How to reach clients of female sex workers: a survey by surprise in brothels in Dakar, Senegal.
OBJECTIVE
To describe the sampling techniques and survey procedures used in identifying male clients who frequent brothels to buy sexual services from female sex workers in Dakar, Senegal, with the aim of measuring the prevalence of human immunodeficiency virus (HIV) infection and investigating related risk behaviours.


METHODS
Surveys were conducted in seven brothels in Dakar, Senegal. Clients were identified "by surprise" and interviewed and requested to donate saliva for HIV testing.


RESULTS
Of the 1450 clients of prostitutes who were solicited to enter the study, 1140 (79.8%) agreed to be interviewed; 1083 (95%) of these clients provided saliva samples for testing. Of the samples tested, 47 were positive for HIV-1 or HIV-2, giving an HIV prevalence of 4.4%.


CONCLUSIONS
The procedures adopted were successful in reaching the target population. Men present in the brothels could not deny being there, and it proved possible to explain the purpose of the study and to gain their confidence. Collection of saliva samples was shown to be an excellent method for performing HIV testing in difficult field conditions where it is hard to gain access to the population under study. The surveying of prostitution sites is recommended as a means of identifying core groups for HIV infection with a view to targeting education programmes more effectively. In countries such as Senegal, where the prevalence of HIV infection is still low, interventions among commercial sex workers and their clients may substantially delay the onset of a larger epidemic in the general population.
Espirito Santo
M E Gomes do
ME
Service National des Grandes Endémies, Ministère de la Santé du Sénégal. egomes@noos.fr
Etheredge
G D
GD
D016358:Contact Tracing / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015528:HIV Seroprevalence; D006306:Health Surveys; D006801:Humans; D008297:Male; D012307:Risk Factors; D012463:Saliva / Q000821:virology; D012675:Senegal / Q000453:epidemiology; D011477:Sex Work; D012747:Sexual Partners; D011795:Surveys and Questionnaires