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Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Côte d'Ivoire, 19911998

Ghys, Peter D.a,b; Diallo, Mamadou O.a; Ettiègne-Traoré, Virginiea; Kalé, Kouaméc; Tawil, Oussamae; Caraël, Michele; Traoré, Moussac; Mah-bi, Guessanc,d; De Cock, Kevin M.a,f; Wiktor, Stefan Z.a,f; Laga, Marieb; Greenberg, Alan E.a,f

Epidemiology & Social

Objective: To assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually transmitted diseases (STD) in female sex workers in Abidjan, Côte d'Ivoire.

Design: Multiyear cross-sectional study of first-time attenders in Clinique de Confiance, a confidential STD clinic; biannual community-based behavioral surveys.

Methods: From 1992 to 1998, female sex workers were invited to attend Clinique de Confiance, where they were counseled, interviewed, clinically examined during their first visit and tested for STD and HIV infection. Community-based surveys, conducted in 1991, 1993, 1995, and 1997, interviewed women regarding socio-demographic characteristics and HIV/STD-related knowledge, attitudes and behavior.

Results: Among female sex workers in Abidjan, there was a trend toward shorter duration of sex work, higher prices, and more condom use. Among sex workers attending Clinique de Confiance for the first time, significant declines were found in the prevalence of HIV infection (from 89 to 32%), gonorrhoea (from 33 to 11%), genital ulcers (from 21 to 4%), and syphilis (from 21 to 2%). In a logistic regression model that controlled for socio-demographic and behavioral changes, the year of screening remained significantly associated with HIV infection.

Conclusion: The increase in condom use and the decline in prevalence of HIV infection and other STD may well have resulted from the prevention campaign for female sex workers, and such campaigns should therefore be continued, strengthened, and expanded.

From the aProjet RETRO-CI Abidjan, Côte d'Ivoire, the bInstitute of Tropical Medicine, Antwerp, Belgium, the cInstitut National de Santé Publique, Abidjan, Côte d'Ivoire, the dNational AIDS/STD/TB Control Program, Abidjan, Côte d'Ivoire, the eWorld Health Organization, Geneva, Switzerland / UNAIDS, Geneva, Switzerland and the fCenters for Disease Control and Prevention, Atlanta, Georgia, USA.

Correspondence to Dr Peter D. Ghys, UNAIDS, 20 Avenue Appia; CH-1211 Geneva 27 Switzerland. E-mail:

Received: 23 March 2001;

revised: 1 August 2001; accepted: 8 August 2001.

Sponsorship: The study was supported in part by grants from Rockefeller Foundation, New York; Nationaal Fonds voor Wetenschappelijk Onderzoek, Brussels; World Health Organisation, Geneva; European Community Programme on Science and Technology for Development, Brussels; USAID (grant # PASA DPE-5972-P-HC-8080), Abidjan; American Foundation for AIDS Research, San Francisco; UNAIDS, Geneva; and Vlaamse Interuniversitaire Raad, Brussels. During part of the study P.D.G. was a scholar of the American Foundation for AIDS Research, San Francisco, USA.

© 2002 Lippincott Williams & Wilkins, Inc.