Background As female sex workers (FSW) continue to play a key role in HIV-1 epidemic in sub-Saharan Africa, programs aiming at reducing sexually transmitted infections (STI) involved in HIV acquisition and transmission are still needed. The objective of this study was to determine factors influencing STI acquisition among FSW in Cotonou, Benin.
Methods Three hundred and eighty seven (387) FSW were recruited in a medical center dedicated to STI treatment among female sex workers and their clients. Cervical infections by Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT; SDA, BD Probe Tec®) were investigated at enrolment into the study. All infected FSW received adequate treatment for free. We used a multivariate logistic regression model to assess variables independently associated with cervical infection at enrolment (p value<0.05).
Results The FSW were essentially from Benin (39.5%) and neighbouring countries such as Nigeria (22.1%), Togo (21.8%) and Ghana (15.1%). One hundred and forty three subjects (143; 37.0%) were HIV-1 positive (52 were treated with antiretroviral therapy and 91 remained untreated because not yet meeting eligibility for treatment). Median age (IQR) and median duration (IQR) in the work were 33 (27—40) and 3 (1.2—5) years. Cervical infections by NG and CT were diagnosed in 4.4% and 3.9% cases, respectively. Only two women (0.5%) had both infections. Seventy seven per cent (77.1%) and 86.8% of the FSW reported, respectively, consistent condom use during the last 7 days of work and condom use at last sexual intercourse with a client. After adjustment for age and condom use, being HIV-1 infected [RR 3.04; 95% CI 1.25—to 7.40], not working in a brothel (RR 3.28; 95% CI 1.64—to 9.27), and being working for less than 12 months (RR 3.55; 95% CI 1.53—to 8.23) were independently associated with cervical infection in our study population.
Conclusion Our results suggest that HIV-1 infection and cervical infection by NG and CT alter each other. Antiretroviral therapy in association with preventive programmes aiming at controlling STI should be encouraged among new FSW and also among those working outside brothels.
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