Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in
Ã
Abidjan, Cote d'Ivoire, 1991±1998
Á
Â
Peter D. Ghysa,b, Mamadou O. Dialloa , Virginie Ettiegne-Traorea ,
Â
Â
Â
È
Kouame Kalec , Oussama Tawile , Michel Caraele , Moussa Traorec ,
Guessan Mah-bic,d , Kevin M. De Cocka,f , Stefan Z. Wiktora,f,
Marie Lagab and Alan E. Greenberga,f
Objective: To assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually
Ã
transmitted diseases (STD) in female sex workers in Abidjan, Cote d'Ivoire.
Design: Multiyear cross-sectional study of ®rst-time attenders in Clinique de Con®ance, a con®dential STD clinic; biannual community-based behavioral surveys.
Methods: From 1992 to 1998, female sex workers were invited to attend Clinique de
Con®ance, where they were counseled, interviewed, clinically examined during their
®rst visit and tested for STD and HIV infection. Community-based surveys, conducted in 1991, 1993, 1995, and 1997, interviewed women regarding socio-demographic characteristics and HIV/STD-related knowledge, attitudes and behavior.
Results: Among female sex workers in Abidjan, there was a trend toward shorter duration of sex work, higher prices, and more condom use. Among sex workers attending Clinique de Con®ance for the ®rst time, signi®cant declines were found in the prevalence of HIV infection (from 89 to 32%), gonorrhoea (from 33 to 11%), genital ulcers (from 21 to 4%), and syphilis (from 21 to 2%). In a logistic regression model that controlled for socio-demographic and behavioral changes, the year of screening remained signi®cantly associated with HIV infection.
Conclusion: The increase in condom use and the decline in prevalence of HIV infection and other STD may well have resulted from the prevention campaign for female sex workers, and such campaigns should therefore be continued, strengthened,
& 2002 Lippincott Williams & Wilkins and expanded.

AIDS 2002, 16:251±258
Keywords: sexually transmitted diseases, female sex workers, Africa, prevention, condom use, behavioral surveillance

Introduction
Ã
Cote d'Ivoire, along with several other African countries, experienced an explosive AIDS epidemic in the

late 1980s [1±3], and by 1989 AIDS had become the leading cause of death in adult males [4]. Female sex workers and their clients appear to have played a central role in this epidemic, as sexual contact with

Ã
From the a Projet RETRO-CI Abidjan, Cote d'Ivoire, the b Institute of Tropical Medicine, Antwerp, Belgium, the c Institut National
Â
Ã
Ã
de Sante Publique, Abidjan, Cote d'Ivoire, the d National AIDS/STD/TB Control Program, Abidjan, Cote d'Ivoire, the e World
Health Organization, Geneva, Switzerland / UNAIDS, Geneva, Switzerland and the f Centers for Disease Control and
Prevention, Atlanta, Georgia, USA.
Correspondence to Dr Peter D. Ghys, UNAIDS, 20 Avenue Appia; CH-1211 Geneva 27 Switzerland.
E-mail: ghysp@unaids.org
Received: 23 March 2001; revised: 1 August 2001; accepted: 8 August 2001.

ISSN 0269-9370 & 2002 Lippincott Williams & Wilkins

251

252

AIDS 2002, Vol 16 No 2

female sex workers was common among men in
Abidjan and was an important risk factor for HIV infection in male blood donors [5], sexually transmitted diseases (STD) clinic patients [6], and tuberculosis patients [7].
To educate the general public concerning AIDS and its
Ã
prevention, the Cote d'Ivoire Ministry of Health initiated a general information campaign in 1987, using media such as television, radio, newspapers, and billboards. In 1991 a condom social marketing program was started [8]. As of 1991 a prevention campaign directed to female sex workers was conducted by the
Â
`Programme de Prevention et de Prise en charge des
MST/SIDA chez les femmes libres et leurs Partenaires'
(PPP). The PPP was initiated in 1991 in three