Estimating the size of female sex workers in Cameroon to inform HIV program design and implementation

CaHReF 2016, Yaoundé Conges hall, 23 – 26 August 2016 , PL201

Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1

Female Sex Workers (FSWs) represent a key driver of HIV/AIDS in Cameroon. Due to their high HIV prevalence (36.5%) they have been prioritized in the national HIV response. The objectives of this study were to estimate the size of FSWs, their typologies; the service availability at FSWs sites and neighborhood to strengthen the HIV prevention program.

Cities selected for mapping included Bafoussam, Bamenda, Bertoua, Buea, Douala, Kribi, Limbé, and Yaoundé. A programmatic mapping approach was used, consisting of interviews with secondary key informantsto identify ‘‘hot’’ spots frequented by FSW, their operational dynamics and the estimated numbers of FSW in those spots.This was followed by validation of the estimates through interviews with FSW at each spot identified.

A total of 2,194 hotspots were identified: Douala (760), Yaoundé (622), Bamenda (263), Bafoussam (194), Kribi (154), Bertoua (140), Limbé (35), and Buea (26). The estimated total number (with range) of FSWs were 21,124 (16,079-26,170): Douala 7,557 (5,550-9,364), Yaoundé 6,596 (4,712-8,480), Bafoussam 2,458 (1,994-2,923), Bamenda 1,975 (1,605-2,345), Kribi 1,121 (832-1,408), Bertoua 1,044 (891-1,198), Buea 225 (185-266), and Limbé 148 (110-148). The variability of estimates among cities was also observed within city councils . Size estimations in the councils mapped were extended to non-mapped councils using Poisson regression. The national predicted estimates of FSW population was 115,562 (99,931-131,192), covering all councils of Cameroon, which was approximately two percent (1.96%:  0.5%-3.43%) of adult female population in Cameroon .The key operational typologies reported were Bar (45.3%), Hotel/Brothel (21.1%), Street (13.8%), and Night Club (13.5%) based SWs. Forty three percent of hotspots had received free prevention services during the last 6 months.

The results of this study can be extensively used to inform FSW program planning and implementation. These include providing: a) denominators for setting coverage targets and program reach; b) critical information that can be included in the terms of references of implementing agencies; c) sampling frame for planned research studies. Information on the operational typologies of the hotspots can be used in determining the best service delivery modalities and intervention packages to be provided.