title: Decline in the prevalence of HIV and sexually transmitted infections among female sex workers in Benin over 15 years of targeted interventions.
abstract: BACKGROUND
  An HIV-preventive intervention targeting the sex work milieu and involving fully integrated components of structural interventions, communication for behavioral change and care for sexually transmitted infections (STIs), was implemented in Benin by a Canadian project from 1992 to 2006. It first covered Cotonou before being extended to other main cities from 2000. At the project end, the Beninese authorities took over the intervention, but structural interventions were interrupted and other intervention components were implemented separately. We estimated time trends in HIV/STI prevalence among female sex workers (FSWs) from 1993 to 2008 and assessed the impact of the change in intervention model on trends.
  
  
  METHODS
  Six integrated biological and behavioral surveys were carried out among FSWs. Time trend analysis controlled for potential sociodemographic confounders using log-binomial regression.
  
  
  RESULTS
  In Cotonou, from 1993 to 2008, there was a significant decrease in HIV (53.3%-30.4%), gonorrhea (43.2%-6.4%), and chlamydia (9.4%-2.8%) prevalence (all adjusted P = 0.0001). The decrease in HIV and gonorrhea prevalence was also significant in the other cities between 2002 and 2008. In 2002, gonorrhea prevalence was lower in Cotonou than elsewhere (prevalence ratio = 0.53, 95% confidence interval: 0.32 to 0.88). From 2005 to 2008, there was an increase in gonorrhea prevalence (prevalence ratio = 1.76, 95% confidence interval: 1.17 to 2.65) in all cities combined.
  
  
  CONCLUSIONS
  Our results suggest a significant impact of this targeted preventive intervention on HIV/STI prevalence among FSWs. The recent increase in gonorrhea prevalence could be related to the lack of integration of the intervention components.
authors: Unité de Recherche en Santé des Populations, Centre de Recherche FRQS du CHA Universitaire de Québec, Québec, Canada.
authors: Luc
authors: L
authors: Béhanzin
authors: Souleymane
authors: S
authors: Diabaté
authors: Isaac
authors: I
authors: Minani
authors: Marie-Claude
authors: MC
authors: Boily
authors: Annie-Claude
authors: AC
authors: Labbé
authors: Clément
authors: C
authors: Ahoussinou
authors: Séverin
authors: S
authors: Anagonou
authors: Djimon M
authors: DM
authors: Zannou
authors: Catherine M
authors: CM
authors: Lowndes
authors: Michel
authors: M
authors: Alary
mesh_terms: D000293:Adolescent; D000328:Adult; D001541:Benin / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology* / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015995:Prevalence; D011477:Sex Work / Q000706:statistics & numerical data; D060386:Sex Workers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult