Sexual health needs of female sex workers reached by two NGOs in Côte d’Ivoire: considerations for the future implementation of PrEP

Valentine Becquet, INED
Marcellin Nouaman, PACCI
Mélanie Plazy, ISPED (Inserm - Université de Bordeaux)
Jean-Marie Masumbuko, PACCI
Camille Anoma, Espace Confiance
Soh Kouamé, Aprosam
Christine Danel, PACCI
Serge Eholié, PACCI
Joseph Larmarange, Centre Francais sur la Population et le Developpement (CEPED)

This paper describes sexual and reproductive health (SRH) needs of female sex workers (FSWs) in Côte d’Ivoire to inform the future implementation of a new HIV prevention tool, pre-exposure prophylaxis (PrEP). The ANRS 12361 PrEP-CI study was designed and implemented with two Ivorian community-based organizations. 1000 FSWs completed a standardized questionnaire and 60 FSWs were interviewed at prostitution sites. 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. 23% accepted condomless sexual intercourse for a large sum of money. Moreover, FSWs faced many unmet needs regarding SRH beyond HIV prevention and treatment. Inconsistent condom use exposed FSWs to STIs and undesired pregnancies, but the prevalence of contraceptive use was low. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.