A Tale of Two Countries: HIV Among Core Groups in Togo AA

A Tale of Two Countries: HIV Among Core Groups in Togo

Sobéla and colleagues set out to describe the epidemiology of HIV among core groups in Togo. The authors enumerated sex workers and conducted cross-sectional surveys of sex workers and their clients in 2003 in Lomé and in 2005 in the whole country. Sex work was concentrated in Lomé, which comprised 15% of the population, but 52% of the 5397 SWs enumerated in Togo in 2005 and 68% of the estimated 101,376 men who had bought sex in the year before the 2005 survey. HIV prevalence among sex workers was highest in Lomé (45.4% in 2005) and progressively decreased from south to north. A similar geographical pattern was seen for clients (8.3% were HIV infected in Lomé in 2005) and had already been reported for pregnant women. In Lomé, the population attributable fraction of prevalent cases of HIV acquired during transactional sex was estimated at 32%; in the rest of the country, this was only 2%. This is the first study quantifying sex work at a national level in Africa. Variations in HIV prevalence within Togo, with a north-south gradient among sex workers, their clients, and pregnant women, may to a large extent reflect the concentration of the sex trade within Lomé. Prostitution played only a modest a role in HIV dynamics outside Lomé.

Editors’ note : This unique national study used the anonymous linked method of HIV surveillance by which sex workers and clients who wished to learn their HIV test results returned to the clinic presenting the envelope with their study number they had been given at the time that their fingerprick blood specimen was taken. The authors attribute the relatively low population attributable fraction (the proportion of incidence that is due to sex work-related transmission) in Lomé of 32%, compared to 84% in Accra and 76% in Cotonou, to the sustained NGO-implemented programme (Forces et Action pour le Mieux-Être de la Mère et de l’Enfant) that has ensured condom availability in sex work environments since the early 1990s.