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The first category of professional FSWs Finally, the consumption of other psycho-active substances, frequently observed among the kata subgroup, also increases the risk of acquiring HIV among sex workers Fritz et al.

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Spectrum of female commercial sex work in Bangui, Central African Republic

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Thus, efforts to support progressive policy and legislation concerning FSW through the minimum packages of services for the country will likely encourage decreasing barriers to STI prevention and care services for populations that already face societal discrimination.

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Spectrum of female commercial sex work in Bangui, Central African Republic

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In each study enrolment area, women were recruited on a volunteer basis. Twelve peer educators contacted all women attending the 21 selected sites during a 3-month period and proposed that they be included in the study after an oral explanation and collective awareness sessions on the objectives of the survey. It contained questions on demographic and behavioural data, knowledge of HIV infection, associated diseases and comorbidities, and possible sex transactions, and included the following sections: 0 identification data 5 items1 background characteristics 12 items2 marriage, family, work 9 items3 sexual history: numbers and types of partners Prostitutes Le Kremlin-Bicetre items4 sexual history: paying clients 6 items5 sexual history: non-paying Prostitutes Le Kremlin-Bicetre 6 items6 use of male and female condoms 7 items7 STIs 5 items8 knowledge, opinions and attitudes towards HIV and AIDS 18 items and 9 STIs and HIV prevention 3 items.

In addition to the questionnaire, open questions were asked about the characteristics of sex work by the counsellors. It is worth noting that the invitation to attend the clinical centre was proposed to all women, regardless of possible paid sexual practices.

Note that the study participants were not recruited because of external evidence of sex work, such as evocating clothing or dressing, nor because obvious lingering around the sex trade hotspot.

Inclusion criteria consisted of the following: being a volunteer, having given oral consent, being sexually active, having more than three sexual partners, other than a regular partner, during the prior three months and having received money or gifts in return for sexual relationships. Exclusion criteria included not willing to participate to the study, having had a sexual relationship to obtain a job or to obtain a good average at school or university.

All women attending benefited from clinical services clinical examination, adapted biological analyses and carereceived an information session on HIV and STIs, and completed a face-to-face questionnaire. The following variables were taken into consideration. The results of the previously described variables of the questionnaire were entered into an Excel sheet and analysed using Epi Info TM version 3.

All included women gave their informed Prostitutes Le Kremlin-Bicetre consent to participate in the study. No consent from the parents or guardians Prostitutes Le Kremlin-Bicetre minor women could be obtained.

For each included woman, the record of the consent to participate in the Prostitutes Le Kremlin-Bicetre was documented on Prostitutes Le Kremlin-Bicetre questionnaire. This Prostitutes Le Kremlin-Bicetre procedure was formally approved by the National Ethical Committee.

A total of women received information about the objectives of the study and advice on sexual and reproductive health, as presented in the study flow chart Fig. Thousand hundred and twenty-eight Among the women sensitized to the study purposes, Prostitutes Le Kremlin-Bicetre, 12 questionnaires were excluded because 3 were incomplete and 9 were abandoned during execution.

Finally, FSW Prostitutes Le Kremlin-Bicetre were selected for study analysis.

Among them, The remaining Flow diagram showing enrolment, inclusion Prostitutes Le Kremlin-Bicetre data analysis for the study. The group of professional FSWs included women declaring paid sex as their principal sources of income, and the other women who practiced occasional paid sex and had not declared themselves as FSWs were classified as non-professional or clandestine FSWs.

Besides the professional sex workers, non-professional sex workers appeared clearly as a frequent secondary population of FSWs. We attempted to define socio-behavioural categories, encompassing this Prostitutes Le Kremlin-Bicetre spectrum professionals and non-professionals of commercial sex activity in two different ways, depending on the main social and behavioural characteristics highlighted through the questionnaire.

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Firstly, we classified official professional FSWs Indeed, there was a marked separation between the two categories of professional FSWs, depending on whether they worked downtown, near hotels, in bars and night clubs or in the peripheral areas of Bangui. Prostitutes Le Kremlin-Bicetre first category of professional FSWs The second category of professional FSWs included women working in the poor neighbourhoods Prostitutes Le Kremlin-Bicetre Bangui, who are called kata a pejorative word with no other Sango meaning.

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Secondly, we classified non-professional FSWs Thus, four categories of non-professional FSW were identified according to Prostitutes Le Kremlin-Bicetre occupation as street vendors, schoolgirl or student, housewife or unskilled civil servant. The first category of non-professional FSWs included market and street vendors Actually, this activity often hides a commercial sex business.

The second category was schoolgirls or students Most do so to pay for their school fees or for their living expenses, but others Prostitutes Le Kremlin-Bicetre money to buy clothing or jewellery. Finally, the fourth category of non-professional FSWs was made up of unskilled female civil servants Table 1 depicts the characteristics of Prostitutes Le Kremlin-Bicetre FSW selected for study analysis.

Their mean age was The mean age of first sexual intercourse was 17 years range, 10—24 years. Our first approach for analysis was to compare professional versus non-professional Prostitutes Le Kremlin-Bicetre. Taken together, these observations demonstrate similar characteristics, but also demonstrate seemingly different profiles among professional and non-professional FSWs Table 2.

Thus, professional FSWs and non-professional FSWs have in common similar proportions of knowledge of HIV their serological status, past history of STIs Prostitutes Le Kremlin-Bicetre capability of proposing a condom to their last male sexual partner or to effectively use a condom during the last sexual intercourse. Regarding their differences, professional FSWs had generally reached legal majority age, but one-third of them were younger; about one Prostitutes Le Kremlin-Bicetre of five were foreigners from neighbouring countries; they were often relatively well educated; they had begun sexual life early; their knowledge of HIV was often satisfactory, without erroneous knowledge or misconception on AIDS, and they had a high proportion of self-perception of a high risk for Prostitutes Le Kremlin-Bicetre.

Finally, most professional FSWs regularly consumed alcohol or, to a lesser extent, psycho-active substances. Non-professional FSWs were older; they generally originated from the CAR; they had their first sexual intercourse near the age of majority; they were often poorly educated; their knowledge of HIV was often satisfactory, but they may have had erroneous information about AIDS; and they showed a low proportion of self-perception of the high risk of HIV.

Only a minority regularly consumed alcohol, and none of them consumed psycho-active substances. Combined, the category of official FSW comprised two subgroups of FSWs that presented fewer similarities than differences. The similarities were that they both basically considered themselves Prostitutes Le Kremlin-Bicetre FSWs, originating from the CAR, remaining largely free without a stable partner and, most often, having no or few children.

The differences were more evident. Prostitutes Le Kremlin-Bicetre usually Black men without preference on their nationalities men from CAR Prostitutes Le Kremlin-Bicetre well as foreigners.

Our third analysis approach was to compare the four discrete groups among non-professional FSWs Table 4. Non-professional FSWs practiced occasional paid sex as a secondary source of income, but did not consider or report themselves as FSWs. They were most often originating from the CAR. Taken together, the four subgroups of non-professional FSWs appeared very heterogeneous. The only similarities were that they Prostitutes Le Kremlin-Bicetre from CAR, had begun sexual life at a similar age and did not use psycho-active substances.

The three other groups showed more subtle differences, notably as regards marital status, number of children, past history of STI and alcohol consumption. Apart from housewives, they frequently used condoms and showed high capabilities to negotiate save sex. Occasional paid sex as secondary source of income in women not feeling themselves as prostitutes. Thus, we herein conducted a cross-sectional survey in a very heterogeneous population of women involved in commercial sex transactions.

We described a large socio-behavioural spectrum of commercial sex activities comprising both professional and non-professional FSWs living in Bangui, the capital city of the CAR. We first observed that an unexpectedly high proportion of women involved in CSW do not identify themselves as FSWs, despite an excessively high risk Prostitutes Le Kremlin-Bicetre exposure. The deep sociological and cultural background, including profound gender inequalities, as well as the practices of polygamy and of male monetary compensation for female sex, may explain the Prostitutes Le Kremlin-Bicetre of these non-professional groups, accentuated by the current difficult socio-economic conditions.

Developing comprehensive sexual health promotion programmes requires a comprehensive understanding of the spectrum of sex work in a particular area. Commercial sex activity is characterized by its considerable heterogeneity. These types of work are often grouped under the headings of direct and indirect CSW, with the latter group less likely to be perceived or to perceive themselves Prostitutes Le Kremlin-Bicetre sex workers.

Direct CSW includes a variety of sex-related services for which the primary purpose is the exchange of sex for a fee.

Other authors proposed a dual typology separating professional commercial sex workers from non-professional sex workers, to distinguish those that make this activity a primary occupation or source of income from those who practice it secondarily Nagot et al.

In our study, we were able to classify the women in two categories on the basis on their being reported as sex workers, corresponding to professional FSW or non-professional FSW. Both categories are associated with a great variety in the social context and Prostitutes Le Kremlin-Bicetre possible harms associated with such paid sex transactions. The public health implications of each category Prostitutes Le Kremlin-Bicetre vary widely, and our study provides relevant information for conceiving and developing appropriate and targeted programmes.

The category of non-professional FSW could be sub-divided into four subgroups, thus, it is widely heterogeneous. In Burkina Faso, Nagot and colleagues described four categories quite similar to those found in Bangui, including bar waitresses, street vendors, cabarets and students Nagot et al. The subgroup of women who sit on their stools and expect men in front of their working chamber, as previously reported in Burkina Faso Nagot et al.

Prostitutes Le Kremlin-Bicetre addition to the concept of free girl that applies to all, the Sango language assesses the existence of two groups of FSWs. Indeed, the term of pupulenge specifically designates young women seeking wealthy men especially Prostitutes Le Kremlin-Bicetre French soldiers stationed in Bangui.

Synonymous with pupulenge is another Sango term, gba moundjouwhich literally means look at the White. The pupulenge are contacted by their customers via the telephone, sometimes via the Internet, through the hotel staff, the staff employed in the military camps French or African peacekeeping forcesand sexual interactions take place in hotels or in private homes escorts.

They are also sought by their clients in places such as nightclubs, terraces, bars, hotels, airport arrival areas, swimming pools and gyms. The deprecating Prostitutes Le Kremlin-Bicetre kata designates a more heterogeneous population of usually young and frequently unschooled girls, living in the poor suburbs of Bangui who roam the streets of popular neighbourhoods looking for men. The kata seek their customers along the sidewalks or roads.

They also meet with their clients in drinking establishments clubs, bars or Prostitutes Le Kremlin-Bicetre halls of the lively and popular areas of the city.

They also perform at bus stations and taxi and bus parking areas. Sexual interactions may take place in cheap hostels, similar to brothels, or even outdoors Prostitutes Le Kremlin-Bicetre dark places. In this study, the risk of HIV exposure of women involved in commercial sex was found to be particularly high.

Similar observations of high-risk commercial sex have been previously reported in sub-Saharan Africa. For example, in the Republic of Congo Brazzavilleduring the 30 day period prior to being questioned, Taken together, these observations clearly demonstrate that the risk perception Prostitutes Le Kremlin-Bicetre to the category of male sex partner is variously appreciated among the population of FSWs, and, furthermore, it changes over time and with intervention programmes Ghys et al.

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It is remarkable Prostitutes Le Kremlin-Bicetre the risk perception with paying partners was particularly low in our study population, a finding that should be taken into account when planning interventions targeting FSWs in Prostitutes Le Kremlin-Bicetre CAR.

The ability to negotiate condom use with sexual partners, other than their regular partner, voluntary counselling and testing should clearly be improved because they are likely Prostitutes Le Kremlin-Bicetre have an impact on behaviour.

Another important observation is the lower frequency of condom use in the last sexual intercourse in non-professional FSWs, as Prostitutes Le Kremlin-Bicetre with professional FSWs The professional subgroups of kata and the non-professional subgroup of street vendors are often difficult to distinguish.

Indeed, some women are involved in informal trade as an activity, and in the long term, they may leave their small business for CSW since it pays more. Unexpectedly, no clandestine FSWs working in cabarets or in bars as waitresses could be observed in the present study, as described by other authors in West Africa Ahoyo et al.

Finally, the consumption of psycho-active substances, as an important cofactor contributing to sexual risk behaviours for HIV infection Bryant,was frequent, reaching daily excessive i. Alcohol consumption is also a factor contributing to unprotected sex in female FSWs Mgone et al.

An additional Prostitutes Le Kremlin-Bicetre feature is that Prostitutes Le Kremlin-Bicetre vast majority Finally, the consumption of other psycho-active substances, frequently observed among the kata subgroup, also increases the risk of acquiring HIV among sex workers Fritz et al. The World Health Organization recommends that information campaigns for the prevention of HIV and other STIs for general adult populations include the problem of sexual risk behaviour changes secondary to Prostitutes Le Kremlin-Bicetre and the consumption of other psycho-active substances, especially for vulnerable populations including sex workers and youths World Health Prostitutes Le Kremlin-Bicetre, Our study has some limitations.

Thus, the representativeness of the included study population likely depends on the completeness of the mapping sites of Prostitutes Le Kremlin-Bicetre sexual transactions that were used as a sampling frame. Second, participants were included on a voluntary basis for completion of the questionnaire. This latter approach may be a source of recruitment bias. Furthermore, by using a face-to-face questionnaire, the validity of the answers to the questions were collected from participants, including items related to the intimacy of their sexual life.

In the CAR, a number of women are unable to read and write properly, and so a self-administered questionnaire was not relevant for this reason; however, it has been documented that questions about personal privacy are best collected anonymously by means of a self-administered Prostitutes Le Kremlin-Bicetre Teunis, In addition, the recruitment based on associative networks Prostitutes Le Kremlin-Bicetre peer educators, which constituted the only way to easily connect with the social world of commercial sex workers, may have introduced a selection bias, at least because the Prostitutes Le Kremlin-Bicetre participants could themselves be part of the networks of peer educators.

Despite possible limitations, our study constitutes the first report providing objective information on the characteristics of women living in the CAR involved in transactional sex, thus, enabling us to propose a typology of female CSW that can very possibly be generalized to the whole country. It seems clear that FSWs of all categories are vulnerable because of the unequal gender relationships, gender violence and the Prostitutes Le Kremlin-Bicetre slipperiness of the lack of criminalization of sex work in Africa.

Our study constitutes the starting point for a reflection on the management of FSW in the CAR, including health authorities, non-governmental organizations of people living with HIV and public health researchers mainly from the faculty of medicine. The identification of several categories of FSW will help to determine the hot spots of some forms of Prostitutes Le Kremlin-Bicetre across the country, and also to estimate the number of FSWs to be targeted.

Targeted interventions that aim to increase condom use and reduce transmission of STI and HIV infection among FSWs and their clients have been shown to be feasible and effective Ghys et al. In addition, population-specific minimum packages of services will be defined for each category of reachable FSWs, including behaviour change, communication and condom promotion, by and in collaboration with peer educators, as well as STI screening and treatment, counselling, and Prostitutes Le Kremlin-Bicetre and care for the HIV infected Bekker et al.

In the CAR, commercial sex is legal but not regulated; however, brothels are illegal. Thus, efforts to support progressive policy and legislation concerning FSW through the minimum packages of services for the country will likely encourage decreasing barriers to STI prevention and care services for populations that already face societal discrimination. The final aim is to effect national intervention allowing the expansion and ramping up of both community-based and clinic-based HIV and STI prevention activities for FSWs country-wide.

The intervention will use a phased approach Prostitutes Le Kremlin-Bicetre new clinic sites providing services for FSWs. At each site, comprehensive minimum packages of prevention and care services will be offered.

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Challenge me! Categorization of commercial sex work Besides the professional sex workers, non-professional sex workers appeared clearly as a frequent secondary population of FSWs. External link.