High prevalence of HIV and sexually transmitted infections among male sex workers in Abidjan, Cote d'Ivoire: need for services tailored to their needs
Vuylsteke B, Semde G, Sika L, Crucitti T, Ettiegne Traore V, Buve A, Laga M. Sex Transm Infect. 2012 Feb 11. [Epub ahead of print]
To assess condom use and prevalence of sexually transmitted infections (STI) and HIV among male sex workers in Abidjan, Côte d'Ivoire a cross-sectional survey was conducted between October 2007 and January 2008 among men attending a sex worker clinic in Abidjan. A short questionnaire was administered in a face-to-face interview, and the participants were asked to provide a urine sample for STI testing and to self-collect transudate of the gingival mucosa for anonymous HIV testing, using a rapid test. A rectal swab for STI testing was taken by a physician. Molecular amplification assays were performed for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. 96 male sex workers participated in the survey, their median age was 27 years and the median duration of sex work was 5 years. Consistent condom use with clients during the last working day was 86.0%, and consistent condom use with the regular partner during the last week was 81.6%. HIV infection was detected in 50.0% of the participants. The prevalence of N gonorrhoeae was 12.8%, chlamydia infection was present in 3.2% and T vaginalis in 2.1% of the study participants. HIV and STI rates found in this study confirm the high risk and vulnerability status of male sex workers in Côte d'Ivoire. There is a definite need for studies exploring risk and risk perceptions among male sex workers in more depth and for services tailored to their needs, including developing and validating simple algorithms for the diagnosis of STI in MSW and men who have sex with men.
Editor’s note: This is the first facility-based survey of male sex workers in Africa to be published. HIV prevalence is very high: 42% for first-time attenders and 54% for those coming for a repeat visit. In total, 55% of first time attenders had never had an HIV test before whereas 16% of repeat attenders had done so, of whom some were now on antiretroviral therapy. The Clinique de Confiance, established in 1992, is well known for its services for female sex workers. In 2002, male sex workers began attending the clinic and in 2004 the Clinique began offering specialised services for male sex workers, the majority of whom are men who have sex with men, many of them married to women. Some of these men are street-based workers, while others offer their services via the internet. The high condom use with clients and with regular partners was self-reported in face-to-face interviews and is belied by the high prevalence of anal gonorrhoea. Strikingly, most of the STI laboratory work was conducted in Belgium, underscoring the urgent need for point of care STI testing. What is most important here, however, is that ‘if you build it, they will come’. Tailored services for this marginalised, stigmatised population can attract them and provide critical HIV prevention and treatment service access.