Outreach strategies for the promotion of HIV testing and care: closing the gap between health services and female sex workers in Benin.
BACKGROUND
Regular voluntary counseling and testing is a key component of the fight against HIV/AIDS. In Benin, the project SIDA-1/2/3 established to decrease HIV/sexually transmitted infection (STIs) among female sex workers (FSWs), implemented a multifaceted intervention, including outreach activities. The objective of this article was to present potential advantages and limitations of 3 categories of outreach interventions designed to increase the use of testing services among FSWs in Benin.


METHODS
This analysis is based on ethnographic fieldwork conducted in Benin from June to December 2012.


RESULTS
Sixty-six FSWs and 24 health care workers were interviewed. Their narratives revealed 3 main factors impeding the development of appropriate HIV testing behavior. These negative elements can be positioned along a continuum of health care behaviors, with each stage of this continuum presenting its own challenges: fear or lack of motivation to use testing services, inaccessibility of care when the decision to go has been made, and a perceived lack of quality in the care offered at the health care center. Many of these needs seem to be addressed in the outreach strategies tested. However, the study also exposed some potential barriers or limitations to the success of these strategies when applied in this specific context, due to social disruption, mobility, access to care, and hard to reach population.


CONCLUSIONS
To increase the use of testing services, an outreach strategy based on community workers or peer educators, along with improved access to testing services, would be well adapted to this context and appreciated by both FSWs and health care workers.
*Centre de recherche, CHU de Québec, Québec City, Québec, Canada; †Département des sciences infirmières, Université du Québec à Rimouski, Campus Lévis, Lévis, Québec, Canada; ‡Département des sciences infirmières, Université Laval, Québec City, Québec, Canada; §Faculté des lettres, arts et sciences humaines, Université d'Abomey-Calavi, Abomey-Calavi, Bénin; ‖Dispensaire IST, Cotonou, Bénin; ¶Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada; #Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada; and **Institut national de santé publique du Québec, Québec City, Québec, Canada.
Marylène
M
Dugas
Emmanuelle
E
Bédard
Georges
G
Batona
Adolphe C
AC
Kpatchavi
Fernand A
FA
Guédou
Eric
E
Dubé
Michel
M
Alary
D000293:Adolescent; D000328:Adult; D001541:Benin / Q000453:epidemiology; D003159:Community-Institutional Relations; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006282:Health Personnel; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods; D060386:Sex Workers; D055815:Young Adult