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Interventions among male clients of female sex workers in Benin, West Africa: an essential component of targeted HIV preventive interventions
  1. C M Lowndes1,
  2. M Alary2,
  3. A-C Labbé3,
  4. C Gnintoungbè4,
  5. M Belleau2,
  6. L Mukenge2,
  7. H Meda4,
  8. M Ndour4,
  9. S Anagonou5,
  10. A Gbaguidi5
  1. 1Health Protection Agency, London, UK
  2. 2Population Health Research Unit, Centre hospitalier affilié universitaire de Québec & Université Laval, Quebec, Canada
  3. 3Hôpital Maisonneuve-Rosemont, Montreal, Canada
  4. 4Projet SIDA-3-Benin, Cotonou, Benin
  5. 5Programme national de lutte contre le Sida et les MST, Cotonou, Benin
  1. Correspondence to:
 C M Lowndes
 Department of HIV and Sexually Transmitted Infections, Centre for Infections (CfI), Health Protection Agency, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK; clowndes{at}


Objectives: To assess the impact of interventions targeted towards female sex workers (FSWs) and their male clients on client HIV/STI prevalence and sexual behaviour.

Methods: From 1993 to 2006, an HIV/STI preventive intervention focusing on condom promotion and STI care was implemented among FSWs in Cotonou, Benin, and then expanded to cover their male sexual partners in 2000. The interventions were scaled up to five other cities of Benin in 2001–2002. Serial cross-sectional surveys of HIV/STI prevalence and sexual behaviour were carried out among clients in Cotonou in 1998, 2002 and 2005; and in the five other cities (O/Cotonou) in 2002 and 2005.

Results: Significant declines in gonorrhoea prevalence among clients of FSWs: Cotonou, from 5.4% in 1998 to 1.6% in 2005; O/Cotonou: from 3.5% in 2002 to 0.59% in 2005. Chlamydia prevalence also declined O/Cotonou, from 4.8% to 1.8%, while HIV prevalence remained stable. Reported condom use by clients with both FSWs and casual non-FSW partners, but not regular partners, increased significantly. While condom use at last sex with an FSW was similar in Cotonou to O/Cotonou around the time of implementation of the interventions (56% in 1998 vs 49% in 2002, respectively), it had risen to similar levels by 2005 (95% and 96%, respectively).

Conclusions: These results demonstrate that it is possible to implement preventive and clinical services for clients of FSWs, and suggest that such interventions, integrated with those targeted towards FSWs, can have a significant effect on sexual behaviour and STI prevalence (particularly gonorrhoea) among this population.

  • CAC, Clinique des Amis de Cotonou
  • FSW, female sex worker
  • IBBS, integrated biological and behavioural surveys
  • LED, leucocyte esterase dipstick

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  • Sponsorship: This study was funded in part by the Canadian International Development Agency through its West African AIDS Project (Project SIDA-1/2/3) executed by the Centre de Coopération Internationale en Santé et Développement Inc. (Québec, Canada). Diagnostic kits for HIV-1 for the 1998 study were provided by Calypte Biomedical Corporation, Berkeley, California, USA. MA is a National Researcher of the Fonds de la Recherche en Santé du Québec, Canada (grant # 8722). CG was the recipient of an MSc training award from the World Health Organization.

  • Competing interests: None declared.