Prospective Study of the Incidence of HIV among Registered Female Sex Workers between 1992-2010 in Dakar, Senegal Pubblico

Abstract

Background: HIV prevalence in Senegal is 1% nationwide but 30% among female sex
workers (FSWs). In 1970, the government mandated FSW registration, which included
periodic monitoring for sexually transmitted infections and HIV. While clinical data have
been prospectively collected on all FSWs since 1985, limited analysis has been
performed regarding HIV incidence. This study aims to provide updated estimates of
HIV incidence among FSWs and identify potential predictors of seroconversion.
Methods: We analyzed 1992-2010 longitudinal data on 974 FSWs. Eligibility criteria
included availability of data from a baseline and ≥1 follow-up visit, an enrollment
questionnaire with demographics and sexual behaviors data, ≥2 serology results and a
negative HIV baseline serum. Dividing the number of FSWs who seroconverted by time
in the observational cohort provided an estimate of HIV incidence. The association
between independent variables and HIV seroconversion was analyzed using univariate
Cox Proportional hazards (CPH) regression models. Factors significantly associated
(P<0.05) on univariate analysis were used in CPH multiple regression modeling.
Results: Out of 974 FSWs, 958 (98.4%) were eligible for inclusion. Of these, 66 (6.9%)
seroconverted to HIV (HIV-1=61; HIV-2=4; both=1) during the 4921.5 person-years of
observation (PYO) of follow-up through the end of 2010. The overall estimated HIV
incidence was 1.3 per 100 PYO (95% CI, 1.0-1.7). In univariate analyses, seroconversion
was significantly associated (p<0.05) with low prices for services, > 5 partners/week, and
older age at registration. Length of time as registered FSWs and low prices for services
were significant (p<0.05) in multivariate analysis. Length of time as registered FSW was
protective.
Conclusion: HIV seroconversion rates are moderately high. FSWs with more partners
and lower prices are at greater risk of seroconversion; prevention interventions should be
prioritized for them. Length of time registered is protective, suggesting that registration
of FSWs might be associated with lower HIV transmission.

Table of Contents

Background/Literature Review...1
Abstract...10
Introduction...11
Methods...12
Results...14
Discussion...16
References...21
Tables...27
Summary, Conclusions, Public Health Implications...30
Appendices...31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	HIV Female sex workers registration Senegal Incidence
Committee Chair / Thesis Advisor	Spaulding, Anne C, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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