TY - JOUR
T1 - Anal Intercourse among Female Sex Workers in Côte d'Ivoire
T2 - Prevalence, Determinants, and Model-Based Estimates of the Population-Level Impact on HIV Transmission
AU - Maheu-Giroux, Mathieu
AU - Baral, Stefan
AU - Vesga, Juan F.
AU - Diouf, Daouda
AU - Diabaté, Souleymane
AU - Alary, Michel
AU - Abo, Kouamé
AU - Boily, Marie Claude
N1 - Funding Information:
Author affiliations: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada (Mathieu Maheu-Giroux); Key Populations Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Stefan Baral); Department of Infectious Disease Epidemiology, Imperial College London, St Mary’sHospital, London, United Kingdom (Juan F. Vesga, Marie-Claude Boily); Enda Santé, Dakar, Sénégal (Daouda Diouf); Centre de recherche du CHU de Québec–Université Laval, Ville de Québec, Canada (Souleymane Diabaté, Michel Alary); Département d’infectiologie et santé publique, Université Alassane Ouattara, Bouaké, Côte d’Ivoire (Souleymane Diabaté); Département de médecine sociale et préventive, Université Laval, Ville de Québec, Canada (Michel Alary); Institut national de santé publique du Québec, Ville de Québec, Canada (Michel Alary); and Programme National de Lutte Contre le SIDA, Ministère de la santé et de l’hygiène publique, Abidjan, Côte d’Ivoire (Kouamé Abo). M.M.-G.’s work was supported by the Bisby Fellowship Prize and an HIV/AIDS Health Services/Population Health Fellowship from the Canadian Institutes of Health Research. We acknowledge the support of the Joint United Nations Program on HIV/AIDS Regional Office for West and Central Africa and the HIV Prevention Trials Network (HPTN) Modelling Centre, which is funded by the US National Institutes of Health (NIH UM1 AI068617) through HPTN. Conflict of interest: none declared.
Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Current evidence suggests that anal intercourse (AI) during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus (HIV) epidemics has been investigated. Using a respondent-driven sampling survey of female sex workers (FSWs; n = 466) in Abidjan, Côte d'Ivoire, in 2014, we estimated AI prevalence and frequency. Poisson regressions were used to identify AI determinants. Approximately 20% of FSWs engaged in AI during a normal week (95% confidence interval: 15, 26). Women who performed AI were generally younger, had been selling sex for longer, were born in Côte d'Ivoire, and reported higher sex-work income, more frequent sex in public places, and violence from clients than women not reporting AI. Condom use was lower, condom breakage/slippage more frequent, and use of water-based lubricants was less frequently reported for AI than for vaginal intercourse. Using a dynamic transmission model, we estimated that 22% (95% credible interval: 11, 37% of new HIV infections could have been averted among FSWs during 2000-2015 if AI had been substituted for vaginal intercourse. Despite representing a small fraction of all sex acts, AI is an underestimated source of HIV transmission. Increasing availability and uptake of condoms, lubricants, and pre-exposure prophylaxis for women engaging in AI could help mitigate HIV risk.
AB - Current evidence suggests that anal intercourse (AI) during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus (HIV) epidemics has been investigated. Using a respondent-driven sampling survey of female sex workers (FSWs; n = 466) in Abidjan, Côte d'Ivoire, in 2014, we estimated AI prevalence and frequency. Poisson regressions were used to identify AI determinants. Approximately 20% of FSWs engaged in AI during a normal week (95% confidence interval: 15, 26). Women who performed AI were generally younger, had been selling sex for longer, were born in Côte d'Ivoire, and reported higher sex-work income, more frequent sex in public places, and violence from clients than women not reporting AI. Condom use was lower, condom breakage/slippage more frequent, and use of water-based lubricants was less frequently reported for AI than for vaginal intercourse. Using a dynamic transmission model, we estimated that 22% (95% credible interval: 11, 37% of new HIV infections could have been averted among FSWs during 2000-2015 if AI had been substituted for vaginal intercourse. Despite representing a small fraction of all sex acts, AI is an underestimated source of HIV transmission. Increasing availability and uptake of condoms, lubricants, and pre-exposure prophylaxis for women engaging in AI could help mitigate HIV risk.
KW - Côte d'Ivoire
KW - HIV/AIDS
KW - West Africa
KW - anal sex
KW - female sex worker
KW - mathematical model
KW - respondent-driven sampling
UR - http://www.scopus.com/inward/record.url?scp=85044289858&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044289858&partnerID=8YFLogxK
U2 - 10.1093/aje/kwx244
DO - 10.1093/aje/kwx244
M3 - Article
C2 - 28633387
AN - SCOPUS:85044289858
SN - 0002-9262
VL - 187
SP - 287
EP - 297
JO - American journal of epidemiology
JF - American journal of epidemiology
IS - 2
ER -