Gonorrhea, Chlamydia, and HIV Incidence among Female Sex Workers in Cotonou, Benin: A Longitudinal Study (Diabaté, 2018)
Diabaté, Souleymane, Annie Chamberland, Nassirou Geraldo et al., “Gonorrhea, Chlamydia, and HIV Incidence among Female Sex Workers in Cotonou, Benin: A Longitudinal Study,” PLOS One 13, no.5 (May 2018), doi:10.1371/journal.pone.0197251
URL: journals.plos.org/plosone/article?id=10.1371/journal.pone.0197251
Abstract
Female sex workers (FSWs) continue to carry a heavy burden of sexually transmitted infections (STI). For prevention purposes, there is a need to identify most-at-risk subgroups among them. The objective of this longitudinal cohort study conducted at Dispensaire IST, Cotonou, Benin, was to assess Neisseria gonorrhoeae (NG) / Chlamydia trachomatis (CT) incidence and determinants; and HIV incidence among FSWs in presence of STI/HIV risk reduction activities. Overall, 319 adult FSWs were followed quarterly from September 2008 to March 2012. NG/CT were detected from endocervical swabs by Amplified DNA Assays employing Strand displacement amplification technology. HIV testing was done on capillary blood using two consecutive rapid diagnostic tests. Anderson-Gill proportional hazard models (HR) were used to determine factors independently associated with NG/CT incidence. The majority of FSWs were HIV-negative (188, 58.9%). There were 6 HIV seroconversions among these 188 HIV-negative women. HIV incidence (95% Confidence interval, CI) was 1.41 (0.28–2.54) seroconversions per 100 person-years at risk (PYAR): 6 events / 425.1 PYAR. Sixty-two out of 319 women experienced 83 new episodes of NG/CT for an overall incidence rate (95% CI) of 10.8 (8.17–13.88) events / 100 PYAR. From month-24 onwards, HIV-positive women (treated: HR (95%CI): 4.2 (1.60–10.77); untreated: HR (95%CI): 4.2 (1.59–11.49) were more likely to acquire NG/CT compared to HIV-negative FSWs. Longer duration in sex work (>2 years: HR; 95%CI: 0.4 (0.22–0.72)) was protective against NG/CT. Refusal by clients (55.8%) was the main reason for non-condom use. Enrolling women from one clinic (Dispensaire IST) may have impaired generalizability of the findings. New NG/CT/HIV infections were observed among FSWs notwithstanding ongoing prevention interventions. To eliminate HIV transmission among FSWs, STI/HIV control programs need to promote women’s empowerment and address vulnerability to infection of HIV-positive FSWs.
Because the female sex workers (FSW) gave consent to participate in this study, it implies that women in Benin are sex workers willingly. However, according to the 2015 Trafficking in Persons Report from the U.S. Department of State,
Benin is a source, transit, and destination country for women, children, and men subjected to forced labor and sex trafficking. The majority of identified victims are Beninese girls subjected to domestic servitude or sex trafficking in Cotonou. . . . The Government of Benin does not fully comply with the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so. The government continued to prosecute and convict child traffickers and to identify and provide protective services to child victims. During the reporting period, the government identified 220 potential child trafficking victims and convicted ten offenders for the illegal movement of these children. However, authorities continued to focus on intercepting traffickers and victims in transit rather than rescuing persons from exploitation in the country.
As healthcare professionals seek to provide FSW with needed healthcare in countries where prostitution is legal, it is imperative that they be trained for signs of trafficking and how to seek help for any women or girls caught in trafficking they may encounter.