title: Socio-demographic and behavioural factors associated with high incidence of sexually transmitted infections in female sex workers in Madagascar following presumptive therapy.
abstract: BACKGROUND
  Too little is known about the many women who generate income in Madagascar by trading sex.
  
  
  METHODS
  Clinical and laboratory exams were offered to 493 non-care seeking female sex workers (SWs) in Antananarivo and 493 in Tamatave. SWs were recruited by peers in their community; they were interviewed, counselled and treated for sexually transmitted infections (STIs) at recruitment and re-evaluated 2 months later.
  
  
  RESULTS
  One hundred and eighty six (38%) of the SWs in Antananarivo and 113 (23%) in Tamatave did not complete primary school (P < 0.0001). The incidence rates per person per month in Antananarivo and Tamatave, respectively, were 0.09 and 0.08 for gonorrhoea; 0.05 and 0.03 for chlamydia; 0.24 and 0.15 for trichomoniasis; 0.07 and 0.05 for syphilis. At follow-up, consistent condom use with clients was reported by 56 (12%) SWs in Antananarivo and 137 (29%) in Tamatave (P < 0.0001); 320 (70%) SWs in Antananarivo and 11 (2%) in Tamatave reported sex with a non-paying partner in the past month (P < 0.0001). In Antananarivo, 422 (92%) of the SWs thought they were at no or low risk of having an STI compared to 100 (21%) in Tamatave (P = 0.02). At follow-up, 277 (61%) SWs reported no birth control for their last sex act in Antananarivo, compared to 26 (5%) in Tamatave (P < 0.0001). Socio-demographic and behavioural risk factors for incident gonorrhoea, chlamydia and trichomoniasis varied by city.
  
  
  CONCLUSIONS
  Strategies to address the needs of women who trade sex should include educational and economic opportunities; should tackle male partners of SWs; promote dual protection against unintended pregnancy and STIs, while taking into account local socio-demographic and behavioural characteristics.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599-7435, USA. frieda_behets@unc.edu
authors.forename: Frieda M-T
authors.initials: FM
authors.lastname: Behets
authors.forename: Kathleen
authors.initials: K
authors.lastname: Van Damme
authors.forename: Andry
authors.initials: A
authors.lastname: Rasamindrakotroka
authors.forename: Marcia
authors.initials: M
authors.lastname: Hobbs
authors.forename: Kristi
authors.initials: K
authors.lastname: McClamroch
authors.forename: Justin Ranjalahy
authors.initials: JR
authors.lastname: Rasolofomanana
authors.forename: Leonardine
authors.initials: L
authors.lastname: Raharimalala
authors.forename: Gina
authors.initials: G
authors.lastname: Dallabetta
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Andriamiadana
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008270:Madagascar / Q000453:epidemiology; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D012959:Socioeconomic Factors; D013997:Time Factors; D047568:Unsafe Sex / Q000517:prevention & control / Q000706:statistics & numerical data*; D016387:Women's Health