Generation of the political will and financial support necessary to implement, scale up and sustain the integration of national HIV care and prevention services targeting FSWs will be key , particularly at a time when the sustainability of donor programs for HIV control is debated . In a context of scarce resources, wherein high-impact actions should take precedence, United Nations agencies, such as UNAIDS and the World Bank, will need to strongly advocate the prioritisation of such interventions with the national authorities. As is already the case in Benin  and Côte d’Ivoire , units responsible for coordinating targeted interventions should be created within the government structures in charge of the fight against HIV/AIDS. These units will be essential to link and integrate the clinical, community and structural components of the interventions, as well as their monitoring and evaluation, to fully realize the benefits of combination prevention [42,43] and expanded treatment services. Interventions should also target clients and other male sexual partners of FSWs as in the West African context, they constitute the main bridge population for HIV transmission to the general population [2–4,44] and can be targeted successfully by preventive interventions . To achieve sustainability, it will be important that all donors adhere to the national programmes by supporting the targeted intervention units.
Finally, with the recent decrease in HIV prevalence in many countries of Southern and East Africa , a ‘reversed’ epidemiological transition from generalized to concentrated epidemics is likely to occur in many settings. In this context, the targeted interventions that we propose for West Africa will also be essential for effective HIV control in these countries.
M.A., C.M.L. and N.N. conceptualized the article. Its content was discussed with all the other co-authors who brought their respective expertise to the content (epidemiologic research and prevention program design for LB and FG, field work and program evaluation for GB, clinical research for PVDP, IK and IT, program management at the government level for EA and program management at the NGO level for CAA). M.A. drafted the article and all authors contributed edits to the article and approved its final content.
All authors declare that they have no conflict of interest.
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