Violence, condom breakage, and HIV infection among female sex workers in Benin, West Africa.
OBJECTIVE
To examine the relationship between violence, condom breakage, and HIV prevalence among female sex workers (FSWs).


METHODS
Data were obtained from the 2012 cross-sectional integrated biological and behavioral survey conducted in Benin. Multivariable log-binomial regression was used to estimate the adjusted prevalence ratios of HIV infection and condom breakage in relation to violence toward FSWs. A score was created to examine the relationship between the number of violence types reported and HIV infection.


RESULTS
Among the 981 women who provided a blood sample, HIV prevalence was 20.4%. During the last month, 17.2%, 13.5%, and 33.5% of them had experienced physical, sexual, and psychological violence, respectively. In addition, 15.9% reported at least 1 condom breakage during the previous week. There was a significant association between all types of violence and HIV prevalence. The adjusted prevalence ratios of HIV were 1.45 (95% confidence interval [95% CI], 1.05-2.00), 1.42 (95% CI, 1.02-1.98), and 1.41 (95% CI, 1.08-1.41) among those who had ever experienced physical, sexual, and psychological violence, respectively. HIV prevalence increased with the violence score (P = 0.002, test for trend), and physical and sexual violence were independently associated with condom breakage (P = 0.010 and P = 0.003, respectively).


CONCLUSIONS
The results show that violence is associated with a higher HIV prevalence among FSWs and that condom breakage is a potential mediator for this association. Longitudinal studies designed to analyze this relationship and specific interventions integrated to current HIV prevention strategies are needed to reduce the burden of violence among FSWs.
From the *URESP, Centre de recherche du CHU de Québec, Québec, Canada; †Département de médecine sociale et préventive, Université Laval, Québec, Canada; ‡Dispensaire IST, Cotonou, Benin; §Programme National de Lutte Contre le Sida et les IST au Bénin, Cotonou, Bénin; ¶Faculté des sciences dela santé and ∥Département de sociologie, Université d'Abomey-Calavi, Godomey, Bénin; **Département des sciences infirmières, Université du Québec à Rimouski, Campus Lévis, Lévis, Canada; and ††Institut national de santé publique du Québec, Québec, Canada.
Fatoumata K
FK
Tounkara
Souleymane
S
Diabaté
Fernand A
FA
Guédou
Clément
C
Ahoussinou
Frédéric
F
Kintin
Djimon M
DM
Zannou
Adolphe
A
Kpatchavi
Emmanuelle
E
Bédard
Raphaël
R
Bietra
Michel
M
Alary
D000328:Adult; D001541:Benin / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004868:Equipment Failure; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006806:Human Rights; D006801:Humans; D016015:Logistic Models; D015995:Prevalence; D011634:Public Health; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers; D012725:Sexual Behavior; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data; D016387:Women's Health