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There is no mention of any comfort station operated by military personnel. Among them are the following:. FSW having more than 29 clients per week were 2.

Participant files were stored in secure filing cabinets. The Prostitutes Meda outcome was HIV incidence. Secondary outcomes included changes in mean number of sexual partners during follow-up and condom use with these sexual partners at the last sexual intercourse. Consistent condom use was defined by a systematic use of condoms Prostitutes Meda the last week for Prostitutes Meda clients and during the last month for regular Prostitutes Meda and regular clients.

A Bernoulli mathematical model with weighted risk factors was used to estimate the individual relative risk of HIV acquisition during follow-up [ 26 Prostitutes Meda Figure 1. Transmission model to estimate the expected HIV incidence in the absence of intervention. We multiplied the number of sexual intercourses with casual clients during the Prostitutes Meda week as reported by FSW at baseline Prostitutes Meda, by the total number of person-weeks and by the rate of non-condom use with casual clients estimated at screening visit.

Then, we obtained the total number of unprotected sexual intercourses with casual clients without the intervention during follow-up.

The number of unprotected sexual intercourses with both regular Prostitutes Meda and regular partners were also calculated Prostitutes Meda. The total number of all unprotected sexual intercourses during follow-up without intervention was obtained by summing the total numbers of unprotected sexual intercourses with casual clients, regular clients, and regular partners. To obtain the total number of unprotected sexual acts with each group of partners N1—5we used the reported HIV prevalence in Ouagadougou among these sexual partners 3.

These latter two stages have the highest score of HIV transmission risk compared with Prostitutes Meda chronic stage 4. To estimate the expected number of HIV infections without intervention during the same follow-up time, we included in the Bernoulli-weighted model the average rates of the per-act male-to-female risk, the HIV prevalence among male partners and the scores related to factors increasing infectivity of sexual partners and susceptibility of FSW [ 26 ].

For each scenario, observed and expected number of HIV infections were also compared using a Poisson distribution.

In the absence of incidence data in a control group, we Prostitutes Meda used HIV prevalence at screening among young FSW who participated in sex work for less than one year, to estimate HIV incidence in the absence of the intervention [ 3132 ].

The number of sexual partners was categorized as above or Prostitutes Meda the third quartile value of the number of casual clients at baseline, and as none or any for regular clients and regular Prostitutes Meda. The trend over time of key determinants of sexual behaviours number and types of sexual partners and condom use rate were described using a random effect-logistic approach [ 33 ]. In multivariable models, FSW category was kept in all final models and we used backward elimination to Prostitutes Meda other covariates to include in the final models.

Complete case analysis was used to handle missing data. All analyses were conducted using SAS version 9. We enrolled FSW in the cohort Figure 2.

Flow chart of participants from screening to the month follow-up visit in Prostitutes Meda. The latter were also more likely to have an earlier age of sex work debut Table 1. Baseline participant characteristics and comparison with potentially eligible female sex workers who missed their enrolment visit in Ouagadougou.

At enrolment, the median age of participants was 21 years [interquartile range IQR 19—23], the median number of clients the week before Prostitutes Meda enrolment visit was 2 IQR, 1—3 and the median numbers of Prostitutes Meda clients and regular Prostitutes Meda during the Prostitutes Meda prior to enrolment were 1 IQR, 0—2 and 1 IQR, 1—1respectively.

Among FSW who completed at least one follow-up visit and who were included in the incidence analysis, the median follow-up time was No participant seroconverted during the person-years of follow-up, whereas 5. In the sensitivity analyses, the expected number of HIV infections in the absence of the intervention ranged between 0.

FSW were sensitized on safe sex protection measures against STDs , were encouraged to undergo a serological test for syphilis every 3 to 6 months, and were provided with condoms and lubricants free of charge.

Model parameters and sensitivity analyses for the expected number of HIV infections in the absence Prostitutes Meda the intervention among female sex workers in Ouagadougou. Predictors of consistent condom use with casual clients during follow-up of female sex workers in Ouagadougou.

Our findings Prostitutes Meda that our model of intervention, integrating prevention and care in the same setting with a strong involvement of the community, had a significant impact on the HIV incidence Prostitutes Meda young FSW Prostitutes Meda the capital city of Burkina Faso.

Even though this impact was not statistically significant in the extreme and most detrimental scenario, the observed null HIV infection contrasted with the expected number of HIV infections. The good quality of the data collected in the general population and among clients of FSW at the same time allowed a robust estimation of the HIV incidence expected in the study population in the absence of any targeted intervention. However, our group and others have reported that such Prostitutes Meda, barmaids for example, had a risk of HIV infection similar to that of professionals [ 36 ].

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At screening, Prostitutes Meda HIV prevalence among young sex workers 7. Similarly, their HSV-2 prevalence was also much higher [ 37 ], highlighting their risky sexual behaviours.

Prostitutes Meda, the null HIV incidence Prostitutes Meda likely due to our intervention and not to a selection bias of women with low exposure. This impact on HIV incidence was likely driven by a reduction in most risky sexual behaviours during the intervention period. The number of sexual partners decreased over time with a concomitant increase in condom use with casual and regular clients during the intervention. However, the intervention could not markedly increase consistent condom use with Prostitutes Meda partners.

The HIV risk is probably high among these men who, in the local context, have many sex worker girlfriends with whom condom use is seldom used.

Despite specific sensitization modules on this topic, young FSW are unable to improve their condom negotiation Prostitutes Meda these partners, most likely because of their vulnerability and willingness to get married. Similarly, the independent negative association between previous pregnancies and consistent condom use with casual clients is probably explained by a reduced condom negotiation power of FSW having dependent children.

Our model of intervention combines prevention and care activities within the same setting, with peers playing a pivotal role in service delivery. We strongly believe that the continuum of care proposed in our intervention was crucial to get a high adherence level of FSW to the intervention, as highlighted by the high rate of Prostitutes Meda for this stigmatized and hard to reach population.

In addition, the peer organization provided some support for non-medical issues which are Prostitutes Meda crucial importance for FSW, such as children schooling, administrative measures and nutritional assistance.

Adapted services to the special needs of each study Prostitutes Meda, dedicated to prevention and care in general not only HIVin a user-friendly and empathetic setting to build confidence and empowerment of FSW, including Prostitutes Meda self-esteem, are certainly pivotal in the success of interventions Prostitutes Meda FSW.

Our study had a number of limitations.

The Prostitutes Meda involvement contribution was not Prostitutes Meda in our impact evaluation [ 19 ]. In the absence of a control group, the calculation of the expected incidence without intervention is prone to imprecision and information bias on self-report of sexual behaviours in the general population study [ 41 ].

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Our sensitivity analyses addressed these points and the true HIV incidence likely lies between the ranges of calculated values. The data Prostitutes Meda for the calculation were collected at the Prostitutes Meda time as the cohort initiation. We cannot exclude a desirability bias in the self-report of sexual behaviours [ 41 ]. However, the FSW did not hesitate to report poor condom use with regular partners, even after specific risk-reduction sessions. We reported previously that the same intervention could achieve high rates of follow-up and virological success among FSW [ 17 ], which induced a marked reduction in infectiousness [ 15 ].

In this study in Ouagadougou, we showed that Prostitutes Meda intervention can also markedly have an impact on HIV incidence within Prostitutes Meda similar but younger population. Our study group reported that this combined intervention is not more expensive than either treating HIV in the general population [ 42 ] or funding local NGOs to implement prevention activities.

Such a model could also be appropriate for other parts of Africa where sex workers share similar discrimination and limited access to prevention and care [ 18 ]. In light of our results, the Burkina Faso health and Prostitutes Meda authorities are scaling up this integrated peer-administered package of interventions at the country level.

A proper evaluation of this programme will Prostitutes Meda on its cost-effectiveness and relevance when implemented widely in routine.

This impact was driven by a reduction in the number of regular partners and by increased condom use with clients. They acknowledge all the women who participated in this study and Prostitutes Meda non-governmental associations that facilitated the study as well as their involvement in the community advisory boards: the Ministry of Prostitutes Meda and the National Program for AIDS control.

Isidore T Traore contributed to designing the study, and the acquisition, analysis and interpretation of the data. He also wrote the draft manuscript. Nicolas Nagot contributed to designing the study, and the acquisition, analysis and interpretation of the data.

He also wrote the manuscript and supervised its development. Nicolas Meda, Philippe Van De Perre Prostitutes Meda Philippe Mayaud contributed to designing the study, interpretation of the data and critically reviewed the manuscript. Noelie M. Prostitutes Meda authors have read and approved the final version.

National Prostitutes Meda for Biotechnology InformationU. Published online Sep Author information Article notes Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Introduction Although interventions to control HIV among high-risk groups Prostitutes Meda as female sex workers FSW are highly recommended in Prostitutes Meda, the contents and efficacy of these interventions are unclear. Methods Between September and September we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months.

Conclusions Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours. Keywords: female sex workers, HIV, incidence, Africa. Methods Study design From toProstitutes Meda conducted a prospective, interventional cohort among HIV-uninfected FSW in Ouagadougou, with quarterly follow-up for a maximum of 21 months.

Study population Women who declared receiving money Prostitutes Meda goods in exchange for sexual services [ 2021 ], were born in Burkina Faso, were aged between 18 and 25 years, had at least three sexual contacts per week and three different sexual partners during the last three months were eligible for this cohort.

Procedures and follow-up During the formative research, sex work Prostitutes Meda were Prostitutes Meda using geographic information system. Study outcomes The primary outcome was HIV incidence. Open in a separate window.

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Figure 1. Number of unprotected sexual acts during follow-up, according to HIV, ART and disease-stage status of FSW sexual partners N1—N5 We multiplied the number of sexual Prostitutes Meda with casual clients during the previous week as reported by FSW at baselineby the total Prostitutes Meda of person-weeks and by the rate of non-condom use with casual clients estimated at screening visit.

Estimation of the impact of the intervention To estimate the expected number of HIV infections without intervention during the same follow-up time, we included in the Bernoulli-weighted model the average rates of the per-act male-to-female risk, the HIV prevalence among male partners and the scores related to factors increasing infectivity of sexual partners and susceptibility of FSW [ 26 ].

Model validation In the absence of incidence data in a control group, we also used HIV prevalence at screening among young FSW who participated in sex work for less than one year, to estimate HIV incidence in the absence of the intervention [ 31Prostitutes Meda ]. High-risk behaviours overtime The Prostitutes Meda of sexual partners was categorized as above Prostitutes Meda below the third quartile value of the number of casual Prostitutes Meda at baseline, and Prostitutes Meda none or any for regular clients and regular partners.

Figure 2. Table 1 Baseline Prostitutes Meda characteristics and comparison with potentially eligible female sex workers Prostitutes Meda missed their enrolment visit in Ouagadougou. Observed Prostitutes Meda expected HIV incidence Among FSW who completed at least one follow-up visit and who were included in the incidence analysis, the median follow-up time was These antibiotics Prostitutes Meda used for other indications have significantly contributed to reducing the incidence and evolution of infectious syphilis, including symptomatic and severe chronic forms [ 1 ].

Paradoxically, the prevalence of syphilis in our sample was increased, compared to the data [ 34 ]. This could be related to increase in sexual risk-taking, especially unprotected sex following high-active antiretroviral therapy availability and its effectiveness in HIV prevention that could lead to increase acquisition of other sexual-transmitted diseases such as syphilis [ 3940 ].

Prostitutes Meda addition, the prevalence of active syphilis in our study remains high in comparison with the Prostitutes Meda of 0.

FSW are a leading group at Prostitutes Meda risk of syphilis infection due to several factors such as the multiple sexual partners and barriers to condom use [ 43 ]. Similar to prior research, in our study, FSW reporting more than 29 clients per week were three times more likely to be infected compared to those having less than 14 clients per week. Lower education was also a risk factor for syphilis infection in our study and more generally, for STDs in prior research [ 44Prostitutes Meda ].

The control Prostitutes Meda STDs and particularly syphilis infection is a public health challenge [ 8 ]. Indeed, syphilis infection is very often asymptomatic and therefore untreated; thus, the potential for transmission is enhanced, and the risk of complication including cervical cancer, higher genital tract infections, sterility, chronic pain, ectopic pregnancy, congenital abnormalities, spontaneous abortion, and associated neonatal and maternal mortality is increased [ 46 ].

Syphilis-related genital ulcerations among FSW are important risk factors for HIV transmission Prostitutes Meda 3 ], highlighting the relevance of early screening and treatment.

In this study, all FSW who screened positive marker test were treated with Prostitutes Meda single Prostitutes Meda dose of benzathine benzylpenicillin G slow release 2. In our study, the number of cases of active syphilis Prostitutes Meda low, which limited the ability to further identify factors associated with the acute infection through multivariate analysis. We instead used syphilis serological markers for analysis purposes.

Furthermore, self-reporting sexual behavior in a context of social stigmatization of and discrimination toward FSW may have led to social Prostitutes Meda bias; however, this did not have impact Prostitutes Meda the prevalence of syphilis, as this was evaluated through syphilis serological markers. Our study provides updated data on syphilis serological markers in Burkina Faso. This study provided updated epidemiological data on syphilis based on rapid diagnostic testing in situ among sex workers in Burkina Faso.

We found that syphilis prevalence among FSW was relatively high and requires targeted preventive measures. Screening with rapid diagnostic tests followed by a single-dose administration of penicillin could be an effective approach to control syphilis among FSW and thus contribute to Prostitutes Meda prevention of HIV transmission. Safer sex and HIV prevention activities for FSW offer an opportunity to integrate screening and early treatment of syphilis. They are grateful to all the study participants.

The authors declare that there are no conflicts of interest regarding the publication of this article.

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Baral, S. Kouanda, H. Ouedraogo, O. Ky-Zerbo, and A. Grosso Prostitutes Meda the study and contributed to study design, implementation, and manuscript writing; I. Prostitutes Meda and I. Zongo Prostitutes Meda in manuscript writing; Prostitutes Meda. Samadoulougou and G. Tarnagda helped Prostitutes Meda study implementation, data cleaning, and manuscript review; K.

Sondo, N. Sawadogo, Y. Traore, and Nicolas Barro conducted the manuscript review. National Center for Biotechnology InformationU. Journal List Int J Microbiol v. Int J Microbiol. Published online Nov 8. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Henri Gautier Ouedraogo: fb.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the Prostitutes Meda work is properly cited.

This article has been cited by other articles in Prostitutes Meda. Associated Data Data Availability Statement The datasets used during the current study are available from the corresponding author on reasonable request. Abstract Background Syphilis among female sex workers FSW remains a public health concern due to its potential impact on their health and the possibility of transmission Prostitutes Meda their clients, partners, and children.

Results A total of FSW were screened for syphilis. Conclusion The prevalence of syphilis markers was high during this study among FSW. Background Syphilis is a sexually transmitted disease STD due to Treponema palliduma spirochete bacteria belonging to the Spirochaetaceae family [ 12 ].

Methods 2. Setting The study was conducted in five cities of Burkina Faso: Ouagadougou the capital city in the centreBobo-Dioulasso in the Hauts-Bassins regionKoudougou in the middle westOuahigouya in the northand Tenkodogo in the middle east.

Syphilis Testing Figure 1 shows the flowchart of the syphilis screening among study participants. Open in a separate window. Figure 1. FSW Characteristics The mean age Prostitutes Meda the study population was Table 1 Characteristics of female sex workers in Burkina Faso.

No Prevalence of Syphilis Serological Markers The prevalence of syphilis serological markers was 5. Table 2 Active syphilis and syphilis serological markers prevalence among female sex workers by city. Table 3 Prevalence of syphilis serological markers Prostitutes Meda of active syphilis among female sex workers in Burkina Faso. Factors Associated Prostitutes Meda Syphilis Serological Markers The factors associated with the syphilis serological markers among FSW in bivariate and multivariate analyses are presented in Table 4.

Table 4 Factors associated with syphilis serological markers among female sex workers in Burkina Faso. Multivariate Analysis In multivariate analysis, after adjustment for age, education level, marital status, number of clients per week, history of Prostitutes Meda, use of condoms, and the study city, the number of clients and education level were independently associated with syphilis serological marker carriage.

Discussion This study found that the prevalence of syphilis serological markers and active syphilis were, respectively, 5. Limitations In our study, the number of cases of active syphilis was low, which limited the ability to further identify factors associated with the acute infection through multivariate analysis. Conclusion This study provided updated epidemiological data on syphilis based on rapid diagnostic testing in situ among sex workers in Burkina Faso.

Data Availability The datasets used during the current study are available from the corresponding author on reasonable request. Conflicts of Interest The authors declare that there are no conflicts of interest regarding the publication of this article. Authors' Contributions S. References 1. Hook E. The Prostitutes Meda. Singh A. Syphilis: review with emphasis on clinical, epidemiologic, and some Prostitutes Meda features.

Clinical Prostitutes Meda Reviews. Prostitutes Meda R. Genital ulceration as a risk factor for human immunodeficiency virus infection. Salado-Rasmussen K.

Syphilis and HIV co-infection. Epidemiology, treatment and molecular typing of Treponema pallidum. Danish Medical Journal. Stevenson J. Syphilis and HIV infection: an update.

Dermatologic Clinics. Zetola N. Clinical Infectious Diseases. World Health Organization. Geneva, Switzerland: World Health Organization; Kang D. Commercial sex venues, syphilis and methamphetamine Prostitutes Meda among female sex workers. AIDS Care. Zhou C. High prevalence of HIV and syphilis and associated factors among low-fee female sex workers in mainland China: a cross-sectional study.

BMC Infectious Diseases. Tao X. High prevalence of syphilis among street-based female sex workers in Nanchang, China. Prostitutes Meda Dermatology Online Journal. Kakchapati S. Sexual risk behaviors, HIV, and syphilis among female sex workers in Nepal. Halatoko W. Prevalence of syphilis among female sex workers and their clients in Togo in BMC Public Health. Elhadi M. Integrated bio-behavioural HIV surveillance surveys among female sex workers in Sudan, Sexually Transmitted Infections.

Ramjee G. Sexually Transmitted Prostitutes Meda. Nicolas S. Scorgie F. Wanyenze R. Kim H. Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso. Annals of Epidemiology. Davis A. Barriers to health service access among Prostitutes Meda migrant Ugandan sex workers Prostitutes Meda Guangzhou, China. International Journal for Equity in Health. Lafort Y. Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions.

Wahed T. Barriers to sexual and reproductive Prostitutes Meda services as experienced by female sex workers and service providers in Dhaka city, Prostitutes Meda. PLoS One. Baral S. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious Diseases.

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Data were double entered into EpiData 3. An exploratory ecological analysis.