INED (French Institute for Demographic Studies), Paris, France
CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France.
BMJ Open. 2020 Jan 8;10(1):e028508. doi: 10.1136/bmjopen-2018-028508.
OBJECTIVE: To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. DESIGN AND SETTING: The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire. PARTICIPANTS: A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. RESULTS: Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication. CONCLUSIONS: Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular 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 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.
目的：描述性工作者（FSW）的性与生殖健康（SRH）需求，为未来在该人群中实施艾滋病毒预防的暴露前预防（PrEP）提供信息。
设计和设置：ANRS 12361 PrEP-CI 是一项横断面和混合方法研究，在科特迪瓦的两个社区组织中进行设计和实施。
参与者：1000 名年龄≥18 岁、未知 HIV 阳性的便利样本 FSW 完成了一份标准问卷，评估社会人口特征、性行为、社区卫生服务使用情况以及 PrEP 的事先可接受性。还进行了 22 次深入访谈和 8 次焦点小组讨论，以记录 FSW 的高危行为和性行为、暴力和歧视经历、对艾滋病毒和性传播感染（STI）的态度以及 SRH 服务障碍。
结果：尽管 87%的人描述了与客户一致使用避孕套，但仍有超过 22%的人表示愿意为一大笔钱进行无保护性行为。此外，尽管她们承认有同时发生的性伴侣关系，但与固定伴侣使用避孕套和了解伴侣的 HIV 状况的比例很低。虽然不一致的避孕套使用使 FSW 面临 STI 和意外怀孕的风险，但除了避孕套以外的避孕策略的流行率较低（39%），因为担心避孕会导致不育。FSW 面临获得 SRH 护理的障碍，更愿意从同龄人或自我用药中获得建议。
结论：尽管大多数情况下都采取了预防行为，但 FSW 仍然面临高度感染艾滋病毒的风险。此外，FSW 在获得 SRH 服务方面似乎面临一些障碍。在科特迪瓦等西非国家实施 PrEP 为 FSW 提供了一个机会，可以考虑定期随访 HIV 阴性 FSW。PrEP 启动不应成为获得 SRH 服务的条件；相反，SRH 服务可以成为吸引 FSW 参与艾滋病毒预防的一种方式。我们的研究结果强调了在从 PrEP 疗效试验过渡到实施阶段时，发展以人为本的方法，整合所有 SRH 需求的重要性。
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