***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : To estimate the prevalence rates of HIV and other sexually transmitted infections ( STI ) among unregistered sex workers , and to describe their sociodemographic characteristics and sexual behaviours , and the reasons why they were not officially registered as sex workers , in order to design specific public health interventions . Methods : A one-stage cluster- sample survey was conducted in Dakar in 2000 . Unregistered sex workers were interviewed in r and omly selected establishments ( official and cl and estine bars , brothels and nightclubs ) , and blood , endocervical and vaginal sample s were collected for laboratory diagnosis . Results : A total of 390 women with a median age of 29 years were recruited . One-seventh of them were under the legal age for prostitution in Senegal ( 21 years ) . The median length of prostitution was 24 months and 73.5 % of the women stated regular prostitution . Three-quarters of the women were found to have markers for at least one infection . The prevalence rates were as follows : HIV-1 , 6.0 % ; HIV-2 , 3.6 % ; HIV-1 + 2 , 0.4 % ; syphilis , 23.8 % ; gonorrhea , 22.0 % ; chlamydial infection , 20.0 % ; trichomoniasis , 22.4 % ; c and idiasis , 19.0 % ; and bacterial vaginosis , 28.8 % . The main reported reason for non- registration was ignorance of the legal system and its procedures ( 19.4 % ) ; 18.9 % of the women refused to register . One-third of the women reported that their clients used condoms inconsistently or never . Conclusion : This survey suggests that a multidimensional public health response is needed in Senegal , comprising legal information , downwards revision of the legal age for prostitution , and specific medical follow-up based on education , condom promotion and management of STI for non-registered sex workers Background Concerns have been raised that marginalised population s may not achieve adequate compliance to antiretroviral therapy . Our objective was to describe the long-term virological , immunological and mortality outcomes of providing highly active antiretroviral therapy ( HAART ) with strong adherence support to HIV-infected female sex workers ( FSWs ) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women . Methods Prospect i ve study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007 . Patients were followed monthly for drug adherence ( interview and pill count ) , and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads ( PVLs ) and clinical events . Results 95 women , including 47 FSWs , were followed for a median of 32 months ( interquartile range [ IQR ] , 20 - 41 ) . At HAART initiation , the median CD4 count was 147 cells/μl ( IQR , 79 - 183 ) and 144 cells/μl ( 100 - 197 ) , and the mean PVLs were 4.94 log10copies/ml ( 95 % confidence interval [ CI ] , 4.70 - 5.18 ) and 5.15 log10 copies/ml ( 4.97 - 5.33 ) , in FSWs and non-FSWs , respectively . Four FSWs died during follow-up ( mortality rate : 1.7 per 100 person-years ) and none among other women . At 36 months , the median CD4 count increase was 230 cells/μl ( IQR , 90 - 400 ) in FSWs vs. 284 cells/μl ( 193 - 420 ) in non-FSWs ; PVL was undetectable in 81.8 % ( 95 % CI , 59.7 - 94.8 ) of FSWs vs. 100 % ( 83.9 - 100 ) of non-FSWs ; and high adherence to HAART ( > 95 % pills taken ) was reported by 83.3 % ( 95 % CI , 67.2 - 93.6 ) , 92.1 % ( 95 % CI , 78.6 - 98.3 ) , and 100 % ( 95 % CI , 54.1 - 100 ) of FSWs at 6 , 12 , and 36 months after HAART initiation , respectively , with no statistical difference compared to the pattern observed among non-FSWs . Conclusions Clinical and biological benefits of HAART can be maintained over the long term among FSWs in Africa and could also lead to important public health benefits Background To assess the performance of BED-CEIA ( BED ) and AxSYM Avidity Index ( Ax-AI ) assays in estimating HIV incidence among female sex workers ( FSW ) in Kigali , Rw and a. Methodology and Findings Eight hundred FSW of unknown HIV status were HIV tested ; HIV-positive women had BED and Ax-AI testing at baseline and ≥12 months later to estimate assay false-recent rates ( FRR ) . STARHS-based HIV incidence was estimated using the McWalter/Welte formula , and adjusted with locally derived FRR and CD4 results . HIV incidence and local assay window periods were estimated from a prospect i ve cohort of FSW . At baseline , 190 HIV-positive women were BED and Ax-AI tested ; 23 were classified as recent infection ( RI ) .  Assay FRR with 95 % confidence intervals were : 3.6 % ( 1.2–8.1 ) ( BED ) ; 10.6 % ( 6.1–17.0 ) ( Ax-AI ) ; and 2.1 % ( 0.4–6.1 ) ( BED/Ax-AI combined ) . After FRR-adjustment , incidence estimates by BED , Ax-AI , and BED/Ax-AI were : 5.5/100 person-years ( 95 % CI 2.2–8.7 ) ; 7.7 ( 3.2–12.3 ) ; and 4.4 ( 1.4–7.3 ) . After CD4-adjustment , BED , Ax-AI , and BED/Ax-AI incidence estimates were : 5.6 ( 2.6–8.6 ) ; 9.7 ( 5.0–14.4 ) ; and 4.7 ( 2.0–7.5 ) . HIV incidence rates in the first and second 6 months of the cohort were 4.6 ( 1.6–7.7 ) and 2.2 ( 0.1–4.4 ) . Conclusions Adjusted incidence estimates by BED/Ax-AI combined were similar to incidence in the first 6 months of the cohort . Furthermore , false-recent rate on the combined BED/Ax-AI algorithm was low and substantially lower than for either assay alone . Improved assay specificity with time since seroconversion suggests that specificity would be higher in population -based testing where more individuals have long-term infection OBJECTIVE To determine the efficacy of the nonoxynol 9 contraceptive sponge in preventing  sexual acquisition of the human immunodeficiency virus ( HIV ) .  DESIGN Prospect i ve , r and omized placebo-controlled trial . SETTING Research clinic for prostitutes in Nairobi , Kenya . PATIENTS AND INTERVENTIONS One hundred thirty-eight HIV-seronegative women were enrolled , of whom 74 were assigned to  nonoxynol 9 sponge use and 64 to  placebo  use . These two groups did not significantly differ with respect to demographic characteristics , sexual practice s , or prevalence of genital infections at enrollment , except for a lower number of sex partners per week and a higher initial prevalence of genital ulcers among women assigned to nonoxynol 9 sponge use . Among the 116 women who returned for follow-up , the mean duration s of follow-up were 14 and 17 months for the two groups , respectively . MAIN OUTCOME MEASURE HIV seroconversion . RESULTS Nonoxynol 9 sponge use was associated with an increased frequency of genital ulcers ( relative risk [ RR ] , 3.3 ; P less than .0001 ) and vulvitis ( RR , 3.3 ; P less than .0001 ) and a reduced risk of gonococcal cervicitis ( RR , 0.4 ; P less than .0001 ) . Twenty-seven ( 45 % ) of 60 women in the nonoxynol 9 sponge group and 20 ( 36 % ) of 56 women in the placebo group developed HIV antibodies . The hazard ratio for the association between nonoxynol 9 sponge use and HIV seroconversion was 1.7 ( 95 % confidence interval [ CI ] , 0.9 to 3.0 ) . Using multivariate analysis to control for the presence of genital ulcers at enrollment , the adjusted hazard ratio for the association between  nonoxynol 9 sponge use and seroconversion was 1.6 ( 95 % CI , 0.8 to 2.8 ) . CONCLUSIONS Genital ulcers and vulvitis occurred with increased frequency in nonoxynol 9 sponge users . We were unable to demonstrate that nonoxynol 9 sponge use was effective in reducing the risk of HIV infection among highly exposed women Objectives If proven acceptable , safe and effective , the diaphragm could be used as a female-controlled method of preventing both sexually-transmitted infections ( STIs ) and pregnancy . This study 's aim was to assess the acceptability and safety of the diaphragm  among sexually-active women in Mombasa , Kenya . Methods We conducted a 6-month prospect i ve study among female sex workers ( FSWs ) , and women attending sexual and reproductive health services .  Diaphragm acceptability was assessed using continuation rates and factors associated with acceptability . Safety evaluations included colposcopy findings and incidence of urinary tract infections ( UTIs ) and STIs . Results Half the 185 participants were FSWs who had less schooling and were less likely to be married than other women . After 6 months , 55 % ( 56/102 ) of sexually-active women reported having used the  diaphragm  each sex act during the preceding month . Women liked using the diaphragm  ( 95 % , 104/109 ) , and 96 % ( 125/130 ) reported willingness to continue using it . Colposcopy did not reveal significantly more vaginal or cervical lesions . Use of the diaphragm was not associated with an increase in bacterial vaginosis or UTIs . A pregnancy rate of 12 per 100 women/years was observed . Conclusion After 6 months of diaphragm use in this setting , continuation rates were sustained , user satisfaction was high and adverse effects were few Objective To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra , Ghana . Design The 4-year prospect i ve study follows-up cohorts enrolled in the intervention in 1987 and 1988 , comparing condom use in 1991 with that among a comparison group not enrolled in the intervention . Setting The community-based intervention was initiated in Accra , Ghana in 1987 . Participants Self-identified female prostitutes who volunteered participation . InterventionThe educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributers to their peers . Outcome measures Self-reported condom use with clients . Results Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention . In 1991 , after 3 years of program relapse , 107 ( 43 % ) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview . Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled . Sixty-four per cent of those followed-up reported always using condoms with clients in 1991 . These ‘ always users ' were more likely to have maintained informal contact with project staff , know that HIV can be transmitted by healthy clients , and report that clients frequently initiate condom use . Conclusions Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes , available channels for informal program diffusion , individual changes in condom use over time , and the role of clients in condom negotiation Viral DNA load and physical status might be predictive of either high- grade cervical lesions or disease progression among women infected by human papillomavirus ( HPV ) 16 , but these virological markers have rarely been studied in HPV 18 infections . The relationships between HPV 18 DNA load , viral genome physical status and cervical squamous intraepithelial lesions were analyzed among female sex workers infected with HPV18 in Burkina Faso .  HPV 18 E2 and E6 genes were quantitated by real-time PCR .  Among 21 women infected with HPV 18 , 67 % of whom were HIV-1-seropositive , 11 ( 52.4 % ) had a normal cytology , 8 ( 38.1 % ) had low- grade squamous intraepithelial lesions , and 2 ( 9.5 % ) had high- grade squamous intraepithelial lesions .  Total viral load and integrated viral load were 
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Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities , few progressed to involvement , community ownership or sustainability .
These reported improved sexual negotiating power and community solidarity , and positive behavioural and clinical outcomes .
Sustainability of many projects was weakened by disunity within transient communities , variable commitment of programmers , low human re source capacity and general re source limitations .
Conclusions Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment , although isolated projects demonstrate proof of concept for successful empowerment interventions in African setting