{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T07:17:38Z","timestamp":1793431058372,"version":"4.5.0"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003323","name":"Agence Nationale de Recherches sur le Sida et les Hepatites Virales","doi-asserted-by":"publisher","award":["PrEP CI ANRS 12361"],"award-info":[{"award-number":["PrEP CI ANRS 12361"]}],"id":[{"id":"10.13039\/501100003323","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["Investment ID: OPP1106343"],"award-info":[{"award-number":["Investment ID: OPP1106343"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,12,11]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and setting<\/jats:title>\n                  <jats:p>The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in C\u00f4te d\u2019Ivoire.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A convenience sample of 1000 FSWs aged \u226518, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs\u2019 risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner\u2019s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in C\u00f4te d\u2019Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-028508","type":"journal-article","created":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T04:55:14Z","timestamp":1578545714000},"page":"e028508","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Sexual health needs of female sex workers in C\u00f4te d\u2019Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3599-5445","authenticated-orcid":false,"given":"Valentine","family":"Becquet","sequence":"first","affiliation":[{"name":"INED (French Institute for Demographic Studies), Paris, France"},{"name":"CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcellin","family":"Nouaman","sequence":"additional","affiliation":[{"name":"Programme PAC-CI\/ANRS Research Site, Abidjan, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lanie","family":"Plazy","sequence":"additional","affiliation":[{"name":"ISPED, Inserm Research Center 1219 (Bordeaux Population Health), Universit\u00e9 de Bordeaux, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marie","family":"Masumbuko","sequence":"additional","affiliation":[{"name":"Programme PAC-CI\/ANRS Research Site, Abidjan, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Anoma","sequence":"additional","affiliation":[{"name":"Espace Confiance, Abidjan, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soh","family":"Kouame","sequence":"additional","affiliation":[{"name":"Aprosam, San Pedro, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Danel","sequence":"additional","affiliation":[{"name":"Programme PAC-CI\/ANRS Research Site, Abidjan, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge Paul","family":"Eholie","sequence":"additional","affiliation":[{"name":"Programme PAC-CI\/ANRS Research Site, Abidjan, C\u00f4te d'Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Larmarange","sequence":"additional","affiliation":[{"name":"CEPED, Centre for Population and Development, (Paris Descartes University, IRD, Inserm), Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"2025101814014315000_10.1.e028508.1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/s41586-019-1200-9","article-title":"Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017","volume":"570","author":"Dwyer-Lindgren","year":"2019","journal-title":"Nature"},{"key":"2025101814014315000_10.1.e028508.2","doi-asserted-by":"publisher","DOI":"10.2174\/1874613601610010034"},{"key":"2025101814014315000_10.1.e028508.3","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.100818"},{"key":"2025101814014315000_10.1.e028508.4","unstructured":"World Health Organization . Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations [Internet]. World Health Organization, 2016. http:\/\/proxy.library.carleton.ca\/loginurl=https:\/\/www.deslibris.ca\/ID\/10063272"},{"key":"2025101814014315000_10.1.e028508.5","unstructured":"World Health Organization . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. In: Recommendations for a public health approach. 2nd edn. World Health Organization, 2016: 429."},{"key":"2025101814014315000_10.1.e028508.6","unstructured":"UNAIDS . Factsheet - Global AIDS Update 2019, 2019: 6."},{"key":"2025101814014315000_10.1.e028508.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506273"},{"key":"2025101814014315000_10.1.e028508.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"2025101814014315000_10.1.e028508.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"2025101814014315000_10.1.e028508.10","unstructured":"World Health Organisation . Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV [Internet]. Report No.: 978 92 4 150956 5. Geneva: World Health Organisation, 2015: 78. http:\/\/apps.who.int\/iris\/bitstream\/10665\/186275\/1\/9789241509565_eng.pdf"},{"key":"2025101814014315000_10.1.e028508.11","unstructured":"UNAIDS . UNAIDS data 2017 [Internet], 2017. Available: http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2017_data-book_en.pdf [Accessed 11 Jul 2018]."},{"key":"2025101814014315000_10.1.e028508.12","unstructured":"UNAIDS . On the fast-track to end AIDS by 2030: focus on location and population [Internet], 2015: 268. http:\/\/www.unaids.org\/en\/resources\/documents\/2015\/FocusLocationPopulation"},{"key":"2025101814014315000_10.1.e028508.13","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000158"},{"key":"2025101814014315000_10.1.e028508.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402269"},{"key":"2025101814014315000_10.1.e028508.15","unstructured":"B\u00e9hanzin L , Gu\u00e9dou FA , Geraldo N , et al . Prep and early antiretroviral therapy demonstration project: challenges to ensure follow-up and adherence among female sex workers in Cotonou, Benin. In: Chicago: HIVR4P 2016 conference, 2016."},{"key":"2025101814014315000_10.1.e028508.16","unstructured":"Alary M , B\u00e9hanzin L , Mboup A , et al . Early antiretroviral therapy and daily pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: a demonstration study. In: Madrid: HIVR4P 2016 conference, 2018."},{"key":"2025101814014315000_10.1.e028508.17","doi-asserted-by":"crossref","first-page":"e1002444","DOI":"10.1371\/journal.pmed.1002444","article-title":"Hiv pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project","volume":"14","author":"Eakle","year":"2017","journal-title":"PLoS Med"},{"key":"2025101814014315000_10.1.e028508.18","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25081","article-title":"Exploring acceptability of oral PreP prior to implementation among female sex workers in South Africa","volume":"21","author":"Eakle","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"2025101814014315000_10.1.e028508.19","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1097\/QAD.0000000000001749","article-title":"Implementing preexposure prophylaxis among key populations: an opportunity for patient-centered services and management of hepatitis B","volume":"32","author":"Larmarange","year":"2018","journal-title":"AIDS"},{"key":"2025101814014315000_10.1.e028508.20","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1080\/09540121.2015.1050981","article-title":"Fertility intentions, power relations and condom use within intimate and other non-paying partnerships of women in sex work in Bagalkot district, South India","volume":"27","author":"Deering","year":"2015","journal-title":"AIDS Care"},{"key":"2025101814014315000_10.1.e028508.21","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6874-11-42","article-title":"Reasons for non- use of condoms and self- efficacy among female sex workers: a qualitative study in Nepal","volume":"11","author":"Ghimire","year":"2011","journal-title":"BMC Womens Health"},{"key":"2025101814014315000_10.1.e028508.22","doi-asserted-by":"crossref","first-page":"S171","DOI":"10.1097\/QAI.0000000000000451","article-title":"Sexual violence, condom negotiation, and condom use in the context of sex work: results from two West African countries","volume":"68(Suppl 2)","author":"Wirtz","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2025101814014315000_10.1.e028508.23","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2009.037846"},{"key":"2025101814014315000_10.1.e028508.24","unstructured":"Nouaman MN , Becquet V , Masumbuko J-M , et al . \u00c9valuation de l\u2019incidence du VIH chez des travailleuses du sexe en C\u00f4te d\u2019Ivoire (PREPCI ANRS 12361). 9e Conf\u00e9rence Internationale Francophone sur le VIH et les H\u00e9patites Virales (AFRAVIH 2018), Bordeaux, France, 2018."},{"key":"2025101814014315000_10.1.e028508.25","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1521\/aeap.2017.29.2.141","article-title":"Perspectives on HIV pre- and post-exposure Prophylaxes (PreP and PEP) among female and male sex workers in Mombasa, Kenya: implications for integrating biomedical prevention into sexual health services","volume":"29","author":"Restar","year":"2017","journal-title":"AIDS Educ Prev"},{"key":"2025101814014315000_10.1.e028508.26","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31820b8eba"},{"key":"2025101814014315000_10.1.e028508.27","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-011-9985-z"},{"key":"2025101814014315000_10.1.e028508.28","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1097\/QAI.0000000000000448","article-title":"An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in C\u00f4te d'Ivoire","volume":"68(Suppl 2)","author":"Schwartz","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2025101814014315000_10.1.e028508.29","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2002.004077"},{"key":"2025101814014315000_10.1.e028508.30","first-page":"657","article-title":"The Role of Abortion in the Fertility Transition in Abidjan (C\u00f4te d\u2019Ivoire) during the 1990s","volume":"58","author":"Guillaume","year":"2003","journal-title":"Population"},{"key":"2025101814014315000_10.1.e028508.31","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.035543"},{"key":"2025101814014315000_10.1.e028508.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0182249","article-title":"Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka City, Bangladesh","volume":"12","author":"Wahed","year":"2017","journal-title":"PLoS One"},{"key":"2025101814014315000_10.1.e028508.33","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/sifp.12020","article-title":"Meeting the reproductive health needs of female key populations affected by HIV in low- and middle-income countries: a review of the evidence","volume":"48","author":"Ippoliti","year":"2017","journal-title":"Stud Fam Plann"},{"key":"2025101814014315000_10.1.e028508.34","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1007\/s10461-015-1238-0","article-title":"Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PreP) among a large national sample of U.S. men who have sex with men (MSM)","volume":"20","author":"Elsesser","year":"2016","journal-title":"AIDS Behav"},{"key":"2025101814014315000_10.1.e028508.35","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1080\/13691058.2016.1164899","article-title":"When and why women might suspend PreP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling","volume":"18","author":"Namey","year":"2016","journal-title":"Cult Health Sex"},{"key":"2025101814014315000_10.1.e028508.36","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/COH.0000000000000215","article-title":"Promise and pitfalls of pre-exposure prophylaxis for female sex workers","volume":"11","author":"Cowan","year":"2016","journal-title":"Curr Opin HIV AIDS"},{"key":"2025101814014315000_10.1.e028508.37","doi-asserted-by":"crossref","DOI":"10.1186\/1744-8603-10-46","article-title":"Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa","volume":"10","author":"Dhana","year":"2014","journal-title":"Global Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-028508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:01:52Z","timestamp":1760821312000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-028508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1,8]]},"published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1136\/bmjopen-2018-028508"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-028508","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}