La PrEP seule ne suffit pas : elle doit être accompagnée d'une offre de soins globale

Joseph LARMARANGE — 2022-05-19T09:49:15Z

Cette note de politique, préparée par PAC-CI, repose sur des résultats du projet PrEP-CI ANRS 12361.

La PrEP seule ne suffit pas : elle doit être accompagnée d'une offre de soins globale

Alexandra Bitty-Anderson , Annick Guié , Eulalie Kanga , Marcellin Nouaman , Joseph Larmarange

Note de politique PAC-CI #3, Programme PAC-CI. 2022

Rapport

ird-03882265

Santé sexuelle : un enjeu au-delà des infections

Joseph LARMARANGE — 2022-04-11T14:16:10Z

Communication plénière présentée à l'AFRAVIH 2022

Santé sexuelle : un enjeu au-delà des infections

Joseph Larmarange

11e AFRAVIH, AFRAVIH, Apr 2022, Marseille, France

Communication dans un congrès

ird-03883007

Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention

Joseph LARMARANGE — 2020-01-09T12:21:05Z

Authors

Valentine Becquet, Marcellin Nouaman, Mélanie Plazy, Jean-Marie Masumbuko, Camille Anoma, Soh Kouame, Christine Danel, Serge Paul Eholie, Joseph Larmarange for the ANRS 12361 PrEP-CI Study group

Abstract

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.

Reference

Becquet Valentine, Nouaman Marcellin, Plazy Mélanie, Masumbuko Jean-Marie, Anoma Camille, Kouame Soh, Danel Christine, Eholie Serge Paul, Larmarange Joseph and ANRS 12361 PrEP-CI Study group (2020) “Sexual health needs of female sex workers in Côte d'Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention”, BMJ Open, 10 (1) (January 1). DOI : 10.1136/bmjopen-2018-028508. https://bmjopen.bmj.com/content/10/1/e028508.