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Classification of professional and non-professional female sex workers FSWs into different categories, never previously reported in the Central African Republic CAR , may be useful to assess the dynamics of the human immunodeficiency virus HIV epidemic, design operational intervention programmes to combat HIV and other sexually transmitted infections STIs and to adapt these programmes to the broad spectrum of sexual transactions in the CAR.

Our study proposes a socio-behavioural classification of FSWs living in the CAR and engaged in transactional and commercial sex. Thus, the aims of the study were these: A cross-sectional questionnaire survey was conducted in to describe the spectrum of commercial sex work CSW in Bangui among sexually active women having more than 2 sexual partners, other than their regular partner, during the prior 3 months and reporting to have received money or gifts in return for their sexual relationships.

According to socio-behavioural characteristics, FSWs were classified into six different categories. Professional FSWs, constituting Non-professional FSWs, constituting The groups of katas and street vendors were poorer and less educated, consumed more alcohol or other psycho-active substances cannabis, tramadol and glue and, consequently, were more exposed to STI. Specifically, a strong synergistic association between heterosexual transmission and acquisition of HIV and genital herpes type 2 has been demonstrated in sexually active adults LeGoff et al.

In Africa, sex work may be stigmatized and illegal, and female sex workers FSWs represent a particularly marginalized section of the population. Current research on the extent and context of CSW in sub-Saharan Africa includes several important outcomes Ngugi et al. Indeed, policy debates are often fuelled by passionate advocates both for and against the selling of sex.

Feminist debates on the issue are fervent and often polarized, with one side arguing CSW is always forced and, thus, equates to rape Schwitters et al. Finally, the categorization of FSW could help to conceive and adapt public health interventions in the direction of specific groups of vulnerable women, by improving understanding of the location, population size, density and organizational typologies of CSW Ikpeazu et al.

However, to this point, little consideration has been given to the different patterns and faces that CSW displays in the CAR. Most previous studies focused on women who identified themselves as commercial FSWs, representing only the visible CSW network, with the nature and role of clandestine CSW being generally ignored Nagot et al. Finally, the aim of the present work is to propose a socio-behavioural classification of the various modalities of professional and non-professional transactional and commercial sex activity among adult women living in Bangui, the capital city of the CAR.

The study was a descriptive, quantitative, population-based cross-sectional survey, using a face-to-face questionnaire to collect data in among FSW populations living in Bangui. Field survey and data collection were preceded by an exploratory survey and pilot study done to validate the instrument of data collection, especially the questionnaire used for the study. An empirical purposive sampling strategy was used to select the study FSW population by which the representativeness of commercial sex work in Bangui was expected to be ensured by the reasoned approach of our enrolment and selection protocol.

In order to avoid selection bias, the vast majority of the most notorious places were sex trade occurs in Bangui, including schools and universities, were selected. Due to a lack of information on the study target of FSWs in Bangui, our approach was to first establish a possible cartography of the vast majority of well-known areas of sex transactions throughout the city.

In addition, 13 secondary schools and university institutions were also selected. In each study enrolment area, women were recruited on a volunteer basis. Twelve peer educators contacted all women attending the 21 selected sites during a 3-month period and proposed that they be included in the study after an oral explanation and collective awareness sessions on the objectives of the survey. It contained questions on demographic and behavioural data, knowledge of HIV infection, associated diseases and comorbidities, and possible sex transactions, and included the following sections: In addition to the questionnaire, open questions were asked about the characteristics of sex work by the counsellors.

It is worth noting that the invitation to attend the clinical centre was proposed to all women, regardless of possible paid sexual practices. Note that the study participants were not recruited because of external evidence of sex work, such as evocating clothing or dressing, nor because obvious lingering around the sex trade hotspot.

Inclusion criteria consisted of the following: Exclusion criteria included not willing to participate to the study, having had a sexual relationship to obtain a job or to obtain a good average at school or university. All women attending benefited from clinical services clinical examination, adapted biological analyses and care , received an information session on HIV and STIs, and completed a face-to-face questionnaire.

The following variables were taken into consideration. The results of the previously described variables of the questionnaire were entered into an Excel sheet and analysed using Epi Info TM version 3. All included women gave their informed oral consent to participate in the study.

No consent from the parents or guardians of minor women could be obtained. For each included woman, the record of the consent to participate in the study was documented on each questionnaire. This consent procedure was formally approved by the National Ethical Committee. A total of women received information about the objectives of the study and advice on sexual and reproductive health, as presented in the study flow chart Fig.

Thousand hundred and twenty-eight Among the women sensitized to the study purposes, However, 12 questionnaires were excluded because 3 were incomplete and 9 were abandoned during execution. Finally, FSW questionnaires were selected for study analysis.

Among them, The remaining Flow diagram showing enrolment, inclusion and data analysis for the study. The group of professional FSWs included women declaring paid sex as their principal sources of income, and the other women who practiced occasional paid sex and had not declared themselves as FSWs were classified as non-professional or clandestine FSWs. Besides the professional sex workers, non-professional sex workers appeared clearly as a frequent secondary population of FSWs.

We attempted to define socio-behavioural categories, encompassing this large spectrum professionals and non-professionals of commercial sex activity in two different ways, depending on the main social and behavioural characteristics highlighted through the questionnaire. Firstly, we classified official professional FSWs Indeed, there was a marked separation between the two categories of professional FSWs, depending on whether they worked downtown, near hotels, in bars and night clubs or in the peripheral areas of Bangui.

The first category of professional FSWs The second category of professional FSWs included women working in the poor neighbourhoods of Bangui, who are called kata a pejorative word with no other Sango meaning.

Secondly, we classified non-professional FSWs Thus, four categories of non-professional FSW were identified according to their occupation as street vendors, schoolgirl or student, housewife or unskilled civil servant. The first category of non-professional FSWs included market and street vendors Actually, this activity often hides a commercial sex business. The second category was schoolgirls or students Most do so to pay for their school fees or for their living expenses, but others want money to buy clothing or jewellery.

Finally, the fourth category of non-professional FSWs was made up of unskilled female civil servants Table 1 depicts the characteristics of the FSW selected for study analysis. Their mean age was The mean age of first sexual intercourse was 17 years range, 10—24 years. Sexually transmitted infection; NA: Our first approach for analysis was to compare professional versus non-professional FSWs. Taken together, these observations demonstrate similar characteristics, but also demonstrate seemingly different profiles among professional and non-professional FSWs Table 2.

Thus, professional FSWs and non-professional FSWs have in common similar proportions of knowledge of HIV their serological status, past history of STIs and capability of proposing a condom to their last male sexual partner or to effectively use a condom during the last sexual intercourse. Regarding their differences, professional FSWs had generally reached legal majority age, but one-third of them were younger; about one out of five were foreigners from neighbouring countries; they were often relatively well educated; they had begun sexual life early; their knowledge of HIV was often satisfactory, without erroneous knowledge or misconception on AIDS, and they had a high proportion of self-perception of a high risk for HIV.

Finally, most professional FSWs regularly consumed alcohol or, to a lesser extent, psycho-active substances. Non-professional FSWs were older; they generally originated from the CAR; they had their first sexual intercourse near the age of majority; they were often poorly educated; their knowledge of HIV was often satisfactory, but they may have had erroneous information about AIDS; and they showed a low proportion of self-perception of the high risk of HIV.

Only a minority regularly consumed alcohol, and none of them consumed psycho-active substances. Combined, the category of official FSW comprised two subgroups of FSWs that presented fewer similarities than differences. The similarities were that they both basically considered themselves as FSWs, originating from the CAR, remaining largely free without a stable partner and, most often, having no or few children. The differences were more evident. Our third analysis approach was to compare the four discrete groups among non-professional FSWs Table 4.

Non-professional FSWs practiced occasional paid sex as a secondary source of income, but did not consider or report themselves as FSWs. They were most often originating from the CAR. Taken together, the four subgroups of non-professional FSWs appeared very heterogeneous. The only similarities were that they originated from CAR, had begun sexual life at a similar age and did not use psycho-active substances.

The three other groups showed more subtle differences, notably as regards marital status, number of children, past history of STI and alcohol consumption. Apart from housewives, they frequently used condoms and showed high capabilities to negotiate save sex. Thus, we herein conducted a cross-sectional survey in a very heterogeneous population of women involved in commercial sex transactions.

We described a large socio-behavioural spectrum of commercial sex activities comprising both professional and non-professional FSWs living in Bangui, the capital city of the CAR.

We first observed that an unexpectedly high proportion of women involved in CSW do not identify themselves as FSWs, despite an excessively high risk of exposure. The deep sociological and cultural background, including profound gender inequalities, as well as the practices of polygamy and of male monetary compensation for female sex, may explain the importance of these non-professional groups, accentuated by the current difficult socio-economic conditions.

Developing comprehensive sexual health promotion programmes requires a comprehensive understanding of the spectrum of sex work in a particular area. Commercial sex activity is characterized by its considerable heterogeneity.

These types of work are often grouped under the headings of direct and indirect CSW, with the latter group less likely to be perceived or to perceive themselves as sex workers. Direct CSW includes a variety of sex-related services for which the primary purpose is the exchange of sex for a fee.

Other authors proposed a dual typology separating professional commercial sex workers from non-professional sex workers, to distinguish those that make this activity a primary occupation or source of income from those who practice it secondarily Nagot et al.

In our study, we were able to classify the women in two categories on the basis on their being reported as sex workers, corresponding to professional FSW or non-professional FSW. Both categories are associated with a great variety in the social context and the possible harms associated with such paid sex transactions. The public health implications of each category may vary widely, and our study provides relevant information for conceiving and developing appropriate and targeted programmes.

The category of non-professional FSW could be sub-divided into four subgroups, thus, it is widely heterogeneous. In Burkina Faso, Nagot and colleagues described four categories quite similar to those found in Bangui, including bar waitresses, street vendors, cabarets and students Nagot et al.

The subgroup of women who sit on their stools and expect men in front of their working chamber, as previously reported in Burkina Faso Nagot et al. In addition to the concept of free girl that applies to all, the Sango language assesses the existence of two groups of FSWs.

Indeed, the term of pupulenge specifically designates young women seeking wealthy men especially the French soldiers stationed in Bangui. Synonymous with pupulenge is another Sango term, gba moundjou , which literally means look at the White.

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Spectrum of female commercial sex work in Bangui, Central African Republic. Longo JD(1), Simaléko MM(1), Ngbale R(2), Grésenguet G(1), Brücker G(3), Bélec. Members of a U.N. peacekeeping force in the Central African Republic allegedly turned to sexual predation, betraying their duty to protect. “Anders Kompass: UN Whistleblower Who Exposed Child Sex Abuse by Peacekeepers in Central African Republic Is Cleared.” International Business Times.