A short history of HIV prevention programs for female sex workers in Ghana: lessons learned over 3 decades.
BACKGROUND
Female sex workers (FSWs) in Ghana have a 10-fold greater risk for acquiring HIV than the general adult population, and they contribute a substantial proportion of the new HIV infections in the country. Although researchers have conducted behavioral and biological surveys, there has been no review of the contextual, programmatic, and epidemiological changes over time.


METHODS
The authors conducted a historical review of HIV prevention programs in Ghana. We reviewed the use of different interventions for HIV prevention among FSWs and data from program monitoring and Integrated Biological and Behavioral Surveillance Surveys. In particular, we looked at changes in service access and coverage, the use of HIV testing and counseling services, and the changing prevalence of HIV and other sexually transmitted infections.


RESULTS
HIV prevention interventions among FSWs increased greatly between 1987 and 2013. Only 72 FSWs were reached in a pilot program in 1987, whereas 40,508 FSWs were reached during a national program in 2013. Annual condom sales and the proportion of FSWs who used HIV testing and counseling services increased significantly, whereas the prevalence of gonorrhea and chlamydia decreased. The representation of FSWs in national HIV strategic plans and guidelines also improved.


CONCLUSIONS
Ghana offers an important historical example of an evolving HIV prevention program that-despite periods of inactivity-grew in breadth and coverage over time. The prevention of HIV infections among sex workers has gained momentum in recent years through the efforts of the national government and its partners-a trend that is critically important to Ghana's future.
*United States Agency for International Development, Yaounde, Cameroon; †FHI 360, Accra, Ghana and Durham, NC; ‡West Africa Program to Combat AIDS and STI, Accra, Ghana; §UNAIDS-TSF, Ouagadougou, Burkina Faso; and ‖Accra, Ghana AIDS Commission.
Peter
P
Wondergem
Kimberly
K
Green
Samuel
S
Wambugu
Comfort
C
Asamoah-Adu
Nana Fosua
NF
Clement
Richard
R
Amenyah
Kyeremeh
K
Atuahene
Michael
M
Szpir
D005260:Female; D005869:Ghana / Q000453:epidemiology; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D009313:National Health Programs / Q000266:history* / Q000706:statistics & numerical data*; D015995:Prevalence; D060386:Sex Workers / Q000706:statistics & numerical data*