Sexual health needs of female sex workers reached by two NGOs in Côte d’Ivoire: considerations for the future implementation of PrEP
Aim In West Africa, most countries have mixed HIV epidemics; new tools such as pre-exposure prophylaxis (PrEP) should target in priority most affected populations, particularly female sex workers (FSWs). This paper describes sexual and reproductive health (SRH) needs of FSWs in Côte d’Ivoire to inform the future implementation of PrEP in this population. Method/Issue The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two Ivorian community-based organizations. 1000 FSWs completed a standardized questionnaire assessing women’s sociodemographic characteristics, sexual practices and behaviors, use of community health services, a priori acceptability of PrEP. Twenty-two in-depth interviews and eight focus group discussions were conducted at prostitution sites. FSWs were interviewed about risky practices and sexual behaviors, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. Results/Comments The quantitative and qualitative results showed that FSWs were highly exposed to HIV despite their use of condoms with clients. 91% did not use condoms with their regular partner, despite their acknowledged concurrent sexual partnerships. 23% accepted condomless sexual intercourse for a large sum of money, especially when they had had few previous clients. Moreover, FSWs faced many unmet needs regarding SRH beyond HIV prevention and treatment. Inconsistent condom use exposed FSWs to STIs and undesired pregnancies. However, the prevalence of contraceptive use was low (40%) due to fear of contraception causing sterility. FSWs faced obstacles in accessing SRH care and preferred advice from their peers or self-medication. Discussion Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the chronic follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into practicing HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.