Anal Intercourse Among Female Sex Workers in Côte d’Ivoire: Prevalence, Determinants, and Model-Based Estimates of the Population-Level Impact on HIV Transmission

Abstract Current evidence suggests that anal intercourse (AI) during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus (HIV) epidemics has been investigated. Using a respondent-driven sampling survey...

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Bibliographic Details
Published in:American journal of epidemiology 2018-02, Vol.187 (2), p.287-297
Main Authors: Maheu-Giroux, Mathieu, Baral, Stefan, Vesga, Juan F, Diouf, Daouda, Diabaté, Souleymane, Alary, Michel, Abo, Kouamé, Boily, Marie-Claude
Format: Article
Language:English
Subjects:
Aggression
Breakage
Condoms
Confidence intervals
Disease transmission
Epidemics
Health risks
HIV
Human immunodeficiency virus
Lubricants
Original Contributions
Prophylaxis
Prostitution
Sex
Sex industry
Sexually transmitted diseases
Slippage
STD
Vagina
Violence
Viruses
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Summary:Abstract Current evidence suggests that anal intercourse (AI) during sex work is common in sub-Saharan Africa, but there have been few studies in which the contribution of heterosexual AI to human immunodeficiency virus (HIV) epidemics has been investigated. Using a respondent-driven sampling survey of female sex workers (FSWs; n = 466) in Abidjan, Côte d’Ivoire, in 2014, we estimated AI prevalence and frequency. Poisson regressions were used to identify AI determinants. Approximately 20% of FSWs engaged in AI during a normal week (95% confidence interval: 15, 26). Women who performed AI were generally younger, had been selling sex for longer, were born in Côte d’Ivoire, and reported higher sex-work income, more frequent sex in public places, and violence from clients than women not reporting AI. Condom use was lower, condom breakage/slippage more frequent, and use of water-based lubricants was less frequently reported for AI than for vaginal intercourse. Using a dynamic transmission model, we estimated that 22% (95% credible interval: 11, 37% of new HIV infections could have been averted among FSWs during 2000–2015 if AI had been substituted for vaginal intercourse. Despite representing a small fraction of all sex acts, AI is an underestimated source of HIV transmission. Increasing availability and uptake of condoms, lubricants, and pre-exposure prophylaxis for women engaging in AI could help mitigate HIV risk.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kwx244