title: Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993-1999.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Epidemiology Research Group, Centre Hospitalier Affilié Universitaire de Québec (CHA) and Université Laval, Hôpital du Saint-Sacrement du CHA 1050, Chemin Sainte Foy, Québec, Québec G1S 4L8, Canada. malary@gre.ulaval.ca
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
authors.forename: Léonard
authors.initials: L
authors.lastname: Mukenge-Tshibaka
authors.forename: France
authors.initials: F
authors.lastname: Bernier
authors.forename: Nassirou
authors.initials: N
authors.lastname: Geraldo
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Honoré
authors.initials: H
authors.lastname: Meda
authors.forename: Cyriaque A B
authors.initials: CA
authors.lastname: Gnintoungbè
authors.forename: Séverin
authors.initials: S
authors.lastname: Anagonou
authors.forename: Jean R
authors.initials: JR
authors.lastname: Joly
mesh_terms: D000328:Adult; D001541:Benin / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana / Q000208:ethnology; D006069:Gonorrhea / Q000453:epidemiology / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D009549:Nigeria / Q000208:ethnology; D011477:Sex Work; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors