Contexte: Les travailleuses du sexe (TS) sont un groupe à risque de l’infection à VIH, jouant un rôle majeur dans la dynamique de l’épidémie en Afrique de l’Ouest. Les interventions de prévention et de prise en charge du VIH ciblant ces femmes sont donc indispensables, mais leur contenu reste à définir. Nous avons conçu un paquet d’intervention qui combinait la prévention et les soins, et estimé son impact sur l’incidence du VIH. Méthodes: Entre septembre 2009 et septembre 2010, nous avons réalisé une étude transversale à Ouagadougou (Burkina Faso) suivie d’une étude de cohorte interventionnelle chez des jeunes TS âgées de 18 à 25 ans, avec un suivi trimestriel pendant 21 mois maximum. Le paquet d’intervention de la cohorte combinait des activités de prévention effectuées par des pairs (sessions de communication pour un changement de comportement) et de soins (IST, VIH, soins généraux, santé sexuelle et reproductive, soutien psychologique).A chaque visite, les comportements sexuels étaient collectés par un questionnaire ; des tests VIH, HSV-2 et de grossesses étaient réalisés. L’incidence de l’infection à VIH observée dans la cohorte a été comparée à l’incidence attendue en absence d’intervention. Cette dernière a été estimée grâce à un modèle mathématique de Bernouilli utilisant les données collectées chez les clients des TS, et des estimations de paramètres clés issus de la littérature.Durant le suivi, nous avons défini un comportement à risque comme le premier épisode d’un évènement biologique résultant d’un rapport sexuel non-protégé : grossesse non-désirée, primo-infection HSV-2 ou à T. vaginalis. Nous avons utilisé un modèle logistique à effet aléatoire pour identifier les déterminants de ces comportements à risque durant le suivi.Résultats: Parmi les 609 travailleuses du sexe pré-sélectionnées dont 188 (30,9%) professionnelles, la prévalence du VIH était de 10,3% chez les professionnelles et 6,5% chez les non-professionnelles l’âge médian était de 21 ans. Au total, 41,2% des professionnelles et 47,5% des non-professionnelles rapportaient une utilisation non systématique du préservatif, principalement avec leurs partenaires réguliers.Dans cette étude transversale, l’infection à VIH était associée à l’âge (aOR=1,44; IC95%: 1,22-1,71), la vie en couple (AOR=2,70; IC95%: 1,21-6,04), et l’infection à T. vaginalis (aOR=9,63; IC95%: 2,93-31,59), tandis que la réalisation antérieure d’un test VIH réduisait nettement ce risque (AOR=0,18; IC95%: 0,08-0,40). Les 321 TS non-infectées par le VIH incluses dans la cohorte ont effectué un suivi total de 409 personne-années (p-a). Aucune participante n’a fait une séroconversion au VIH durant le suivi (0/409 p-a) alors que l’incidence attendue modélisée était de 5,05/409 p-a (IC95%, 5,01-5,08) soit 1,23 infection/100 p-a (p=0,005). Cette incidence nulle était associée à une réduction du nombre de partenaires réguliers et de clients réguliers ainsi qu’à une augmentation du taux d’utilisation constante du préservatif avec les nouveaux clients (aOR =2,19; IC95%, 1,16-4,14) et avec les clients réguliers (aOR=2,18; IC95%, 1,26-3,76). Cependant, les comportements à risque restaient élevés durant l’intervention : 26,7/100 p-a (IC95%, 24,1-33,7). Ce risque résiduel était plus élevé chez les TS vivant en couple (aOR =7,47, IC95%, 1,70-30,80) et chez les non-professionnelles (AOR =5,53, IC95%, 1,75-16,84). Ces dernières avaient le plus tendance à ne pas déclarer les comportements à risque lors des interviews. Conclusions: Notre étude a démontré la nécessité de cibler les jeunes TS par des interventions adaptées.Notre paquet d’intervention combinant la prévention du VIH et les soins a permis de réduire l’incidence du VIH chez les jeunes travailleuses du sexe au Burkina Faso. Les interventions devront se focaliser sur le dépistage du VIH, les TS non-professionnelles et les partenaires réguliers. / Background: In West Africa, interventions targeting female sex workers (FSW) are crucial to impact on the HIV dynamics. However, the contents and efficacy of these interventions are unclear, and identifying the most at risk FSW in order to adapt these interventions remain challenging, partly because of the limitations of self-reported sexual behaviours. We therefore designed a comprehensive dedicated intervention targeting young female sex workers, and assessed its impact on HIV incidence in Burkina Faso and the reliability of interview data. Methods: From September 2009 to September 2010 we conducted a cross sectional study in Ouagadougou, Burkina Faso. Then HIV-uninfected FSW aged 18-25 years were enrolled in a prospective interventional cohort. The participants were followed quarterly for a maximum of 21 months. The intervention group received a package which combined prevention and care within the same setting, and consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care, and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. High-risk behaviour was defined as the first occurrence of any biological event resulting from unsafe sex, including unexpected pregnancy or HSV-2 or T. vaginalis infection. We used random logistic models to assess the relationship between socio-demographic characteristics and the residual high risk behaviours during the intervention.We compared the cohort HIV incidence with a Bernoulli modelled expected incidence in the absence of intervention, using data collected at the same time from FSW clients and key parameters from the litterature. Results: We screened 609 FSW including 188 (30.9%) professionals. Their median age was 21 years [IQR, 19-23], and the prevalence of HIV was 10.3% among professionals and 6.5% among non-professionals. Overall, 277 (45.6%) women reported high-risk behaviours (41.2% among professionals and 47.5% among non-professionals), which were driven mainly by non-consistent condom use with regular partners. In multivariable analysis, before the intervention, HIV infection was associated with older age (AOR=1.44; 95%CI: 1.22-1.71), with being married/cohabiting (AOR=2.70; 95%CI: 1.21-6.04), and with T. vaginalis infection (AOR=9.63; 95%CI: 2.93-31.59), while previous HIV testing was associated with a decreased risk (AOR=0.18; 95%CI: 0.08-0.40).The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study while the expected modelled number of HIV infections were 5.05 (95%CI, 5.01-5.08) during the same follow-up (409 person-years) or 1.23 infection per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and to an increase in consistent condom use with casual clients (AOR =2.19; 95%CI, 1.16-4.14, p=0.01) and with regular clients (AOR=2.18; 95%CI, 1.26-3.76, p=0.005). However, the incidence of residual risk was high, at 26.7/100 person-years (95% CI, 24.1-33.7). The residual risk was higher among FSW living in couple (adjusted odd ratio [AOR] =7.47, 95% CI, 1.70-30.80) and among those for whom sex work was not the main source of income (AOR =5.53, 95% CI, 1.75-16.84). The latter also tended not to report high-risk behaviours during face –to–face interview. Conclusions: This study highlights the need for targeted interventions among young FSW focusing particularly on non-professionals, sexual behaviours with regular partners and regular HIV testing. The ANRS 1222 study intervention package which combined peer-based prevention and care within the same setting markedly reduced HIV incidence among young female sex workers in Burkina Faso, through reduced risky behaviours.

In 2020, COVID-19 spread worldwide, and a state of pandemic was declared by the World Health Organization. Female sex workers are in many ways dependant on the social conditions of society and have, throughout time, been considered as a highly victimized group. This study aims to gain insight into the changes and consequences the COVID-19 pandemic has had on female sex workers in Sweden by conducting semi-structured interviews with individuals who, through their employment, have connections to female sex workers. The collected data were analyzed using thematic analysis. The results revealed four themes that describe the changes and consequences witnessed by the participants. The first theme entails the vulnerabilities and circumstances that female sex workers are conditioned by in society. The second theme demonstrates the economic consequences which the pandemic outbreak caused. Not only in relation to expenses and difficulties traveling but also in terms of an increased market due to unemployment and lockdowns in Central Europe. This theme also includes a subgroup of physical consequences as a result of the competition created by the increased market of female sex workers in Sweden. This has caused the women to have to take additional risks and abuse. The third theme includes the bureaucratic and social complications caused by the social restrictions enforced to hinder the spread of the COVID-19. The fourth and last theme presents the participants' post-pandemic predictions.

No description available.

Millions of people in the world are infected by HIV/AIDS or/and other Sexually Transmitted Infections, STIs. Ethiopia is, with its population on almost 94 million people, one of the worst affected countries. One of the methods that are used in the prevention work in order to combat the spread of HIV/AIDS and STIs in Ethiopia is Social Marketing, a concept that adopts traditional marketing techniques in order to obtain social change. This inductive study explores how three various Ethiopian organizations are utilizing Social Marketing in their HIV/AIDS and STI prevention work throughout Ethiopia, how the concept can be used to achieve attitudinal- and behavioral change by people, as well as if the organization’s various Social Marketing projects strive to provide vulnerable groups of the Ethiopian society with empowerment, and if so, in what ways. The empirical material was collected through six qualitative interviews and two focus group discussions during an eight-week long stay in Ethiopia during March-May, 2012. The findings of this study have been analyzed through theories about human behavior with a focus on behavior change, as well as various definitions and concepts of empowerment. The study’s result shows that Social Marketing can be utilized in several ways in the HIV/AIDS and STI prevention work in Ethiopia to obtain attitudinal- and behavior changes, for instance by using various commercial techniques, street campaigns, information/education/behavioral change materials, as well as trainings, outreach work and peer education, which aims to educate people about HIV/AIDS, STIs, condoms and condom use. The organization’s joint Social Marketing project “Wise Up-program” includes Drop In Centers and Cooperative Activity for sex workers. The findings of this essay shows that these projects do strive to provide vulnerable groups of the Ethiopian society with empowerment, psychologically as well as economically.

Orientadores: Paulo César Giraldo, Ana Katherine da Silveira Gonçalves / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T20:57:25Z (GMT). No. of bitstreams: 1 Amaral_RoseLuceGomesdo_D.pdf: 1220448 bytes, checksum: d6f8f0907e1226cc41668603ab978683 (MD5) Previous issue date: 2010 / Resumo: O uso de duchas vaginais é comum em diferentes povos e culturas. Entre as mulheres que a praticam, a maioria a faz após a menstruação, antes ou após a relação sexual, com a finalidade de evitar o odor desagradável ou para eliminar corrimentos, refrescar a genitália ou prevenir a gravidez. Não está claro na literatura se as duchas poderiam causar problemas às usuárias. Objetivo: Verificar se o uso habitual de duchas vaginais associa-se à infecção genital por Chlamydia trachomatis/ Neisseria gonorrhoeae e Papilomavírus humano (HPV) em mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal avaliou 200 mulheres - 111 profissionais do sexo (PS) e 89 não profissionais do sexo (NPS) - assistidas em uma Unidade Básica de Saúde de Campinas, São Paulo, Brasil. Todas as mulheres foram entrevistadas e examinadas por um único pesquisador. A anamnese abordou os antecedentes demográficos, higiênicos, sexuais e médicos, como idade, cor, paridade, escolaridade, tabagismo, estado civil, uso de duchas vaginais, idade da primeira relação sexual, número de parceiros sexuais, número de coitos por semana, práticas sexuais, uso de preservativo e lubrificante. Amostras de células cervicais foram coletadas para testes de captura híbrida objetivando Chlamydia trachomatis/Neisseria gonorrhoaea e HPV. Na análise estatística usou-se o teste exato de Fisher ou X2 para as variáveis discretas, e Mann-Whitney para as variáveis não-paramétricas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (no 902/2009) e contou com a colaboração da Secretaria de Saúde do Estado de São Paulo e Laboratório Digene. Resultado: Cerca de 40% das mulheres investigadas praticavam duchas vaginais três ou mais vezes por semana (61,7% das PS e somente 14,6% das NPS). A infecção por CT/NG foi positiva em 10,5% do total dos casos, 17 casos (15,3%) em PS e em quatro casos (4,5%) das NPS (p=0,01), porém não houve diferenças significativas entre usuárias de duchas vaginais (14,81%) e não usuárias (7,6%), (p=ns). As PS não usuárias de duchas vaginais tiveram quase o dobro de infecção CT/NG que as NPS usuárias de duchas vaginais (13,9% vs 7,7%). O HPV foi positivo em 40,5% dos casos, sendo 55,8% da PS e em 21,3% das NPS (p=0,001), contudo DNA-HPV não foi significativamente diferente (p=0,47) entre PS usuárias de duchas vaginais (54,4%) e em não usuárias (58,1%). HPV de alto risco foi positivo em 16,2% e 11,6% (p=ns) e o HPV de baixo risco em 23,5% e 30,2% (p=ns) em usuárias e não usuárias de duchas vaginais respectivamente. Os HPV de alto e baixo riscos foram encontrados simultaneamente em 14,7% e 16,2% das usuárias e não usuárias de duchas vaginais, respectivamente (p=ns). Conclusão: O uso de duchas vaginais não se associou às infecções genitais por CT/NG e HPV de alto ou baixo grau nas mulheres estudadas (profissionais do sexo e não profissionais do sexo) / Abstract: The use of vaginal douching (VD) is widespread around the world, and is more common than is to be expected. The majority of women douche after menses, before or after sexual intercourse to prevent odor, to alleviate vaginal symptoms, or to prevent pregnancy, however it is not clear in the literature if this habit can cause damages for women. Objective: Establish whether high frequency VD favors Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) and Papilomavírus humano (HPV) infection in female sex workers (SW). Subjects and Methods: A clinical cross-sectional study involving 200 women, 111 SW and 89 non-sex workers (NSW) in a Health Center in Brazil. The subjects were submitted to an interview and examined by a single researcher. A questionnaire was filled out with data that included, medical and demographic history (age, race, parity, education, smoking, marital status), hygiene (use of VD, frequency and the solution used) and sexual behaviour (first sexual relation, number of sexual partners, frequency, sexual practices, homosexual relationships, use of condom and lubricant). Cervical samples were collected for CT and NG testing by hybrid capture 2 assay. Statistical analysis used the Fisher's exact test or qui square for discrete variables and Mann-Whitney test for nonparametric variables. The study was approved by Committee the Ethics in Research (no 902/2009) and received the cooperation of São Paulo Secretariat of Health and Digene laboratory. Results: Approximately 40% of women practiced douche three or more times per week (61.7% of SW and only 14.6% of the NSW). Infection with CT / NG was positive in 10.5% of the total cases, 17 cases (15.3%) in SW and in four cases (4.5%) of the NSW (p = 0.01). However, It was in 14.81% of D and but in and 7.6% of ND (p = ns). SW douchers had almost double CT and NG infections than NSW douchers (13.9% vs 7.7%). HPV infection was detected in 40.5% of cases, 55.8% of SW and 21.3% of NSW of (p = 0.001), despite of DNA HPV was not different (p = 0.47) between SW douchers (54.4%) and non-douchers (58.1%). High-risk DNA-HPV was positive in 16.2% and 11.6% (p = ns) and low-risk DNA-HPV in 23.5% and 30.2% (p = ns) in douchers and non-douchers respectively. High and low risk DNA-HPV were found simultaneously in 14.7% and 16.2% of douchers and non-douchers respectively (p = ns). Conclusion: The use of VD is not a causal factor for cervical CT/NG and High-/low risk HPV infection in women studied (SW and NSW) / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Orientadores: Paulo Cesar Giraldo, Ana Katherine S. Gonçalves / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-08T15:31:40Z (GMT). No. of bitstreams: 1 Amaral_RoseLuceGomesdo_M.pdf: 734908 bytes, checksum: 93d7f5663377e139f755920fc4edece2 (MD5) Previous issue date: 2007 / Resumo: Objetivo: Verificar se o uso de duchas higiênicas íntimas (DHI) pode interferir na microbiota vaginal de mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal realizado durante seis meses verificou o risco de 155 mulheres profissionais do sexo (PS), usuárias e não usuárias de DHI, apresentarem flora vaginal alterada e/ou vaginose bacteriana. As PS foram atendidas em centro de saúde (CS) localizado em zona de prostituição no município de Campinas, São Paulo, e agrupadas em usuárias e não usuárias de duchas higiênicas íntimas para análise da microbiota vaginal. A anamnese determinou os perfis sociodemográfico e sexual destas mulheres que procuraram o CS por diferentes motivos. O conteúdo vaginal foi coletado com swab estéril de Dacron e disposto em duas lâminas de vidro que foram coradas por técnica de Gram. A caracterização da microbiota vaginal pelos critérios de AMSEL adaptado foi realizada por microscopia óptica com lente de imersão. Análises univariável, bivariável com testes de qui-quadrado e exato de Fisher, além de regressão múltipla variável (stepwise) demonstraram o poder de associação entre as variáveis. Resultados: A média de idade, a etnia branca, a escolaridade básica e hábito de fumar encontrados respectivamente nas 94 usuárias e nas 61 não usuárias de DHI foram de 25,5 (± 6,2) vs. 26,0 (± 6,8)anos (p=ns), 48,9% vs. 47,5% (p=ns), 60,6% vs. 45% (p=ns) e 41,5% vs. 49,2% (p=ns) dos casos. Não houve diferença no uso regular de condom com seus parceiros sexuais fixos. Apenas o uso de lubrificantes vaginais foi significativamente maior nas usuárias de DHI (63,8%) que nas não usuárias (36,1%), p=0,0007. As prevalências de flora vaginal alterada, vaginose bacteriana, candidíase, tricomoníase e vaginose citolítica foram de 75,48%; 50,96%; 5,1%; 0,64% e 1,9%, respectivamente. Não houve diferenças significativas destas prevalências quando foram analisados estes achados entre as usuárias e não usuárias de DHI (78,7% vs. 70,5%, ns), (47,9% vs. 55,7%, ns), (5,3% vs. 4,9%, ns), (0 vs. 1,6%, ns) e (1,1% vs. 3,3%, ns). A análise de regressão múltipla tipo stepwise não identificou qualquer risco aumentado de ter flora vaginal alterada ou de vaginose bacteriana em mulheres usuárias de DHI. Conclusão: O uso de DHI não aumentou o risco de flora vaginal alterada e/ou de vaginose bacteriana em mulheres PS. Palavras-chave: profissionais do sexo, duchas higiênicas íntimas, microbiota vaginal, vaginose bacteriana, candidíase vaginal / Abstract: Aims: Verify if vaginal douching (VD) can cause vaginal flora imbalance in Female Sex Workers (FSW). Patients and Methods: A cross sectional study, carried out for six months, analysed the risk of vaginal flora imbalance and/or vaginal bacteriosis due to vaginal douching in 155 FSW. The FSW were seen at a public outpatient in a prostitution area in the city of Campinas, the state of São Paulo, Brazil. The vaginal douching (VD) users and non-users made up the two groups for vaginal microbiological analysis. The social-demographic and sexual profile of these women, who were seen for different reasons, was checked by anamnesis. Vaginal content was collected using a sterile Dacron Swab and placed on two glass slides that were stained using Gram technique. Adapted AMSEL criteria characterized the vaginal flora using optic microscope with immersion lens. Univariate, bivariate statistical analyses with X2 and exact Fisher tests apart from multiple variate regression (Stepwise) analysis determined the association between variables. Results: Mean age, white ethnicity, level of schooling and the habit of smoking analysed in the 94 users and 61 non-users of VD respectively were 25.5 (± 6.2) vs. 26.0 (± 6.8) years (p=ns), 48.9% vs. 47.5% (p=ns), 60.6% vs. 45% (p=ns) and 41.5% vs. 49.2% (p=ns) of the cases. There was no difference in the regular use of condoms with their steady sexual partners. Only the use of vaginal lubricant was significantly higher in the VD users (63.8%) than in the non-users (36.1%); p=0.0007. General prevalence of abnormal flora, bacterial vaginosis, candidiasis, trichomoniasis and cytolitic vaginosis was 75.48%, 50.96%, 5.1%, 0.64% and 1.9% respectively. There were no significant differences when analysing the findings between users and non-users of VD (78.7% vs. 70.5%; ns); (47.9% vs. 55.7%; ns); (5.3% vs. 4.9%; ns); (0 vs. 1.6% ns) and (1.1% vs. 3.3%; ns). Stepwise multiple regression analysis did not identify any increased risk of altered vaginal flora or bacterial vaginosis in VD users. Conclusion: The use of VD did not increase the risk of vaginal flora imbalance and/or bacterial vaginosis in FSW / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

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No. of bitstreams: 2 Dissertação - Dulce Helena Rebouças de Souza - 2012.pdf: 1582264 bytes, checksum: 81d7319b908561e96506800f7a644899 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Lymphotropic virus human T cells 1 (HTLV-1) is a retrovirus associated with the development of diseases such as T cell leukemia in adults (ATL) and tropical spastic paraparesis (TSP) or HTLV-associated myelopathy (HAM/TSP). Transmission occurs by sexual routes, parenteral and vertical. Female sex workers (FSW) are a population vulnerable to parenteral and sexually transmitted infections since they have often risky behaviors including drug use and unprotected sex. The study aimed to investigate the seroepidemiological profile of HTLV-1 infection among a population of female sex workers in Goiânia city, using the Respondent driven Sampling methodology. A total of 402 FSWs were interviewed about demographic and risk characteristics for HTLV infection, between May 2009 and June 2010. Blood samples were collected from all females and screened by ELISA for detection of antibodies to HTLV-1/2. Positive samples were retested for confirmation by western blot and PCR, and characterized by sequencing and phylogenetic analyses. The mean age was 27.5 years (SD: 9.1 years). Most of FSWs (67.1%) were single, 47.3% had 10 a 12 years of formal education. One third of female sex workers reported illicit drug (34.1%), thought only (2.7%) used injection illicit drugs, 51.9% had more than seven sexual partners in the last week and 36.3% did not use condom with their steady sexual partners. Some women reported to recruit their clients in more than one type of venue, being nightclubs (41%), bars (27.7%) and streets (25%) predominant. Of the 402 samples screened by ELISA, three were positive and submitted to detection of DNA-HTLV for the tax, LTR and env regions. Only one was positive for HTLV-1, resulting in a prevalence of 0.2%. (CI 95%: 0.0-1.6). The virus isolate was classified as Transcontinental subgroup of the HTLV-1 Cosmopolitan subtype. These findings show a low endemicity for HTLV-1 infection in female sex workers in Goiânia-GO, however epidemiological studies of this infection are important to reinforce the need for prevention strategies based on the disclosure of the modes of transmission and status tracking serological the infected. / O vírus linfotrópico de células T humanas 1 (HTLV-1) é um retrovírus associado ao desenvolvimento de doenças como leucemia/linfoma de células T do adulto (ATL) e mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP). A transmissão ocorre por vias sexual, parenteral e vertical. As mulheres profissionais do sexo (MPS) constituem uma população vulnerável as infecções de transmissão parenteral e sexual, uma vez que apresentam comportamentos de risco, incluindo o uso de drogas e o sexo sem proteção. Este estudo teve como objetivo investigar o perfil soroepidemiologico da infecção pelo HTLV-1 em mulheres profissionais do sexo em Goiânia, GO, usando a metodologia Respondent-Driven Sampling (RDS). Um total de 402 MPS foi entrevistada sobre dados sociodemográficos e características de risco para a infecção pelo HTLV, entre maio de 2009 e junho de 2010. As amostras de sangue foram coletadas de todas as mulheres e triadas pelo ELISA para a detecção de anticorpos para HTLV-1/2. As amostras positivas foram retestadas para a confirmação por western blot e PCR, sendo caracterizadas por sequenciamento e análise filogenética. A idade média das mulheres foi 27,5 anos (Dp: 9,1 anos). A maioria (67,1%) era solteira, 47,3% tinham entre 10 e 12 anos de educação formal. Um terço das profissionais (34,1%) relatou uso de drogas ilícitas, embora apenas 2,7% usaram drogas injetáveis, 51,9% tiveram mais de sete parceiros sexuais na ultima semana e 36,3% não usaram preservativos com parceiros não pagantes. Algumas mulheres relataram recrutar seus clientes em mais de um tipo de local, boates (41%), bares (27,7%) e ruas (25%). Das 402 amostras triadas pelo ELISA, três foram positivas e submetidas à detecção do HTLV-DNA para as regiões tax, LTR e env. Apenas uma foi positiva para HTLV-1, por PCR, resultando numa prevalência de 0,2% (IC 95%: 0,0-1,6). O isolado viral foi classificado como subtipo Cosmopolita (HTLV-1a), subgrupo Transcontinental (A). Os resultados mostram uma baixa endemicidade para a infecção pelo HTLV-1 em mulheres profissionais do sexo em Goiânia-GO, entretanto estudos epidemiológicos sobre essa infecção são importantes para reforçar a necessidade de estratégias de prevenção baseadas na divulgação dos modos de transmissão e acompanhamento do status sorológico dos infectados.

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Problématique : Les femmes travailleuses du sexe (TS) constituent la population le plus à risque d’infection au VIH dans différents pays d’Afrique subsaharienne. Plusieurs interventions y ont ainsi été menées pour réduire le risque d’infection en influant sur les facteurs de risque. Parmi ces interventions, on peut citer la promotion de l’utilisation du préservatif de même que le dépistage et le traitement des infections sexuellement transmissibles (IST). Cependant, certaines composantes sont peu représentées dans ce panel d’interventions offertes aux femmes TS. Le conseil dépistage volontaire pourrait s’avérer une intervention utile de prévention primaire et secondaire pour cette population mais son acceptabilité est mal connue. Par ailleurs, en termes de surveillance de l’épidémie, l’évaluation de la validité de l’auto-rapport d’utilisation du préservatif, indicateur fréquemment utilisé lors d’enquêtes populationnelles serait souhaitable. Enfin, pour ce qui est de la prévention de l’infection dans cette population, l’effet du désir d’enfant sur l’utilisation non systématique du condom avec le principal partenaire régulier non payant est peu connu. Il en est de même pour la prévalence de certaines IST comme le VPH-16 et l’effet combiné de facteurs sociodémographiques, comportementaux et préventifs sur la présence de ces IST. Objectifs : Les objectifs de cette thèse sont 1) de mesurer l’acceptabilité et les conséquences du conseil dépistage volontaire du VIH chez les femmes TS de Conakry en Guinée; 2) d’évaluer la validité de l’auto-rapport de l’utilisation du préservatif dans cette population grâce à un indicateur biologique de présence de sperme, l’antigène spécifique de la prostate (PSA); 3) d’estimer la fréquence d’utilisation systématique du préservatif avec les partenaires clients et non-clients des femmes TS et d’étudier l’importance du désir d’enfant dans l’utilisation non systématique du préservatif avec le principal partenaire régulier non-client et 4) de mesurer la prévalence des IST et du VIH et d’étudier les facteurs sociodémographiques, comportementaux et préventifs qui y sont associés. Méthodologie : Nous avons mené une étude longitudinale dans la ville de Conakry en Guinée auprès de 421 femmes TS recrutées dans trois services de santé adaptés pour elles. Un devis mixte répété un an plus tard a permis de collecter des données quantitatives et qualitatives. Des analyses biologiques de dépistage des IST et du VIH ont été effectuées. Résultats : Le premier article de résultats présenté dans cette thèse montre que l’acceptabilité du conseil dépistage volontaire est élevée chez les femmes TS. En effet, les taux d’acceptation du test, de retour pour la prise de résultats et de notification du statut sérologique avoisinaient les 100%. Cette acceptabilité semblait être le fait d’une perception de risque d’infection élevé, mais aussi d’une pression sociale du milieu prostitutionnel pour effectuer le dépistage et révéler le statut sérologique. Les conséquences négatives au dépistage étaient rares. Le deuxième article montre que l’auto-rapport de l’usage récent du préservatif a une très faible sensibilité lorsque comparé à l’étalon d’or que constitue la PSA. Ainsi, la plupart des personnes chez qui la PSA était retrouvée ne rapportaient aucun rapport non protégé récent. La discordance entre l’auto-rapport d’utilisation récente du préservatif et la présence de PSA était associée à une perception de risque d’infection au VIH élevé. Enfin, la troisième section montre que si l’utilisation systématique du préservatif était très fréquente avec les clients, elle l’est beaucoup moins avec le principal partenaire régulier non-client. Le désir d’enfant de la femme TS contribue de manière significative à l’utilisation non systématique du condom avec ce type de partenaire. Des facteurs sociodémographiques, comportementaux et la coinfection par d’autres IST sont associés à la présence d’IST/VIH, ces dernières étant fréquentes dans la population des femmes TS malgré les nombreuses interventions qui y sont menées. Conclusion : En conclusion, l’on peut dire que la prévention du VIH chez les femmes TS constitue un défi nécessitant des interventions intégrées tenant compte du contexte commercial dans lequel ces interventions sont implantées et des aspirations des femmes TS en matière de reproduction. / Background: Female sex workers (FSW) constitute the population most at risk for HIV infection in many countries of Sub-Saharan Africa. Several interventions have been implemented in this population to reduce the risk of infection. These interventions include the promotion of condom use and the screening and treatment of sexually transmitted infections (STI). However, some components are poorly represented among the interventions offered to FSW. Voluntary counselling and testing could be a useful intervention of primary and secondary prevention for this population but the acceptability of this intervention by FSW is little-known. In addition, in terms of surveillance of the epidemics, the evaluation of the validity of self-reported condom use is important as this indicator is frequently used in population surveys. More information is also needed about the importance of the desire for children in using inconsistently condoms with the main non-paying regular partner. Finally, the prevalence of STIs such as HPV-16 and the combined impact of sociodemographic, behavioural and preventive factors on HIV/STIs infection in this population need to be assessed. Objectives: The objectives of this thesis are 1) to measure the acceptability and the consequences of voluntary HIV counselling and testing among FSW in Conakry, Guinea; 2) to assess the validity of self-report condom use in this population through a biological indicator of semen, the prostate specific antigen (PSA); 3) to measure condom use with clients and non-client partners of FSW and to study the importance of the desire for children in inconsistent condom use with the main regular non-client partner and 4) to measure the prevalence of STIs and HIV and the socio-demographic, behavioural and preventive factors related to these infection outcomes. Methodology: We conducted a longitudinal study in the city of Conakry, Guinea among 421 FSW recruited in three health centers adapted for FSW. A longitudinal mixed design allowed for quantitative and qualitative data collections at baseline and one year later. Biological screening tests for STIs and HIV were performed. Results: The first article presented in this thesis showed that the acceptability of voluntary counselling and testing is high among FSW. The acceptance rate of testing, the return rate for results and disclosure of HIV status were close to 100%. This acceptability seemed to be the result of a high risk perception of HIV infection and of social pressure on FSW by the sex work stakeholders to undergo testing and to disclose their serostatus. Negatives consequences to VCT were rare. The second paper showed that self-reported recent condom use had a very low sensitivity when compared to the gold standard. Thus, most women in whom the PSA was found did not report any recent unprotected intercourse. The discrepancy between self-reported recent condom use and the presence of PSA was associated with a perceived high risk of HIV infection. The third section showed that while condom use was very common with clients, it was much less with non-client regular partners. The desire for pregnancy among SW contributed significantly to inconsistent condom use with this type of sexual partner. Socio-demographic characteristics, behavioural factors and co-infection with other STIs were associated with the presence of STIs and HIV, which were common despite all the interventions that were conducted in this population. Conclusion: In conclusion, HIV prevention among FSW is a challenge requiring the development of integrated strategies that take into account the commercial context in which these interventions are implemented but also FSW’s childbearing aspirations.

The reasons why African women become engaged in sex work have received little attention in academic research. While it is largely acknowledged that there exists a connection between entering the sex trade and poverty, not all women who are poor enter sex work. Through the use of life histories with 21 women between the ages of 18 and 42, this thesis explores the combination of factors that lead women and girls to become commercial sex workers in Nairobi, Kenya. This method provides a detailed look at initiation into sex work as it occurs over the life course for women and girls in this context. Additionally, this thesis examines how structural violence impinges on their lives, thereby increasing vulnerability to engagement in sex work. Examining the larger socio-political and economic contexts illustrates how issues such as HIV/AIDS, migrant labour, changing gender roles, the erosion of existing familial structures and gender inequities structure risk for suffering for women. These issues result in many girls losing caregiver support by being orphaned, while additionally, women are burdened with providing total economic and social support for the family in a society that has gendered economic opportunities. Both girls and women are left with few options other than the sex trade to survive.