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HIV-Testing Among Female Sex Workers on the Border Between Brazil and French Guiana: the Need for Targeted Interventions

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HIV-Testing Among Female Sex Workers on the Border Between Brazil and French Guiana: the Need for Targeted Interventions ARTIGO ARTICLE 1615 HIV-testing among female sex workers on the border between Brazil and French Guiana: the need for targeted interventions Testes de HIV entre trabalhadoras do sexo na fronteira entre Brasil e Guiana Francesa: a necessidade de intervenções específicas La prueba del VIH en las trabajadoras sexuales en Marie-Claire Parriault 1 Astrid van Melle 1 la frontera entre la Guyana Francesa y Brasil: la Célia Basurko 1 necesidad de intervenciones específicas Emilie Gaubert-Marechal 2 Raimunda Hermelinda Maia Macena 3 Stéphanie Rogier 1 Ligia Regina Franco Sansigolo Kerr 3 Mathieu Nacher 1,2 Abstract Resumo 1 Centre d’Investigation The border between Brazil and French Guiana is A fronteira entre Guiana Francesa e Brasil é um Clinique Antilles Guyane, Cayenne General Hospital, a place of economic, cultural, social and sexual lugar de intercâmbio econômico, cultural, social e Cayenne, French Guiana. exchange. Female sex workers represent a high sexual. Nessa área, onde o turismo sexual é par- 2 COREVIH Guyane, Cayenne risk population for HIV in this area where sexual ticularmente desenvolvido, as mulheres profissio- General Hospital, Cayenne, French Guiana. tourism is particularly developed. HIV testing nais do sexo representam uma população de alto 3 Faculdade de Medicina, seems to be an important element in the fight risco de contágio pelo HIV. Os testes de HIV pare- Universidade Federal do against the epidemic. Indeed, early HIV testing cem ser um elemento importante da luta contra a Ceará, Fortaleza, Brasil. gives access to treatments and prevention. An epidemia. De fato, os primeiros testes de HIV dão Correspondence HIV/AIDS knowledge, attitudes, behaviors and acesso à prevenção e aos tratamentos. Foi realiza- M.-C. Parriault practices survey was conducted in 2011 among da em 2011 uma pesquisa de conhecimento, ati- Centre d’Investigation Clinique Antilles Guyane, sex workers along the border between Brazil and tudes, comportamentos e práticas sobre HIV/AIDS Cayenne General Hospital. French Guiana. A total of 213 female sex work- com mulheres profissionais do sexo ao longo da 6 Avenue des Flamboyants, ers were interviewed. One third (31.5%) of the fronteira da Guiana Francesa com o Brasil. Foram Cayenne / French Guiana – 97300, France. interviewed had never tested for HIV. Factors as- entrevistadas 213 mulheres profissionais do sexo. marie-claire.parriault@ sociated with non HIV-testing were the lack of Um terço (31,5%) delas nunca tinha feito o teste de ch-cayenne.fr knowledge of places where to do an HIV test, to HIV. Fatores associados a não realização do teste be 30 or older, feeling at risk of HIV, not evalu- de HIV foram: a falta de conhecimento dos locais ating one’s own risk towards HIV, and living in onde fazer o teste, ter idade igual ou acima de 30 Oiapoque. These results clearly suggest that tar- anos, sentir-se em risco de contágio pelo HIV, falta geted interventions are needed to encourage and de avaliação do risco de contágio pelo HIV e habi- assist female sex workers to get tested regularly. tante do Oiapoque. Esses resultados sugerem cla- ramente que intervenções direcionadas às mulhe- Sex Workers; Border Areas; HIV res profissionais do sexo são necessárias para que os testes sejam feitos regularmente. Profissionais do Sexo; Áreas de Fronteira; HIV http://dx.doi.org/10.1590/0102-311X00138514 Cad. Saúde Pública, Rio de Janeiro, 31(8):1615-1622, ago, 2015 1616 Parriault M-C et al. Introduction to monitor high risk groups, among whom sex workers figure 14. French Guiana and Brazil share a 730km-long Given the individual and collective benefits border. Trade and exchanges between both sides of highly active antiretroviral therapy, early HIV of the Oyapock river are concentrated around testing is the gateway to proper HIV care and two river towns: Oiapoque, on the Brazilian side treatment, and risk reduction 15,16,17. (21,661 inhabitants in 2011), and Saint Georges The objectives of the present article were de l’Oyapock (3,946 inhabitants in 2011), on the to describe the HIV testing practices among fe- French side. Sex work is widely present in the male sex workers in Oiapoque and Saint Georges area with numerous venues offering sexual ser- de l’Oyapock and to identify predictive factors vices on the Brazilian side and customers coming of HIV testing based on KABP (knowledge, at- from French Guiana. The area is also a supply titudes, beliefs and practices) data collected in and transit hub for illegal gold mining. Sex work 2009-2010. is closely related to gold mining and many sex workers leave to work for a few months in iso- lated gold mines 1,2,3. Material and methods In 2008, 43.5% of women aged 15-64 in North- ern Brazil had already performed an HIV test dur- Study design ing their lifetime 4. In 2011, 78% of persons aged 15-69 years in French Guiana had performed an This is a cross-sectional survey performed HIV test during their lifetime 5.The high inci- among female sex workers aged 18 years and dence of AIDS in Northern Brazil, notably in the above, working on the border between Brazil and state of Amapa, has been a cause for concern. French Guiana and having had at least one paid The North, one of Brazil’s five regions, presents intercourse in the past six months. Data collec- the second highest increase in HIV prevalence tion took place over four months, in 2009-2010. in the country 6. AIDS incidence has declined in This study was conducted in partnership with French Guiana over the past decade but remains the regional coordination for the fight against the highest of all French territories (Institut Na- HIV, the Department of Community Health of tional de Veille Sanitaire. http://www.invs.sante. the Federal University of Ceará and the following fr/display/?doc=surveillance/vih-sida/BDD_si- non-governmental organizations (NGOs): DAAC da/index.htm, accessed on 19/May/2014). and Kikiwi network in French Guiana, and DPAC The epidemic both in Brazil and in French in Brazil. Guiana is described as a concentrated or mixed epidemic 7,8. Epidemics are concentrated if Sampling method transmission occurs largely in defined vulnerable groups 9, and mixed when the epidemic is de- Snowball sampling was used to select partici- fined by a prevalence in pregnant women that is pants 18,19. The principle was to find female sex consistently over 1%, transitioning into the gen- workers, also referred to as “seeds”, who have the eral population and raising concerns about the desired characteristics and use their social net- possibility of a generalized epidemic 9. works to recruit similar participants. After initial The context of the border and the existing so- seeds help to recruit respondents, the respon- cioeconomic differences between the two sides dents then recruit others themselves, starting of the border create a complex situation where a process analogous to a snowball 19. Persons the vulnerability of persons towards HIV can be accepting to participate in the survey were in- increased 10,11. In 2011, the GDP per capita was terviewed by trained interviewers. Individual 15,294 Euros in French Guiana 12 and 3,525 Eu- interviews were conducted confidentially face- ros (11,504 Brazilian Reals) in Amapá (Instituto to-face. The surveyors were all familiar with the Brasileiro de Geografia e Estatística. http://www. field, originating from NGOs or from the com- cidades.ibge.gov.br/xtras/temas.php?lang=&cod munity of sex workers. At the end of the inter- mun=160010&idtema=125&search=amapa, ac- view, documentation of HIV prevention, NGO cessed on 10/Dec/2014). Sex workers are consid- contacts, male and female condoms, and two ered as an important driver of the HIV epidemic food tickets in French Guiana or make-up in in the region and prevalence seems higher in this Oiapoque were given to the persons interviewed population 6,8,13. In order to maximize the im- in order to compensate for the time spent an- pact of prevention, the World Health Organiza- swering the questionnaire. tion (WHO) and the Joint United Nations Pro- gramme on HIV/AIDS (UNAIDS) recommended in the second generation surveillance program Cad. Saúde Pública, Rio de Janeiro, 31(8):1615-1622, ago, 2015 HIV-TESTING AMONG FEMALE SEX WORKERS ON THE FRENCH GUIANESE-BRAZILIAN BORDER 1617 Questionnaire a second sample is usually sent to Cayenne (3 hours away) for confirmation using Western Blot, An anonymous closed-ended questionnaire or, on the Brazilian side, the patient is sent to Ma- of 150 questions was applied to 35 sex work- capá which is 8 hours away by four wheel drive. ers in Saint-Georges-de-l’Oyapock and 178 in The present study did not involve testing. Oiapoque, the two main towns on the border. Thirty-eight percent of sex workers could not It notably explored sociodemographic char- evaluate their risk of HIV, nearly a quarter thought acteristics, sex work, intercourse with clients and they had a high risk (21.1%) and 17.8% thought non-clients, condom use, knowledge, attitudes, they had no risk or a low risk of HIV. Those who behaviors and practices regarding HIV, and STIs thought they had a high risk thought so because and stigma and discrimination towards HIV- they had had unprotected sex and also often be- infected persons. This questionnaire was con- cause they had a large number of partners. Twen- structed with NGOs working in the field, adapting ty-six percent of sex workers did not know where behavioral surveillance survey questionnaires 20. to get an HIV test. Twelve percent of the sex work- Nine questions specifically dealt with free volun- ers thought that HIV-infected persons should be tary counseling and testing (VCT).
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