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Physical and Sexual Violence Affecting Female Sex Workers in Abidjan, Côte d'Ivoire: Prevalence, and the Relationship with the Work Environment, HIV, and Access to Health Services

Lyons, Carrie E. MPH*; Grosso, Ashley PhD*; Drame, Fatou M. PhD†,‡; Ketende, Sosthenes MSc*; Diouf, Daouda MSc; Ba, Ibrahima MSc; Shannon, Kate PhD§,‖; Ezouatchi, Rebecca MA; Bamba, Amara MD, MPH; Kouame, Abo MD#; Baral, Stefan MPH, MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 01 May 2017 - Volume 75 - Issue 1 - p 9–17
doi: 10.1097/QAI.0000000000001310
Epidemiology

Background: Violence is a human rights violation, and an important measure in understanding HIV among female sex workers (FSW). However, limited data exist regarding correlates of violence among FSW in Côte d'Ivoire. Characterizing prevalence and determinants of violence and the relationship with structural risks for HIV can inform development and implementation of comprehensive HIV prevention and treatment programs.

Methods: FSW > 18 years were recruited through respondent driven sampling (RDS) in Abidjan, Côte d'Ivoire. In total, 466 participants completed a socio-behavioral questionnaire and HIV testing. Prevalence estimates of violence were calculated using crude and RDS-adjusted estimates. Relationships between structural risk factors and violence were analyzed using χ2 tests and multivariable logistic regression.

Results: The prevalence of physical violence was 53.6% (250/466), and sexual violence was 43.2% (201/465) among FSW in this study. Police refusal of protection was associated with physical (adjusted Odds Ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.7 to 4.4) and sexual violence (aOR: 3.0; 95% CI: 1.9 to 4.8). Blackmail was associated with physical (aOR: 2.5; 95% CI: 1.5 to 4.2) and sexual violence (aOR: 2.4; 95% CI: 1.5 to 4.0). Physical violence was associated with fear (aOR: 2.2; 95% CI: 1.3 to 3.1) and avoidance of seeking health services (aOR: 2.3; 95% CI: 1.5 to 3.8).

Conclusions: Violence is prevalent among FSW in Abidjan and associated with features of the work environment and access to care. These relationships highlight layers of rights violations affecting FSW, underscoring the need for structural interventions and policy reforms to improve work environments, and to address police harassment, stigma, and rights violations to reduce violence and improve access to HIV interventions.

*Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, Baltimore, MD;

Department of Geography, School of Social Sciences, Gaston Berger University, St. Louis, Senegal;

Enda Santé, Dakar, Senegal;

§Gender and Sexual Health Initiative, B.C. Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada;

Canada University of British Columbia, Vancouver, British Columbia, Canada;

Enda Santé, Abidjan, Côte d'Ivoire; and

#Programme National de Lutte Contre le SIDA, Ministere de la Lutte Contre Le SIDA, Abidjan, Côte d'Ivoire.

Correspondence to: Carrie E. Lyons, MPH, 615 North Wolfe Street, E7137, Baltimore, MD 21205 (e-mail: clyons8@jhu.edu).

Supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This research was conducted by the consortium Enda Santé—Johns Hopkins University in collaboration with the Government of Côte d'Ivoire National AIDS Control Program and with the financial support of the Global Fund to fight AIDS, Tuberculosis and Malaria.

The authors have no funding or conflicts of interest to disclose.

Received August 05, 2016

Accepted January 29, 2017

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