Decline in the Prevalence of HIV and Sexually Transmitted Infections Among Female Sex Workers in Benin Over 15 Years of Targeted Interventions

1URESP, Centre de recherche FRQS du CHA universitaire de Québec, Québec Canada 2Département de médecine sociale et préventive, Université Laval, Québec, Canada 3Dispensaire IST, Cotonou, Bénin 4Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom 5Département de microbiologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada 6Programme national de lutte contre le Sida et les IST au Bénin 7Faculté des sciences de la santé, Université d'Abomey-Calavi, Cotonou, Bénin
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 01/2013; 63(1). DOI: 10.1097/QAI.0b013e318286b9d4
Source: PubMed


An HIV-preventive intervention targeting the sex work milieu and involving fully integrated components of structural interventions, communication for behavioral change and care for sexually transmitted infections (STIs), was implemented in Benin by a Canadian project from 1992 to 2006. It first covered Cotonou before being extended to other main cities from 2000. At the project end, the Beninese authorities took over the intervention, but structural interventions were interrupted and other intervention components were implemented separately. We estimated time trends in HIV/STI prevalence among female sex workers (FSWs) from 1993 to 2008 and assessed the impact of the change in intervention model on trends.

Six integrated biological and behavioral surveys were carried out among FSWs. Time trend analysis controlled for potential sociodemographic confounders using log-binomial regression.

In Cotonou, from 1993 to 2008, there was a significant decrease in HIV (53.3%-30.4%), gonorrhea (43.2%-6.4%), and chlamydia (9.4%-2.8%) prevalence (all adjusted P = 0.0001). The decrease in HIV and gonorrhea prevalence was also significant in the other cities between 2002 and 2008. In 2002, gonorrhea prevalence was lower in Cotonou than elsewhere (prevalence ratio = 0.53, 95% confidence interval: 0.32 to 0.88). From 2005 to 2008, there was an increase in gonorrhea prevalence (prevalence ratio = 1.76, 95% confidence interval: 1.17 to 2.65) in all cities combined.

Our results suggest a significant impact of this targeted preventive intervention on HIV/STI prevalence among FSWs. The recent increase in gonorrhea prevalence could be related to the lack of integration of the intervention components.

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