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      HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study

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          Abstract

          Background

          The HIV epidemic remains an important public health challenge for the sub-Saharan region. Female Sex Workers (FSW) in this region are among the most vulnerable of the key population groups with HIV prevalence as high as twice that of the general population. The aim of this study was to estimate HIV prevalence and explore sexual risk behaviors among FSW in Togo.

          Methods

          A cross-sectional study using a Respondent Driven Sampling method was conducted across the six regions of country among FSW in 2017. A comprehensive questionnaire was used to explore socio-demographic characteristics, sexual history, HIV knowledge, and sexual behaviors. HIV rapid tests were used to assess HIV infection.

          Results

          A total of 1,036 FSW, with a median age of 26 years old [interquartile range (IQR): 22–33], participated in the study, with 49.2% ( n = 510) of them having reached secondary school. Median age at first sexual intercourse was 20 years old [IQR: 17–25] and estimated number of clients per week was of 5 [IQR: 3–10]. A total of 936 (95.6%) reported the use of a condom during last sexual intercourse with a client and 493 (47.6%) reported the use of a condom during their last sexual intercourse with a partner or husband. HIV prevalence was 13.2% [95% CI: 11.2 – 15.4], and was associated with age (being between 26 and 32 years old; aOR = 4.5; 95% CI: [2.4 – 9.1], p < 0.0001) and ≥ 33 years old; aOR = 6.4; 95% CI [3.5 – 12.7], p < 0.0001), education level (being in primary school or less; aOR = 1.7; 95% CI: [1.1–2.6]; p = 0.012) and the number of partners per week (more than 2 and 3 partners; aOR = 2.5; 95% CI [1.2—5.2]; p = 0.014).

          Conclusions

          HIV prevalence and sexual risk behaviors remain high among FSW in Togo, despite prevention efforts aimed at curbing this trend. Other factors, such as access and availability of condoms, the social and legal environment in which FSW operate, should be considered for HIV prevention strategies in this population.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13690-022-00851-0.

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          “When they know that you are a sex worker, you will be the last person to be treated”: Perceptions and experiences of female sex workers in accessing HIV services in Uganda

          Rhoda Wanyenze, Geofrey Musinguzi, Juliet Kiguli … (2017)
          Background HIV prevalence among female sex workers (FSWs) in high burden countries in sub-Saharan Africa varies between 24 and 72%, however their access to HIV services remains limited. This study explored FSWs’ perspectives of the barriers and opportunities to HIV service access in Uganda. Methods The cross-sectional qualitative study was conducted between October and December 2013. Twenty-four focus group discussions were conducted with 190 FSWs in 12 districts. Data were analysed using manifest content analysis, using Atlas.ti software, based on the socio-ecological model. Results FSWs indicated that HIV services were available and these included condoms, HIV testing and treatment, and management of sexually transmitted infections. However, access to HIV services was affected by several individual, societal, structural, and policy related barriers. Individual level factors included limited awareness of some prevention services, fears, and misconceptions while societal stigma was prominent. Structural and policy level barriers included inconvenient hours of operation of the clinics, inflexible facility based distribution of condoms, interuptions in the supply of condoms and other commodities, and limited package of services with virtually no access to lubricants, HIV pre- and post-exposure prophylaxis, and support following client perpetrated violence. Policies such as partner testing and involvement at antenatal care, and using only one facility for antiretroviral drug refills hindered HIV service uptake and retention in care. FSWs had major concerns with the quality of services especially discrimination and rude remarks from providers, denial or delay of services, and potential for breach of confidentiality. However, some FSWs reported positive experiences including interface with friendly providers and participated in formal and informal FSW groups, which supported them to access health services. Conclusion Despite availability of services, FSWs faced major challenges in access to services. Comprehensive multilevel interventions targeting individual, societal, structural and policy level barriers are required to increase access to HIVservices among FSWs in Uganda. Policy and institutional adjustments should emphasize quality friendly services and expanding the package of services to meet the needs of FSWs.
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            Determinants of access to HIV testing and counselling services among female sex workers in sub-Saharan Africa: a systematic review

            Soori Nnko, Evodius Kuringe, Daniel Nyato … (2019)
            Background HIV testing and counselling (HTC) is an essential component for HIV prevention and a critical entry point into the HIV continuum of care and treatment. Despite the importance of HTC for HIV control, access to HTC services among female sex workers (FSWs) in sub-Saharan Africa (SSA) remains suboptimal and little is known about factors influencing FSWs’ access to HTC. Guided by the client-centred conceptual framework, we conducted a systematic review to understand the facilitators and barriers influencing FSWs in SSA to access HTC services. Methods A systematic search was conducted in MEDLINE, POPLINE and Web of Science databases for literature published between January 2000 and July 2017. References of relevant articles were also searched. We included primary studies of any design, conducted in SSA and published in the English language. Studies conducted in multi-sites inclusive of SSA were included only if data from sites in SSA were separately analysed and reported. Similarly, studies that included other subpopulations were only eligible if a separate analysis was done for FSWs. This review excluded papers published as systematic reviews, editorial comments and mathematical modelling. The protocol for this review is registered in the Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017062203. Results This review shows that factors related to approachability, acceptability, availability, affordability and appropriateness of the services are crucial in influencing access to HTC services among FSWs in SSA. These factors were mediated by individual attributes such as HIV risk perceptions, awareness of the availability of HTC, and perceptions of the importance and quality of HTC services. The decision to utilise HTC was predominantly hampered by discriminatory social norms such as HIV stigma and criminalisation of sex work. Conclusions FSWs’ access to HTC is facilitated by multiple factors, including individual awareness of the availability of HTC services, and perceived quality of HTC especially with regard to assured confidentiality. Concerns about HIV stigma and fear about discrimination due to community intolerance of sex work acted as major barriers for FSWs to seek HTC services from the facilities offering health services to the general population. Electronic supplementary material The online version of this article (10.1186/s12889-018-6362-0) contains supplementary material, which is available to authorized users.
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              Estimating the impact of reducing violence against female sex workers on HIV epidemics in Kenya and Ukraine: a policy modeling exercise.

              Michele Decker, Andrea L Wirtz, Carel Pretorius … (2013)
              Female sex workers (FSWs) worldwide suffer disproportionate burdens of HIV and gender-based violence. Despite evidence linking these threats, little is known about the potential HIV epidemic impact of reducing abuse.
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                Author and article information

                Contributors
                Didier K. Ekouevi: didier.ekouevi@gmail.com
                Journal
                Journal ID (nlm-ta): Arch Public Health
                Journal ID (iso-abbrev): Arch Public Health
                Title: Archives of Public Health
                Publisher: BioMed Central (London )
                ISSN (Print): 0778-7367
                ISSN (Electronic): 2049-3258
                Publication date (Electronic): 24 March 2022
                Publication date PMC-release: 24 March 2022
                Publication date Collection: 2022
                Volume: 80
                Electronic Location Identifier: 92
                Affiliations
                [1 ]GRID grid.512663.5, Centre Africain de Recherches en Epidémiologie et en Santé Publique (CARESP), ; Lomé, Togo
                [2 ]GRID grid.508062.9, ISNI 0000 0004 8511 8605, INSERM U1219, Bordeaux Population Health Research, ISPED, Université de Bordeaux, ; Bordeaux, France
                [3 ]GRID grid.411387.8, ISNI 0000 0004 7664 5497, Programme PACCI – Site ANRS Côte d’Ivoire, CHU de Treichville, ; Abidjan, Côte d’Ivoire
                [4 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Département de santé Publique, Faculté des Sciences de la Santé, , Université de Lomé, ; Lomé, Togo
                [5 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire, , Université de Lomé, ; Lomé, Togo
                [6 ]GRID grid.410694.e, ISNI 0000 0001 2176 6353, Département de Dermatologie et d’Infectiologie, , Université Félix Houphouët Boigny, UFR des Sciences Médicales, ; Abidjan, Côte d’Ivoire
                [7 ]GRID grid.411387.8, ISNI 0000 0004 7664 5497, CHU de Treichville, ; Service de Maladies Infectieuses et Tropicales, Abidjan, Côte d’Ivoire
                [8 ]Programme National de Lutte contre le VIH/Sida, les Hépatites virales et les Infections Sexuellement Transmissibles (PNLS/HV/IST), Lomé, Togo
                Article
                Publisher ID: 851
                DOI: 10.1186/s13690-022-00851-0
                PMC ID: 8943989
                PubMed ID: 34983643
                SO-VID: af0932a8-7275-496c-bb3f-c2acfb59e98d
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 2 August 2021
                Date accepted : 14 March 2022
                Funding
                Funded by: centre africain de recherche en epidemiologie et en sante publique
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Public health
                Keywords: hiv,female sex workers,risk behaviours
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: hiv, female sex workers, risk behaviours

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