HIV prevalence and risk behavior among clients of female sex workers in Abidjan, Côte d'Ivoire.

OBJECTIVE: To assess socio-demographic and behavioural characteristics of clients of female sex workers in Abidjan, and to determine their HIV prevalence and related risk factors. DESIGN: A cross-sectional study among clients of female sex workers in Abidjan, Côte d'Ivoire. METHODS: A trained interviewer approached clients leaving the room of a female sex worker and invited them for an interview using a structured questionnaire, and to provide a saliva sample. Saliva was tested for HIV antibodies by the GACELISA assay (Murex, Dartford, UK). RESULTS: A total of 526 clients agreed to participate, and 423 (80.4%) provided a saliva sample. Reported condom use was very high, 92.7% said they always use condoms and 95.4% reported condom use during the visit preceding the interview. The overall HIV prevalence among the clients who provided a saliva sample was 13.4%. Older age and being married or cohabitating was significantly associated with HIV infection in multivariate analysis. CONCLUSIONS: HIV prevalence appears to be relatively low, and condom use is high among clients of female sex workers in Abidjan. Existing HIV prevention efforts among female sex workers and among the general population should be sustained and reinforced.

Assessment of the validity of and adherence to sexually transmitted infection algorithms at a female sex worker clinic in Abidjan, Côte d'Ivoire.

BACKGROUND: Algorithms for sexually transmitted infection (STI) case management were designed in a female sex worker (FSW) clinic in Abidjan, Côte d'Ivoire, in 1993. GOAL: The goal was to evaluate the long-term validity of the algorithms for returning clients of the clinic and to assess the adherence of the health workers to their application. STUDY DESIGN: A cross-sectional study was conducted from 1999 to 2000 among FSWs attending as returning clients. RESULTS: The prevalences of genital infections were as follows: Neisseria gonorrhoeae and/or Chlamydia trachomatis, 8.2%; Trichomonas vaginalis, 16.7%; bacterial vaginosis, 62.3%; and Candida albicans, 6.2%. The sensitivity of the algorithms was 20% and the positive predictive value was 14% for cervical infection. The proportion of cases for which all steps of the algorithm were correctly applied was 30%. CONCLUSION: Algorithms for the treatment of STIs in FSWs should be periodically reevaluated and adapted to the changing population. To maintain healthcare workers' adherence to the algorithms, supervision should be ongoing and reinforced.