# Facilitators and barriers to the enrolment and retention of female sex workers in a sexual health cohort (ANRS 12381 PRINCESSE) in San-Pedro, Côte d'Ivoire

Evelyne Kissi, Rose-Marcelle Dedocoton, Marcelin N'Zebo Nouaman, Mélanie Plazy, Patrick Coffie, Aline Agoua, Joseph Larmarange, Valentine Becquet

<figure><img src="image_1.png" /></figure>

## To cite this version:

Evelyne Kissi, Rose-Marcelle Dedocoton, Marcelin N'Zebo Nouaman, Mélanie Plazy, Patrick Coffie, et al.. Facilitators and barriers to the enrolment and retention of female sex workers in a sexual health cohort (ANRS 12381 PRINCESSE) in San-Pedro, Côte d'Ivoire. AIDS 2024, the 25th International AIDS Conference, Jul 2024, Munich, Germany. . [hal-04660360](https://hal.science/hal-04660360v1)

HAL Id: hal-04660360

https://hal.science/hal-04660360v1

Submitted on 23 Jul 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_2.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
# Facilitators and barriers to sex workers' enrolment and retention in a sexual health cohort in San-Pedro, Côte d'Ivoire

Evelyne Kissi¹, Rose-Marcelle Dedocoton¹, Marcellin Nouaman², Mélanie Plazy³, Patrick A. Coffie⁴, Aline Agoua⁵, Joseph Larmarange⁶, Valentine Becquet⁷

1. Programme PAC-CI, site ANRS Côte d'Ivoire, Abidjan, Cote d'Ivoire, 2. Université Félix Houphouët-Boigny, Département de Santé Publique et d'Odontologie légale, UFR d'Odonto-Stomatologie, Abidjan, Cote d'Ivoire, 3. Bordeaux Population Health Research Center, Université de Bordeaux, Inserm, IRD, France, 4. Université Félix Houphouët Boigny, Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Abidjan, Cote d'Ivoire, 5. Aprosam NGO, San Pedro, Côte d'Ivoire, 6. Ceped, Université Paris Cité, IRD, Inserm, Paris, France, 7. Ined, Aubervilliers, France.

<figure><img src="image_3.png" /></figure>

## Background

The ANRS 12381 PRINCESSE project (November 2019 - June 2023) implemented chronic, community-based sexual and reproductive health care for female sex workers (FSWs) in the San Pedro region of Côte d'Ivoire. This care was provided directly at the sites of prostitution through a mobile clinic. A total of 489 women were enrolled. Retention was low, with less than a third of participants attending the six-month visit.

<figure><img src="image_4.png" /></figure>

## Objective

This analysis examines the factors that influence the adherence and retention of female sex workers (FSWs) in the project, based on their perceptions of the benefits and constraints associated with their participation.

<figure><img src="image_5.png" /></figure>

## Methods

<figure><img src="image_6.png" /></figure>

A qualitative study was conducted in three phases between May 2022 and November 2023. The study included:

* 16 interviews with female sex workers (FSWs) who were included in the project

* 3 interviews and 3 focus groups with FSWs who were not included in the project

* 10 interviews with FSWs who were lost to follow-up.

<figure><img src="image_7.png" /></figure>

## Results

The mobile clinic's physical proximity to the project site was instrumental in encouraging women to participate.

<figure><img src="image_8.png" /></figure>

> "The first day I was at the banguidrome [bistro] when the car drove by, I saw that they'd turned the thing on, and I said, 'What a big truck, it looks like a fridge! I saw the lady get out (...) to come and tell us we're here, come on, we're going to recruit you.'"

V, FSW included, Mai 2023

<figure><img src="image_9.png" /></figure>

In cities, schedules get in the way of their activities.

> "They come from 8pm; at night when they come the customers don't want to come, the customers are ashamed."

M, FSW included, Mai 2022

<figure><img src="image_10.png" /></figure>

<figure><img src="image_11.png" /></figure>

## Conclusion

We observed a peculiar trend in how FSWs perceived healthcare services. The healthcare offer was viewed as inadequate because it did not meet their needs and was considered too time-consuming. Rumors about blood management, FSWs' mobility, and insufficient material benefits affected their willingness to participate. Additionally, delays and stock shortages eroded women's confidence in the project. Nevertheless, the project team managed to keep FSWs engaged by building trust, which helped maintain their participation in the project.

<figure><img src="image_12.png" /></figure>

## Results (continued)

The project was successful because the caregivers and peer educators were welcoming and friendly. It helped sex workers to join and stay in the program.

<figure><img src="image_13.png" /></figure>

<figure><img src="image_14.png" /></figure>

> "Once I get in the truck, they take me well as their mommy who is at home (...) the children there are too nice."

EM, FSW included, May 2023

Free care was important.

<figure><img src="image_15.png" /></figure>

> "It's something you don't pay for (...) there's profit in it because I see they're treating me for free."

J, FSW included, May 2023

However, some difficulties limited adherence to the program

<figure><img src="image_16.png" /></figure>

Visits were too long and benefits were considered insufficient.

<figure><img src="image_17.png" /></figure>

<figure><img src="image_18.png" /></figure>

> "Their questions are too long. Let them do our tests, give us what they need to give us and then we'll go down."

S, FSW lost to follow-up Mai 2023

Not having the right tools or receiving tests late has made women less confident and has prevented them from getting into the truck.

<figure><img src="image_19.png" /></figure>

<figure><img src="image_20.png" /></figure>

> "They told us they had medicine, in case you explained your problem they could give you. But at one point they had nothing (...) Even if they can't have everything, at least the minimum. (...) That's why I stopped riding it."

A, FSWs lost to follow-up Mai 2023

<figure><img src="image_21.png" /></figure>

> "To take simple blood like that and then after there, result-there doesn't come."

Y, FSWs, lost to follow-up Mai 2022

<figure><img src="image_22.png" /></figure>

<figure><img src="image_23.png" /></figure>

Ceped
UMR 196

<figure><img src="image_24.png" /></figure>

Université
Paris Cité

<figure><img src="image_25.png" /></figure>

Institut de Recherche
pour le Développement
FRANCE

ined
INSTITUT NATIONAL
D'ÉTUDES DÉMOGRAPHIQUES

<figure><img src="image_26.png" /></figure>

BORDEAUX
POPULATION
HEALTH |

Cité de
Recherche - U1210

université
de BORDEAUX

<figure><img src="image_27.png" /></figure>

anrs
MALADIES INFECTIEUSES Inserm

<figure><img src="image_28.png" /></figure>

<figure><img src="image_29.png" /></figure>