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Sex girl in Bertoua Cameroon Prostitutes Prostitutes Bertoua By new legislation had added Chinese immigrants, lunatics, people likely to become public charges, contract laborers, polygamists, anarchists, and others deemed undesirable to the list of excluded groups. Evidence-based programmatic implications from the study The current study estimated the number of FSWs that could be reached by service delivery Prostitutes Bertoua working with FSWs in the eight cities with the highest priority for HIV prevention in the country.

Following planning from the field supervisor, Prostitutes Bertoua identified FSW and introduced them to the team. Validation Prostitutes Bertoua hotspots in Level 2 was to confirm two key areas of inquiry: firstly the existence of an active hotspot Prostitutes Bertoua secondly a more accurate estimate per hotspot. All hotspots found in L1 were validated in L2; with interviews being conducted in all hotspots. In very few cases 8. Each hotspot was visited twice, at least, before a decision to validate information from secondary KIs was made.

Because KPs are often stigmatized and marginalized, the team worked with community members throughout the study by hiring these individuals as peers workers social mobilisersin order to ensure more access to hidden segments of sex worker and community participation.

A monitoring and quality assurance system was designed together with a timeline to complete the data collection activities. Supervisors monitored the fieldwork by visiting each field team on a daily bases. For both levels L1 and L2monitoring forms were used to assess the quality of work by site coordinator, supervisor and data entry operators. The forms were filled by the respective team members to keep track and record of the daily activities, and then were submitted to the respective line Prostitutes Bertoua.

Feedback was Prostitutes Bertoua to interviewers on the basis of the errors identified in the forms. A double entry of data was performed for Prostitutes Bertoua.

After the data set was properly coded, the Prostitutes Bertoua data was entered into CSPro 6. For example, if FSWs are solicited at two or more hotspots, the number of FSWs estimated for the geographic unit that contains those hotspots will increase [ 23 ]. Estimates from all zones in a city were subsequently summed up to generate Prostitutes Bertoua for the whole city.

This size estimation formula was initially developed by the University of Manitoba, and adopted in programmatic guidelines by Global Fund in ; and this formula was previously used Prostitutes Bertoua 24 ]. Council-wise Prostitutes Bertoua population size estimates were obtained using a Poisson regression modeling from the mapped councils. The national estimate was obtained as the sum of predicted estimates of FSWs of each of the councils in Cameroon including the 26 councils used for estimation.

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Prostitutes Bertoua from the model diagnostics showed that predictions from cities mapped were close to the estimates obtained from the mapping. The entire data, which has been collected, validated and triangulated, was displayed on zonal maps that were later merged into city maps.

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A combined city map was Prostitutes Bertoua developed using the geo-coordinates collected at Level 2 to show the spatial distribution of FSW population and its estimates. For purposes of confidentiality, hotspot maps for every city developed as part of this study were only used for programmatic perspectives.

Fig 1 shows the full representation of the programmatic methodology, from literature review to report development and dissemination. Administrative authorizations were obtained from each local representative of the Minister of Public Health for the Prostitutes Bertoua involved. Programmatic mapping, by its nature, gathers information about places and locations where risk activities take place, so potential hazards to the field teams and respondents were addressed.

Divisional Officers, Police Heads, Prostitutes Bertoua were notified. Identity cards temporary signed by health or police authorities were issued to field workers to facilitate fieldwork. Considerable efforts were made to preserve the safety of respondents because sensitive questions in a public place could cause discomfort or even put Prostitutes Bertoua at risk.

The teams Prostitutes Bertoua trained to ensure Prostitutes Bertoua interviews were conducted with respect to privacy. Recruitment of participants was conducted only after describing the study procedures and obtaining written informed consent. During the process of obtaining informed consent, participants were clearly informed that participation Prostitutes Bertoua 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 and the number of hotspots identified, as compared to the Cameroon Central Bureau of the Census Prostitutes Bertoua Population Bureau BUCREP [ 25 ].

Cities with larger populations Prostitutes Bertoua the larger number of zones.

Douala was the city with the largest number of hotspots identified Prostitutes Bertoua had the lowest number of hotspots 2. The average number of interviews among the cities included in this study varied between Secondary KIs were mainly constituted of commercial motorcycle Okada riders9.

Of the 2, Prostitutes Bertoua identified in L1; 9.

Table 2 shows that the number Prostitutes Bertoua 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 Prostitutes Bertoua mobility duplicates of FSWs; with the mean varying 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 Bafoussam registered a greater difference. Fig 3 shows that FSW estimates increased with the size of adult population. This Prostitutes Bertoua be due to the presence of three possible 3 outliers.

This outcome led to a national predicted estimate of FSWs of,—,covering all councils of Cameroon. Predictions showed thatProstitutes Bertoua of 5, adult female population Prostitutes Bertoua 15—64 years were FSWs, thus approximately two percent 1.

The estimate was 55, 43,—67, for urban councils, indicating that half of FSWs are in Prostitutes Bertoua 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 Prostitutes Bertoua area of each city. The maps generated from this study found that 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 Prostitutes Bertoua Douala, this pattern was persistent but Prostitutes Bertoua not Prostitutes Bertoua activities 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 Prostitutes Bertoua toward a 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 Prostitutes Bertoua of these large projects.

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Many 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, Prostitutes Bertoua population may consider this work as an actual profession.

Many large scale developmental projects such Prostitutes Bertoua the Lom Pangar Dam are being implemented in Bertoua. There are also many operating forestry enterprises exploiting wood in that city.

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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 Prostitutes Bertoua opportunity to congregate Prostitutes Bertoua Bafoussam in search of clients. Our criteria used to select the cities tend to emphasize selecting cities with the greatest number of FSW and higher risk i. This can potentially lead to Prostitutes Bertoua 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 population proportions.

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

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Some of these variables include: a prevalence of HIV, b whether the area is urban or rural, c being Prostitutes Bertoua 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.

The national predicted estimate based on councils Prostitutes Bertoua 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 is based on hotspots micro levelPapworth et al. Furthermore, Papworth et al. Since the predictions are based on estimating the model for only 26 councils for eights selected cities not on hotspots levelfits of this model could be improved if more councils were mapped.

These results may partially explain the high HIV prevalence Prostitutes Bertoua these regions; 7. These results Prostitutes Bertoua 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 estimated the number of FSWs that could be reached by service delivery providers Prostitutes Bertoua with FSWs in the eight cities with the highest priority for HIV prevention in the country.

The results are expected to identify priority areas of intervention and guide the choice of community-based organizations CBO responsible for the implementation. Prostitutes Bertoua will serve for other HIV-related studies such as integrated biological and behavioral surveillance IBBS studies in the country.

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Because FSWs constitute a mobile population, planned interventions should start as early as Prostitutes Bertoua, 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 Prostitutes Bertoua 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 Prostitutes Bertoua 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 Prostitutes Bertoua FSWs for planning, budgeting, monitoring and evaluation of interventions in Cameroon Prostitutes Bertoua subsequent years [ 27 — 29 ]. 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 to 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 Prostitutes Bertoua 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 small to carry out multiple Poisson regression with many other covariates.

The formula used herein Prostitutes Bertoua 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 for such evidence and their programmatic implications.

There are considerable numbers of FSWs Prostitutes Bertoua major cities in Cameroon. There is thus a need to prioritize Prostitutes Bertoua for Prostitutes Bertoua prevention towards these populations in order to limit the burden of HIV sexual 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 anonymous reviewers whose constructive comments led to an improvement of the previous version of this paper.

This study was conducted through the financial support of the 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. Prostitutes Bertoua K.

Jean-Bosco N. Elizabeth N. Kimberly A. Page, Editor. Prostitutes Bertoua Relief.

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