Epidemiology of HIV among female sex workers, their clients, men who have sex with men and people who inject drugs in West and Central Africa

Abstract

Introduction The West and Central Africa (WCA) sub-region is the most populous region of sub-Saharan Africa (SSA), with an estimated population of 356 million living in 24 countries. The HIV epidemic in WCA appears to have distinct dynamics compared to the rest of SSA, being more concentrated among key populations such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and clients of FSWs. To explore the epidemiology of HIV in the region, a systematic review of HIV literature among key populations in WCA was conducted since the onset of the HIV epidemic.Methods We searched the databases PubMed, CINAHL and others for peer-reviewed articles regarding FSWs, MSM and PWID in 24 countries with no date restriction. Inclusion criteria were sensitive and focused on inclusion of any HIV prevalence data among key populations. HIV prevalence was pooled, and in each country key themes were extracted from the literature.Results The search generated 885 titles, 214 abstracts and 122 full articles, of which 76 met inclusion and exclusion criteria providing HIV prevalence data. There were 60 articles characterizing the burden of disease among FSWs, eight for their clients, one for both, six for MSM and one for PWID. The pooled HIV prevalence among FSWs was 34.9% (n=14,388/41,270), among their clients was 7.3% (n=435/5986), among MSM was 17.7% (n=656/3714) and among PWID from one study in Nigeria was 3.8% (n=56/1459).Conclusions The disproportionate burden of HIV among FSWs appears to be consistent from the beginning of the HIV epidemic in WCA. While there are less data for other key populations such as clients of FSWs and MSM, the prevalence of HIV is higher among these men compared to other men in the region. There have been sporadic reports among PWID, but limited research on the burden of HIV among these men and women. These data affirm that the HIV epidemic in WCA appears to be far more concentrated among key populations than the epidemics in Southern and Eastern Africa. Evidence-based HIV prevention, treatment and care programmes in WCA should focus on engaging populations with the greatest burden of disease in the continuum of HIV care.

Sexual Violence, Condom Negotiation, and Condom Use in the Context of Sex Work

“…14-16 Likewise, with respect to Togo, the same review identified only 1 study has investigated HIV among FSW but also document a high prevalence of HIV at 36.2% (95% CI: 33.6 to 38.8) and 7.9% prevalence among clients (95% CI: 6.6 to 8.0), demonstrating concentration of infection among these key populations. 14,17 Analysis of factors associated with or predicting HIV infection among FSWs and clients has predominantly focused on the individual level, identifying inconsistent condom use, alcohol or other substance use, STI, and number of sexual partners/clients as key correlates of HIV infection. 12,[18][19][20] More recently, however, emerging research has demonstrated the impact of structural factors, such as criminalizing policies, workplace environment, violence, and stigma, on the HIV epidemic among FSWs.…”

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

“…The HIV epidemic in the general population of West and Central Africa has generally not reached the same proportions as that in East and Southern Africa, and HIV infection here appears to be more similar to the HIV epidemics in Europe, Asia and the USA, with high HIV prevalence among particular at-risk groups, including MSM, and relatively low HIV prevalence among the general population [3]. In Nigeria, for example, Vu, Adebajo et al [22] report HIV prevalence rates ranging from 11.3 to 34.9 % among MSM in three cities, and note that these rates are 4-10 times higher than HIV prevalence in the general population.…”

“…In contrast to the generalised epidemics occurring in Southern and Eastern Africa, HIV in West and Central Africa appears to be much more concentrated within high-risk groups such as men who have sex with men (MSM), commercial sex workers (CSW) and injectingdrug users (IDU) [1][2][3]. However, in spite of these differences in the overall characteristics of the epidemic, HIV prevalence is disproportionately high among MSM populations throughout SSA, and recent research has shown that the factors driving HIV risk among MSM in SSA are frequently similar across the many countries in SSA.…”

Physical and Sexual Violence Affecting Female Sex Workers in Abidjan, Côte d'Ivoire: Prevalence, and the Relationship with the Work Environment, HIV, and Access to Health Services

“…In West and Central Africa specifically, the pooled HIV prevalence among FSW in the region is estimated to be 34.9%. 5 Within the region of West Africa, the prevalence among reproductive age adults in Côte d’Ivoire has been estimated to be approximately 3.5%, with the burden among FSW observed to be many times higher. 5,6 …”