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Characterizing Sociostructural Associations With New HIV Diagnoses Among Female Sex Workers in Cameroon

Bowring, Anna L. PhD, MPH, BBiomedSci*; Ketende, Sosthenes MSc, BSc*; Billong, Serge C. MD†,‡; Mfochive Njindam, Iliassou MD, MPH*,§; Rao, Amrita ScM*; Decker, Michele R. ScD, MPH; Lyons, Carrie MPH*; Turpin, Gnilane BA*; Fako, Guy MSc, MPH§; Olawore, Oluwasolape ScM*; Ndonko, Flavien PhD; Levitt, Daniel MPH, MFA#; Fouda, Ghislaine MSoc; Tamoufe, Ubald MSc, MPH§; Njoya, Oudou MD**; Zoung-Kanyi Bissek, Anne-Cecile MD†,†; Baral, Stefan MD, PhD, MPH, MBA*

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1, 2019 - Volume 80 - Issue 3 - p e64–e73
doi: 10.1097/QAI.0000000000001920

Background: Female sex workers (FSW) are disproportionately affected by HIV in Cameroon, with an estimated 23.6% HIV prevalence. Given the unavailability of HIV incidence data, to better understand associations with acquiring HIV we assessed the prevalence and associations with new HIV diagnoses among FSW in Cameroon.

Methods: In 2016, FSW were recruited through respondent-driven sampling from 5 cities for a biobehavioral survey. Participants self-reporting living with HIV or with an indeterminate test status were excluded from analysis. New diagnoses were defined as testing HIV-positive when participants self-reported HIV-negative or unknown status. A multivariable modified Poisson regression model was developed to assess determinants of new HIV diagnosis (referent group: HIV-negative) using key covariates; adjusted prevalence ratios (aPR) are reported if statistically significant (P < 0.05).

Results: Overall 2255 FSW were recruited. Excluding participants who self-reported living with HIV (n = 297) and indeterminate test results (n = 7), 260/1951 (13.3%) FSW were newly diagnosed with HIV. Variables significantly associated with new HIV diagnosis were: no secondary/higher education [aPR: 1.56, 95% confidence interval (CI): 1.12 to 2.15], 5+ dependents compared with none (aPR: 2.11, 95% CI: 1.01 to 4.40), 5+ years involved in sex work compared with <1 year (aPR: 2.84, 95% CI: 1.26 to 6.42), history of incarceration (aPR: 2.13, 95% CI: 1.13 to 3.99), and low social capital (aPR: 1.53, 95% CI: 1.12 to 2.10). Higher monthly income (>250,000 FCFA vs. <50,000 FCFA) was associated with lower prevalence of new HIV diagnosis (aPR: 0.22, 95% CI: 0.05 to 0.86).

Conclusions: There are significant sociostructural factors that seem to potentiate risk of HIV infection and delay diagnosis among FSW in Cameroon. Initiatives to build social capital and integrate services such as pre-exposure prophylaxis and HIV self-testing into HIV programs may reduce new infections and decrease time to diagnosis and treatment.

*Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD;

Central Technical Group (GTC), National AIDS Control Committee (NACC/CNLS), Yaounde, Cameroon;

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon;

§Metabiota, Yaounde, Cameroon;

Department of Population, Family, and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD;

CARE Cameroon, Yaounde, Cameroon;

#CARE USA, New York, NY;

**Department of Internal Medicine, Yaounde University Hospital Center, Yaounde, Cameroon; and

††Division of Operations Research, Ministry of Health, Yaounde, Cameroon

Correspondence to: Anna L. Bowring, PhD, MPH, BBiomedSci, Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 (e-mail:

Supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID). A.L.B. is supported by an Australian National Health and Medical Research Council Early Career Fellowship. S.B.'s effort was funded in part from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID, PEPFAR, NIH, AHRQ, nor other supporting agencies.

Presented in part at: INTEREST Conference; 29 May–1 June; Kigali, Rwanda; The 22nd International AIDS Conference (AIDS 2018); 23–27 July; Amsterdam, the Netherlands.

The authors have no conflicts of interests to declare.

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Received August 27, 2018

Accepted October 29, 2018

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