A Tale of Two Countries: HIV Among Core Groups in Togo

Objective: To describe the epidemiology of HIV among core groups in Togo. Methods: We enumerated sex workers (SWs) and conducted cross-sectional surveys of SWs and their clients in 2003 in Lome and in 2005 in the whole country. Results: Sex work was concentrated in Lome, which comprised 15% of the population, but 52% of the 5397 SWs enumerated in Togo in 2005 and 68% of the estimated 101,376 men who had bought sex in the year before the 2005 survey. HIV prevalence among SWs was highest in Lome (45.4% in 2005) and progressively decreased from south to north. A similar geographical pattern was seen for clients (8.3% were HIV infected in Lome in 2005) and had already been reported for pregnant women. In Lome, the population attributable fraction of prevalent cases of HIV acquired during transactional sex was estimated at 32%; in the rest of the country, this was only 2%. Conclusions: This is the first study quantifying sex work at a national level in Africa. Variations in HIV prevalence within Togo, with a north-south gradient among SWs, their clients, and pregnant women, may to a large extent reflect the concentration of the sex trade within Lome. Prostitution played only a modest a role in HIV dynamics outside Lome.