2016 Integrated Biological and Behavioral Survey (IBBS) Report among Key Populations in Cameroon: Female sex workers and men who have sex with men

In Cameroon, HIV is disproportionately high among female sex workers (FSW) and
men who have sex with men (MSM) compared to the overall adult population (national
prevalence 4.3% in 2011)1. In 2016 an Integrated Biological and Behavioral Survey (IBBS) was conducted among these two key populations. The aim of the IBBS was to assess the knowledge, attitude, risk behavior, and prevalence of HIV and syphilis infections among FSW and MSM in Cameroon, in order to inform programmatic interventions and policies to reduce disease prevalence and incidence in these populations.

A cross-sectional survey was conducted among FSW and MSM recruited from five
locations from December 2015-October 2016. Participants were recruited through respondent
driven sampling (RDS), which enables recruitment of hard-to-reach populations. Trained
interviewers administered a behavioral questionnaire and conducted rapid serological testing for HIV and syphilis. This report focuses on descriptive indicators of risk, HIV prevalence and active syphilis.

In total, 2255 FSW and 1323 MSM were recruited and tested for HIV and syphilis.
Female sex workers: The estimated number (95% CI) of FSW in major cities was: Yaoundé 8,948 (6,988–12,434), Douala 7,111 (7,111–12,652) and Bamenda 1,334 (1,042–1,854). It was
estimated that 1.5% of reproductive aged women in major cities are FSW.
Overall, the crude HIV prevalence estimate was 24.3% (547/2,255), which included 254 (48.3%) FSW with newly diagnosed HIV infection. RDS-adjusted point estimates (95% CI) varied by city: Yaoundé 21.1% (16.9–25.9); Douala 30.3% (23.8–37.7); Bertoua 18.7% (13.3–25.7); Bamenda 33.9% (26.9–41.8); and Kribi 13.6% (10.4–17.6). Crude syphilis prevalence was 8.2% (186/2,255) overall, and 9.5% of HIV positive FSW were coinfected with syphilis.
In addition to their clients, FSW commonly reported regular (83.5%) and casual (27.7%) nonpaying partners. Consistent condom use (CCU) was highest with clients (77.5%) followed by casual non-paying partners (51.3%) then regular non-paying partners (19.5%).
The most common negative experiences related to sex work reported by FSW were blackmail
(44.7%), being arrested (33.5%) and being physically harassed or hurt (24.8%). Further, 32.6% of FSW reported ever being forced to have sex against their will.

Men who have sex with men: The estimated number (95% CI) of MSM in major cities was:
Yaoundé 4,967 (3,506–8,516), Douala 5,069 (3,578–8,692) and Bamenda 705 (4,498–1,209). It was estimated that 0.8% of reproductive aged men in major cities are MSM.
Overall, the crude HIV prevalence estimate was 20.7% (272/1,323), which included 158 (58.1%) MSM with newly diagnosed HIV infection. RDS-adjusted estimates varied by city: Yaoundé 43.1% (33.0-53.7); Douala 20.5% (13.3–30.4); Bertoua 7.2% (4.1–12.5); and Kribi 3.0% (1.4–6.4). Crude syphilis prevalence was 2.7% (36/1,323) overall, and 3.3% of HIV positive MSM were coinfected with syphilis. MSM reported both regular (85.5%) and casual (66.8%) male partners. CCU ranged from 33.8% during insertive sex with regular partners to 41.6% during receptive anal sex with casual partners. In addition to male sex partners, MSM commonly reported ever having regular female (66.2%) or casual female (50.3%) sex partners. CCU was low with female partners (21.5% and 32.4%, respectively). The most common negative experiences related to having sex with men reported by MSM were blackmail (22.6%), being arrested (14.7%) and verbal harassment (14.8%). Additionally, 16.7% of
MSM reported ever being forced to have sex against their will.