Periodical antibiotic treatment for the control of gonococcal and chlamydial infections among sex workers in Benin and Ghana: a cluster-randomized placebo-controlled trial.

BACKGROUND: In resource-poor settings, control of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among female sex workers (FSWs) is difficult. We sought to determine whether periodical antibiotic treatment (PAT) might be effective in controlling these infections among West African FSWs. Secondary objectives were to determine the impact of PAT on human immunodeficiency virus (HIV) incidence among FSWs and on NG/CT prevalence among their clients. METHODS: Cluster-randomized, double-blind, placebo-controlled trial among FSW communities in Benin and Ghana. Within each of 9 pairs of clusters of FSW communities, one was allocated to receive, during 9 months, a monthly antibiotic (alternatively ciprofloxacin or azithromycin, n = 296 FSWs) and the other a placebo (n = 340 FSWs). Prevalence of NG/CT infections was measured at 3-month intervals using the polymerase chain reaction. HIV status was determined at the beginning and at the end of the study. RESULTS: After adjusting for age, HIV status, duration of prostitution, price per intercourse and condom use, and accounting for prevalence at enrollment and cluster-pairing effect, prevalence ratios (intervention vs. placebo) of NG infection were 0.77 (P = NS), 1.07 (P = NS), and 0.49 (P = 0.05) at the first, second, and third follow-up visits, respectively. PAT neither reduced significantly CT prevalence or HIV incidence among FSWs nor NG/CT prevalence among their clients. CONCLUSION: The only beneficial impact of PAT was on the prevalence of gonococcal infections among FSWs 9 months after the beginning of the intervention. Although PAT could be more effective in other circumstances, for instance, in the early stages of a program for FSWs, it can not be recommended at present as a routine strategy to control cervical infections among FSWs.

[Female sex workers in Benin, 2002. Behavioural survey and HIV and other STI screening]. / Enquête de surveillance intégrée du VIH et des autres infections sexuellement transmissibles chez les travailleuses du sexe au Bénin en 2002.

BACKGROUND: As part of an HIV prevention program aimed at female sex workers (FSWs) and their male clients in Benin, we conducted a survey combining laboratory testing and a behavioural questionnaire in 2002 to estimate the prevalence of HIV, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and to determine the social, demographic and behavioral factors associated with these infections. The study provided a follow-up of the epidemiological situation in Cotonou, Benin's largest city, where the intervention began in 1993 with the collection of baseline data; it also collected such data for three other cities in Benin, to which the intervention was being extended in 2002. DESIGN AND METHODS: A cross-sectional study was conducted among 723 self-identified FSWs aged at least 15 years: 474 recruited in Cotonou, 128 in Porto-Novo, 42 in Abomey-Bohicon and 79 in Parakou. The univariate analysis compared the categorical variables with the chi-square test and measured associations with crude prevalence odds ratios (POR). Multivariate logistic regression was used to assess the independent adjusted associations between HIV, NG and CT infections, and the social, demographic and behavioural variables. RESULTS: Globally, the prevalence of HIV was 46%, NG 20.4% and CT 6.0%. All were lower in Cotonou (38.5%, 14%, and 4.8%, respectively) than in the other cities. In multivariate logistic regression analysis, HIV prevalence was significantly associated with gonorrhea (aPOR = 2.77; 95% confidence interval (95% CI): 1.30-5.87), older age (P = 0.0126; trend test), Nigerian origin (aPOR = 0.47; 95% CI: 0.24-0.89) and number of paying clients in the previous 7 days (> 10) (aPOR = 2.41; 95% CI: 1.23-4.71). Infection with NG, CT or both (NG/CT) was significantly associated with HIV (aPOR = 2.22; 95% CI: 1.24-3.95) and 100% condom use was protective against these infections (aPOR = 0.48; 95% CI: 0.25-0.91). CONCLUSION: In developing countries, particularly in sub-Saharan Africa, interventions targeting FSWs are an essential priority for HIV prevention.

Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993-1999.

BACKGROUND: Within an ongoing HIV/STD prevention project aimed at female sex workers (FSW) in Cotonou, Benin, we evaluated time trends in HIV and STD prevalences from 1993 to 1999. DESIGN: Three serial cross-sectional surveys were conducted in 1993 (n = 374), 1995-1996 (n = 365), and 1998-1999 (n = 591). A questionnaire was administered to the FSW and they were screened for HIV, syphilis, Neisseria gonorrhoeae, and Chlamydia trachomatis. RESULTS: The mean percentage of condom use with clients in the week preceding the interview increased from 62.2% in 1993 to 80.7% in 1998-1999 (P = 0.0001). The prevalence of all infections decreased significantly (all P < 0.02; chi-square for trend) over time: HIV from 53.3% in 1993 to 40.6% in 1998-1999; syphilis from 8.9 to 1.5%; gonorrhoea from 43.2 to 20.5%; and chlamydia from 9.4 to 5.1%. However, the mean age of FSW decreased from 31.0 to 28.4 years between 1993 and 1998-1999. Moreover, the country of origin of these women changed dramatically over time: the proportion of Ghanaian women decreased from 66.3% in 1993 to 21.6% in 1998-1999 when the predominant group became Nigerian (38.0%). When controlling for age and country of origin, HIV prevalence was stable over time (P = 0.71), whereas the downward trend remained significant for syphilis and gonorrhoea (both P < 0.001), and was present but not significant for chlamydia (P = 0.13). CONCLUSION: These data suggest that the time trends in HIV and STD prevalences are partly due to the changing sex work milieu, but that the intervention also had an impact. Prevention programmes aimed at FSW should be highly prioritized.