The use of structural equation modelling and behavioural theory to target priority interventions to increase condom use among the intimate partners of sex workers in French Guiana

French Guiana is the French overseas territory that is most affected by HIV. Sex work seems to be an important driver of the epidemic. Although female sex workers are informed by local NGOs, they still have risky behaviours, including not using condoms with their intimate partner despite knowing HIV is highly prevalent. 

The objective of this study was to find intervention targets on this specific behaviour. For this, a structural equation model (SEM) was built using assumptions from behavioural theories. Behaviour theories attempt to connect research and practice. Within the health belief model framework, perceived threats, perceived benefits, and self-perceived efficacy were tested. Vulnerability was added because of the particular context of French Guiana. 

The results highlight that female sex workers’ perceived self-efficacy was central in condom use with the intimate partner (with a significant correlation coefficient of 0.52 in the SEM). The perceived self-efficacy was strongly influenced by sociodemographic factors, particularly by nationality. Female sex workers from Brazil seemed to be more comfortable about asking their intimate partner to use condoms (OR: 7.81; CI: 1.87–32.63) than sex workers of other nationalities. 

These results emphasize that prevention interventions for female sex workers should emphasize their empowerment.

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By:  Marie-Claire Parriault^a*, Astrid Van Melle^a, Célia Basurko^a, Leila Adriouch^b, Stéphanie Rogier^a, Pierre Couppié^c & Mathieu Nacher^ab

^a INSERM CIC 1424, Cayenne General Hospital, Cayenne, French Guiana

^b COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana

^c Department of Dermatology, Cayenne General Hospital, Cayenne, French Guiana

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Predictive Factors of Unprotected Sex for Female Sex Workers: First Study in French Guiana, The French Territory with the Highest HIV Prevalence

French Guiana is the French territory that is most affected by HIV. AIDS incidence is much higher than in mainland France and sex work seems to be an important driver of the epidemic. 

The objective of this study was to describe consistent condom use among female sex workers with their clients and their intimate partners and to identify determinants of non-use of condoms. An HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey was conducted in 2009-2010 among sex workers in French Guiana. A total of 477 sex workers were interviewed. 

Female sex workers were more likely to use condoms with their clients (97%) than with their intimate partners (45%). 

• The factors associated with non-consistent condom use with the intimate partner were 
• having had an abortion, 
• feeling at risk for HIV, 
• not evaluating one's own risk for HIV, 
• living as a couple, 
• being Dominican, 
• and not feeling comfortable asking intimate partners to use condoms. 

Although a high proportion of female sex workers declared using condoms with commercial partners, there is still room for improvement in the prevention of transmission with both commercial and intimate partners.

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By: Parriault MC1, Basurko C2, Melle AV2, Gaubert-Maréchal E3, Rogier S2, Couppié P4, Nacher M5.

• 1Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, French Guiana
• 2Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, French Guiana.
• 3COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana.
• 4Department of Dermatology, Cayenne General Hospital, Cayenne, French Guiana.
• 5Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, French Guiana COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana.

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HIV-Testing among Female Sex Workers on the Border Between Brazil & French Guiana: The Need for Targeted Interventions

The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. 

An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. 

One third (31.5%) of the interviewed had never tested for HIV. 

• Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, 
• to be 30 or older, 
• feeling at risk of HIV, 
• not evaluating one's own risk towards HIV, 
• and living in Oiapoque. 

These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.

Table 2 Predictive factors of having performed a free voluntary HIV test on the border between French Guiana and Brazilian (n = 194): bivariate and multivariate analyses. 

	Has already been tested for HIV n/total (%)	Crude OR (95%CI)	Adjusted OR (95%CI)	Adjusted p-value
Knowledge of where to test
Yes	111/143 (77.6)	1.00	1.00
No	20/51 (39.2)	0.12 (0.07-0.20)	0.23 (0.10-0.52)	0.000
Perceived risk of HIV
Feels at risk	28/43 (65.1)	0.93 (0.46-1.90)	0.26 (0.07-0.93)	0.039
Does not feel at risk	29/35 (82.8)	1.00	1.00
Does not know	35/77 (45.4)	0.21 (0.11-0.40)	0.33 (0.11-0.99)	0.049
No response	40/44 (90.9)	6.85 (2.33-20.10)	3.46 (0.79-15.08)	0.099
Median age
Less than 30	94/129 (72.9)	1.00	1.00
30 or more	38/70 (54.3)	1.40 (0.91-2.15)	0.28 (0.12-0.63)	0.002
Lives in Oiapoque
Yes	104/169 (61.5)	0.11 (0.03-0.49)	0.05 (0.01-0.28)	0.001
No	28/30 (93.3)	1.00	1.00

95%CI: 95% confidence interval; OR: odds ratio.

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By:  Parriault MC1, van Melle A1, Basurko C1, Gaubert-Marechal E2, Macena RH3, Rogier S1, Kerr LR3, Nacher M1.

• 1Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, GF.
• 2COREVIH Guyane, Cayenne General Hospital, Cayenne, GF.
• 3Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, BR.
• 
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