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Papworth et al. To our knowledge, Prostitutes Bertoua study is the first in Cameroon to estimate the size of FSWs at micro hotspot level for programming purposes. Telephones of Girls Bertoua A third important group are the Fulbe Fulawho have immigrated Prostitutes Bertoua the area in great numbers over the Escort Bertoua few decades.

The teams were trained to ensure that interviews were conducted with respect to privacy.

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Prostitutes Bertoua of participants was conducted only after describing the Prostitutes Bertoua procedures and obtaining written informed consent. During the process of obtaining informed consent, participants were clearly informed that participation is voluntary and that non-participation would have no negative consequences in terms of access to programs or services.

In addition, names of respondents were not asked for purposes of confidentiality and anonymity. All survey-related materials e.

Table 1 shows the number of zones where FSWs can be found in various cities in Cameroon as well as the number of interviews conducted, average interview per zone Prostitutes Bertoua the number of hotspots identified, as compared to the Cameroon Central Bureau of the Census and Population Bureau BUCREP [ 25 ].

Cities with larger populations had the larger number of zones. Douala was the city with the largest number of hotspots identified Prostitutes Bertoua Buea had the lowest number of hotspots 2.

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The average number of interviews among the cities included in this study varied between Secondary KIs were Prostitutes Bertoua constituted of commercial motorcycle Okada riders9. Of the 2, hotspots identified in L1; 9. Table 2 shows that Prostitutes Bertoua number of hotspots in every city was: Douala Table 2 shows the number of hotspots, estimated number of FSWs on usual days and on peak days in each of the mapped cities.

Table 2 also shows that heterogeneity in the Parameters for adjusting for mobility duplicates of FSWs; with the mean Prostitutes Bertoua from 1. Bamenda 2. The number of FSWs per adult males was particularly higher in Kribi Variations were also observed between rural and urban settings of the cities. In Urban settings, Bertoua Considering rural and urban settings of the same city, only Prostitutes Bertoua registered a greater difference.

Fig 3 shows that FSW estimates increased with the size of adult population. This may be due to the presence of three possible 3 outliers. This outcome led to a national predicted estimate of FSWs Prostitutes Bertoua,—,covering all councils of Cameroon. Predictions showed that Prostitutes Bertoua, out of 5, adult female population aged 15—64 years were FSWs, thus approximately two percent 1.

The estimate was 55, 43,—67, for urban Prostitutes Bertoua, indicating that half of Prostitutes Bertoua are in urban areas. The predicted FSWs per adult male varied from The hotspots appeared to be unevenly distributed across and within cities and often regrouped into clusters. Most hotspots were located in the urban area of each city.

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The maps generated from this study found Prostitutes Bertoua most cities had hotspots concentrated in the commercial centers and along the major roads and highways leading in and out of the cities. In larger cities such as Douala, this pattern was persistent but did not preclude Prostitutes Bertoua from being dispersed to other areas of the city. Estimating the size of FSWs in a country with generalized HIV epidemics is of great importance to set-up programmatic interventions toward Prostitutes Bertoua better prevention of HIV transmission within such a high-risk population within a resource-limited setting context.

To our knowledge, this study is the first in Cameroon to estimate the size of FSWs at micro hotspot level for programming purposes.

These estimations showed the highest ratio of FSWs in Kribi Kribi is a touristic city visited and inhabited by many wealthy foreigners because of popular beaches. Many large scale developmental projects are currently being implemented in Kribi, such as its port. It is possible that FSWs are going to be moving to Kribi because of these large projects.

Prostitutes Bertoua hotspots are found in the area neighboring an oil producing factory showing a concentration of FSWs. Sex work does not seem to be stigmatized in Kribi, as culturally, the population may consider this work as an actual profession. Many large scale developmental projects such as the Lom Prostitutes Bertoua Dam are being implemented in Bertoua. There are also Prostitutes Bertoua operating forestry enterprises exploiting wood in that city. Many truckers also high risk populations who transport goods from Cameroon to other Central African countries reside in Bertoua.

The high rate of FSWs per adult male Thus, many FSWs may use this opportunity to congregate in Bafoussam in search of clients. Our criteria used to select the cities tend to emphasize selecting cities with the greatest number of Prostitutes Bertoua and higher risk i. This can potentially lead to bias in selecting the cities with larger populations of FSW for mapping, which can overestimate the national FSW population when generalizing from the 8 cities to the rest of the country, even taking into account Prostitutes Bertoua proportions.

Odek et al. The density of FSWs per capita being very different across cities in Cameroon is clearly an indication that in addition to population size, many other variables should enter into play as other predictors when estimating the size of FSWs.

Some of these variables include: a prevalence Prostitutes Bertoua HIV, b whether Prostitutes Bertoua area is urban or rural, c being a touristic site, d its economic opportunities, and e location along a major highway. Methods to deal with these other variables include stratification and multivariate Poisson.

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The national predicted estimate based on councils level of FSWs was,—, ; nearly two percent 1. Papworth et al. The difference with the current study is in terms of methodology and age group. Unlike programmatic mapping whose methodology Prostitutes Bertoua based on hotspots micro levelPapworth et al.

Furthermore, Papworth et al. Since the predictions are based Prostitutes Bertoua estimating the model for only 26 councils for eights selected cities not on hotspots Prostitutes Bertouafits of this model Prostitutes Bertoua be improved if more councils were mapped.

These results may partially explain the high HIV prevalence in these regions; 7. These results can serve in predicting the number of condoms to be distributed per region, as well as the minimum package of interventions for each region.

The current study Prostitutes Bertoua the number of FSWs that could be reached by service delivery providers working with FSWs in the eight cities with Prostitutes Bertoua highest priority for HIV prevention in the country. The results are expected to identify priority areas of intervention and guide Prostitutes Bertoua choice of community-based organizations CBO responsible for the implementation.

Recommendations will serve for other HIV-related studies such as integrated Prostitutes Bertoua and behavioral surveillance IBBS studies in the country. Because FSWs constitute a mobile population, planned interventions should start as early as possible, using current mapping as a routine exercise in order to help NGOs to achieve effective interventions. Mapping of other councils should continue in order to have reliable predictive estimates of the size of FSWs at the entire national level.

Implications of our findings therefore include providing: a denominators that can be used for setting coverage targets and program reach; b critical information that can be used as indicators for implementing agencies; and c sampling frame for operational studies. The Ministry of Public Health in Cameroon has endorsed these estimates of FSWs for planning, budgeting, monitoring and evaluation of interventions in Cameroon Prostitutes Bertoua subsequent years [ 27 — 29 Prostitutes Bertoua.

Some limitations could be reported from our study. For instance, our estimation was based on information from KIs, which is an approach less accurate compared Prostitutes Bertoua a census design, which is generally unfeasible in Cameroon since FSWs are stigmatized and they fear being recognized by family members and friends.

Also because sex work is illegal, they also have fear of being arrested by the police, thus making it difficult to reach them. In addition, this study could not capture hidden FSWs who do not operate in public places e. The adult population alone does not suffice in sizing FSWs in a city. Thus, predictions of this study can only be considered proxy of the true size of FSWs in Cameroon. Finally, the sample size was Prostitutes Bertoua to carry out multiple Poisson regression with many other covariates.

The formula used herein for estimation accounts for mobility of FSW between hotspots in a zone. However, it does not make any adjustment for mobility between cities, which infers likelihood for double counting.

In contrast, this bias is highly minimal because very few FSWs move from one city to another to find clients. Further investigations should be undertaken to account Prostitutes Bertoua such evidence and their programmatic implications.

There are considerable numbers of FSWs in major cities in Cameroon. There Prostitutes Bertoua thus a need to prioritize interventions for HIV prevention towards these populations in order to limit the burden of HIV Prostitutes Bertoua transmission nationwide.

Moreover, our findings would serve as baseline for informing the national HIV program on planning, implementation, monitoring and evaluation targeting FSWs in Cameroon.

We thank the study participants for their collaboration, and the Cameroonian authorities for facilitating the study implementation. We also thank the editor and four Prostitutes Bertoua reviewers whose constructive comments led to an improvement of the previous version of this paper. This study was conducted through the financial support of Prostitutes Bertoua World Bank Group.

The founder had no role in designing, implementing, analysing and in the decision for publication. National Center for Biotechnology InformationU. PLoS One. Published online Feb Serge C. Raoul A. Vincent K. Jean-Bosco N. Elizabeth N. Prostitutes Bertoua A. Page, Editor.

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Author information Article notes Copyright and License information Disclaimer. Competing Interests: The authors have Prostitutes Bertoua that no competing interests exist. Received Apr 20; Accepted Jan This is an open access article distributed under the terms Prostitutes Bertoua the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article has been cited by other articles in PMC.

Associated Data Data Availability Statement Data are legally and ethically Prostitutes Bertoua from public sharing. Materials and methods Study design A cross-sectional study was conducted from September 5 th to November 30 th in locations of Cameroon where high-risk activities related to HIV transmission occur hotspots among FSWs.

Study procedure The target area for mapping was defined by selecting the cities to be Prostitutes Bertoua. Open in a separate window. Fig 1. Level 1 activity Level 1 was the first phase of field activity, in which information was collected on the various high-risk activities and individuals within each zone, by interviewing secondary KIs. Data quality assurance A Prostitutes Bertoua and quality assurance system was designed together with a timeline to complete the Prostitutes Bertoua collection activities.

Data management and analysis After the data set was properly coded, the entire data was entered into CSPro 6. Predicting Prostitutes Bertoua estimates of FSWs Council-wise FSW population size estimates were obtained using a Poisson regression modeling from the mapped councils.

Developing hotspot maps The entire data, which has been collected, validated and triangulated, was displayed on zonal maps that were later merged into city maps. Results Hotspots Prostitutes Bertoua and distribution of secondary key informants Table 1 Prostitutes Bertoua the number of zones where FSWs Prostitutes Bertoua be found in various cities in Cameroon as well as the number of interviews conducted, average interview per zone and the number of hotspots identified, as compared to the Cameroon Central Bureau of the Census and Population Bureau BUCREP [ 25 ].

Table 1 Number of zones, secondary KIs interviewersand hotspots identified during L1 data collection.

Fig 2. Prostitutes Bertoua of L1 interviewers per type of secondary key informants. L1: level one. Table 2 Estimated number of FSWs per city with mobility parameters. Table 3 Comparison of estimates between cities. FSW: female sex workers. Fig 3. FSW estimates Prostitutes Bertoua adult population in councils of selected cities.

FSW: female sex worker. Table 4 Prediction of FSWs estimation per region. Locations of FSWs The hotspots appeared Prostitutes Bertoua be unevenly distributed across and Prostitutes Bertoua cities and often regrouped into clusters.

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