaux, France), Eholie Serge (PAC-CI, Abidjan, Côte d’Ivoire), Ekouevi Didier (PAC-CI, Abidjan, Côte d’Ivoire), Fonsart Julien (Hôpital Saint-Louis, Paris, France), Gbosi Kate (Aprosam, San Pedro, Côte d’Ivoire), Kwamé Abo (Programme National de Lutte contre le Sida, Côte d’Ivoire), Larmarange Joseph (Ceped/IRD, Paris, France), Masumbuko Jean-Marie (PAC-CI, Abidjan, Côte d’Ivoire), Méda Nicolas (Centre Muraz, Bobo-Dioulasso, Burkina Faso), Moh Raoul (PAC-CI, Abidjan, Côte d’Ivoire), Molina Jean-Michel (Hôpital Saint-Louis, Paris, France), N’dri-Yoman Thérèse (PAC-CI, Abidjan, Côte d’Ivoire), Nouaman Marcellin (PAC-CI, Abidjan, Côte d’Ivoire), Plazy Mélanie (ISPED / Inserm, Bordeaux, France), Soh Kouamé (Aprosam, San Pedro, Côte d’Ivoire), Tanoe Solange (Espace Confiance, Abidjan, Côte d’Ivoire), Yeo Roselyne (Espace Confiance, Abidjan, Côte d’Ivoire).

    • Contributors JL, SPE and CD designed the ANRS 12361 PrEP-CI study. J-MM and MN implemented the quantitative survey with the support of CA and SK. VB conducted the qualitative interviews. VB and JL developed the research question addressed in this paper. VB did the qualitative analysis, and MN did the statistical analysis. VB wrote the manuscript with the support of JL, MP and MN. All authors contributed to the interpretation and presentation of the findings. All authors approved the final version of the manuscript for submission.

    • Funding The PrEP-CI ANRS 12361 was funded by the Bill and Melinda Gates Foundation (Investment ID: OPP1106343) and the French National Agency for AIDS and Viral Hepatitis Research (ANRS).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Research authorisations were obtained from the National Committee of Research Ethics within the Ivorian Ministry of Health and Public Hygiene (reference number: 057/MSHP/CNER-kp, delivered on 28 June 2016). Confidentiality was maintained and data were anonymised. Written informed consent was obtained by the investigator before each interview or before answering the questionnaire.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Dataset are available upon request on Zenodo (DOI: 10.5281/zenodo.2269160).

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