Évaluation de l'association entre la violence, le bris du préservatif et l'infection à VIH parmi les travailleuses du sexe au Bénin, Afrique de l'Ouest

• Main Author: Tounkara, Fatoumata Korika
• Other Authors: Alary, Michel
• Format: Dissertation
• Language: French
• Published: Université Laval 2014
• Subjects: Condoms > Utilisation > Bénin; Infections à VIH > Bénin; Prostituées > Bénin; Femmes > Violence envers > Bénin
• Online Access: http://hdl.handle.net/20.500.11794/24820

Nous avons mesuré la fréquence de la violence physique, sexuelle et psychologique à l’encontre des femmes travailleuses du sexe et évalué l’association entre la violence, le bris du préservatif et l’infection à VIH. L’analyse multivariée de régression log-binomiale a été utilisée pour estimer les rapports de prévalence ajustés (RPa) du VIH. La prévalence du VIH était de 20,4%. Au total, 17,2%, 13,5% et 33,5% des participantes ont respectivement été exposées à la violence physique, sexuelle et psychologique; 15,9% ont rapporté avoir eu au moins un bris du préservatif au cours des rapports sexuels de la semaine précédant notre enquête. Les RPa du VIH étaient respectivement de 1,45 (intervalle de confiance [IC]95% : 1,05 – 2,00), 1,42 (IC95%1,02 – 1,98), et 1,41 (IC95%1,08 – 1,41) chez les femmes exposées à la violence physique, sexuelle et psychologique. Nos résultats montrent que les femmes exposées à la violence avaient une prévalence plus élevée du VIH. === Objective: To examine the relationship between violence, condom breakage and HIV prevalence among female sex workers (FSWs). Design: Data were obtained from the 2012 cross-sectional integrated biological and behavioural survey conducted in Benin. Methods: Multivariable log-binomial regression was used to estimate the adjusted prevalence ratios (APRs) of HIV infection and condom breakage in relation to violence towards FSWs. A score was created to examine the relationship between the number of violence types reported and HIV infection. Results: Among the 981 women who provided a blood sample, HIV prevalence was 20.4%. During the last month, 17.2%, 13.5% and 33.5% of them had experienced physical, sexual and psychological violence, respectively. In addition, 15.9% reported at least one condom breakage during the previous week. There was a significant association between all types of violence and HIV prevalence. The APRs of HIV were 1.45 (95% confidence interval [95%CI]: 1.05 - 2.00), 1.42 (95%CI: 1.02 - 1.98), and 1.41 (95%CI: 1.08 - 1.41) among those who had ever experienced physical, sexual and psychological violence, respectively. HIV prevalence increased with the violence score (p=0.002, test for trend), and physical and sexual violence were independently associated with condom breakage (p values 0.010 and 0.003, respectively). Conclusion: The results show that violence is associated with a higher HIV prevalence among FSWs and that condom breakage is a potential mediator for this association. Longitudinal studies designed to analyse this relationship and specific interventions integrated to current HIV prevention strategies are needed to reduce the burden of violence among FSWs. Key words: Violence, condom failure, HIV, female sex workers, sub-Saharan Africa.