Clients of female sex workers in Gonaives and St-Marc, Haiti characteristics, sexually transmitted infection prevalence and risk factors

Background: Few data exist on the role of clients of female sex workers (FSWs) in STI transmission. This study examined sociodemographic characteristics, risk behaviors, and STI prevalence among clients of FSWs in Haiti. Methods: A cross-sectional survey among clients of FWSs (n = 378). Clients were recruited by collaborating local FSWs directly on commercial sex sites. Dried blood spot samples were used to determine prevalence of HIV, syphilis, and herpes simplex virus 2 (HSV-2). Results: Of the respondents, 88% were younger than 30 years, and 60.7% were living with a partner. Fifty-nine percent of clients reported always using condoms with FSWs, 32.8% did so with their stable partners, and 44.9% with casual partners. Clients had a high number of partners; 39.9% had 10 or more within the previous 3 months. The prevalence of HIV-1, previous or active syphilis, and HSV-2 was 7.2%, 13.4%, and 22%, respectively. Multivariate analysis indicated that clients who had tried marijuana, were practicing Voodoo, had a history of STI or were infected with HSV-2 were more often HIV-positive. Living in Gonaives, not being Protestant, being employed, and having tried marijuana were associated with syphilis infection. Older clients, residents of Gonaives and Voodoo practitioners were more likely to be infected with HSV-2. Conclusion: STI prevalence was remarkably high among clients of FSWs. These men had many sex partners and condom use differed, depending on the category of partner. Clients of FSWs likely act as a bridge population, facilitating the spread of STI throughout the general population in Haiti, and should be targeted in prevention programs.