title: Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana.
abstract: OBJECTIVE
  To delineate the population attributable fraction (PAF) of transactional sex in prevalent cases of HIV infection in the male adult population of Accra, Ghana.
  
  
  METHODS
  Cross-sectional study of clients who visited a sex worker (SW), of boyfriends of SW and of male personnel in prostitution venues. A questionnaire was administered and urine obtained for detection of anti-HIV antibodies. The PAF of prevalent HIV acquired from SW was calculated using a combination of data from this survey of clients, from on-going SW surveys, the national HIV surveillance system and the national census.
  
  
  RESULTS
  HIV prevalence was 4.9% (8/162) among clients of mobile SW, 15.8% (53/335) among clients of home-based SW, 17.5% (10/57) among personnel and 32.1% (9/28) among boyfriends. A condom was used in 90% of intercourses, according to clients. Non-use of a condom was clustered in selected locations and independently associated with older age of client, frequency of intercourse with SW in the last year and current urethritis. Among the male population of Accra aged 15-59 years, 84% of prevalent cases of HIV were attributable to transactional sex. A sensitivity analysis showed that under various assumptions PAF varied between 47% and 100%.
  
  
  CONCLUSIONS
  In Accra, approximately four-fifths of prevalent cases of HIV in adult males were acquired from SW. Comprehensive interventions providing education, condoms and treatment for sexually transmitted diseases for SW and their clients should be approached as other public health priorities and provided in all cities, large and small, of West Africa.
authors.affiliation: Centre for International Health, University of Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Côté
authors.forename: François
authors.initials: F
authors.lastname: Sobela
authors.forename: Agnes
authors.initials: A
authors.lastname: Dzokoto
authors.forename: Khonde
authors.initials: K
authors.lastname: Nzambi
authors.forename: Comfort
authors.initials: C
authors.lastname: Asamoah-Adu
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Labbé
authors.forename: Benoit
authors.initials: B
authors.lastname: Mâsse
authors.forename: Joyce
authors.initials: J
authors.lastname: Mensah
authors.forename: Eric
authors.initials: E
authors.lastname: Frost
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D011477:Sex Work