Context In West Africa, HIV/STIs prevention activities targeting female sex workers (FSW) and their partners were developed and supported financially through a bilateral cooperation project. After the end of the project in Benin (2006) and Niger (2007), the national HIV/STI programs took over these interventions.
Objectives (i) to identify the challenges and barriers for FSW program interventions within national programs; (ii) to assess the capacity of FSW dedicated services to treat and prevent STI efficiently.
Methods A triangulation of methods and sources of data collection were used within an evaluative approach centered on the use of the results, such as individual and collective interviews, review of data records from health centers and field observations. Quantitative data from clinical attendance were crossed with qualitative data. A conceptual framework was developed to explain the exploratory and analytical elements. The main findings were validated with the stakeholders.
Results There are several constraints and major challenges facing STI/HIV prevention under the responsibility of national programs, namely: (i) the deficit of synergies between two major components (communication for behavioural change and medical follow-ups), (ii) the lack of coordination and actions in the field, (iii) the abandonment of structural activities, (iv) low resource allocation for activities targeting FSW. Since the integration of the activities into the national programs, the capacity to provide prevention services to the FSW population, both in terms of coverage and of the package and the quality of services provided, has significantly declined, even if the strengthening of staff capacity in this domain remains an encouraging achievement.
Conclusions The national programs of Benin and Niger do not yet cover sufficiently the most exposed groups (FSW and their partners) who are at the centre of the HIV epidemic. Thus, the study proposes reflection and action to improve coverage of this clientele in order better control of STIs and HIV.