Concentrated and linked epidemics of both HSV-2 and HIV-1/HIV-2 infections in Senegal: public health impacts of the spread of HIV

Abstract

The objective of this article is to report seroprevalences on HIV and herpes simplex virus 2 (HSV-2) in female sex workers (FSW) and in two sentinel populations of pregnant women living in Senegal. Serosurveys of HIV and HSV-2 were conducted in two unselected sentinel populations from Dakar, Senegal, and its provinces, including in 2003 only pregnant women and 2006 pregnant women and FSW. The population study involved 888 pregnant women and 604 FSW. In pregnant women, HIV and HSV-2 seroprevalences were, respectively, 1.01% and 15.65%. There was no association between HSV-2 and HIV infection, whatever the age. In contrast, the seroprevalence of HIV infection in the group of FSW was high, reaching 22.9% in women over 30 years old. FSW above 20 years of age harboured much higher HSV-2 seroprevalences that those found in pregnant women of similar age groups. In FSW, strong associations between HSV-2 and age, and among HSV-2 and HIV-1 as well HIV-2, were evidenced. In conclusion, HIV epidemic remains concentrated in high-risk groups of the Senegalese population, such as the FSW population in which the seroprevalence of HSV-2 infection is very high. Intervention against STI including HSV-2 is urgently needed to prevent the spreading of HIV epidemic.

Low prevalences of HIV infection and HSV genital shedding in the general adult female population in Senegal

“…The present observations confirm and extend our previous serosurveys from the general population of adult Senegalese women living in Dakar and Koalack, who had low rates of seropositivity for HSV-2 infection [10,11], comparable with those usually reported in Western countries [21]. The low prevalence of HSV-2 in adult Senegalese women contrasts with the higher HSV-2 seroprevalence reported in the general populations living in neighbouring countries [22][23][24], as well as in central or southern Africa [25][26][27][28][29].…”

“…They also underwent clinical examination. Testing for HIV based on the national guidelines [11] and testing for other common etiologic agents causing STI was offered to the participants.…”

“…In contrast, the HSV-2 seroprevalence in men having sex with men and living in the urban areas of Senegal was much higher, reaching 23% in 2005 [12]. Furthermore, the HIV-1 and HSV-2 seroprevalence in FSW in Senegal were reported to be as high as 23% and 25%, respectively, in 2009 [11]. These observations suggest the possibility that HSV-2 infection is a co-factor in HIV transmission in certain high-risk Senegalese populations, rendering it necessary to survey both HIV and HSV-2 epidemics from a public health perspective [10].…”

“…In a recent survey, the HIV-1 and HSV-2 seroprevalence was low, estimated at approximately 1% and 15% among pregnant women in Dakar and in Kaolack, respectively, in 2004 [10,11]. In contrast, the HSV-2 seroprevalence in men having sex with men and living in the urban areas of Senegal was much higher, reaching 23% in 2005 [12].…”

Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review

“…In the studies reviewed, the average age of sex workers mostly fell between 24 and 31 years, with estimates lower among urban sex workers in East African countries such as Ethiopia and Kenya [4,24] and higher averages recorded in Senegal [58,62,63], and some studies in Ghana (median 37 years [42]) and Kenya (mean 35 and 41.1 years [64,65]). Of concern, several studies documented the existence of very young sex workers: in the Congo, 28% of FSW in a cross-sectional study were between 14 and 18 years [66], and 33% had entered the sex industry before the age of 14.…”