Conclusion

Au stade de l’épidémie au Bénin encore concentrée au sein des TS et leurs clients, le ciblage préventif de ces groupes noyaux, qui entretiennent la propagation de l’infection, a donné les résultats escomptés au travers d’un programme préventif holistique fait de volets programmatiques complémentaires et intégrés, développé dans le milieu prostitutionnel sur 15 ans au Bénin. Nos résultats suggèrent un plausible impact positif, des interventions

préventives des IST/VIH ciblant le milieu prostitutionnel, dans la réduction des prévalences des IST/VIH et dans l’adoption des comportements sexuels préventifs d’abord au sein des TS puis secondairement dans la population générale que notifiait la baisse significative de la prévalence du VIH au sein des jeunes hommes de la population de Cotonou.

Pour être efficace dans la réduction de la propagation de l’épidémie, les différentes composantes d’un programme de prévention holistique ciblant le milieu prostitutionnel et incluant la communication pour le changement de comportement, la prise en charge précoce des IST, la prise en charge aux ARV des personnes infectées par le VIH aussi bien que les interventions structurelles doivent être développées en arrimage. La planification d’un tel programme de prévention réellement adapté au contexte ainsi que son évaluation efficace ayant besoin de données exactes sur le profil épidémiologique, la comparaison de la méthode FTFI avec celle du PBS nous suggère que la méthode du PBS est adaptée au contexte du Bénin pour évaluer de façon valide les comportements à risque des IST/VIH, notamment les comportements sexuels plus sujets au biais de désirabilité sociale. Aux fins de validation de toutes les données comportementales déjà collectées au Bénin, l’évaluation de cette technique du PBS devrait être également réalisée dans les sous-populations particulièrement à risque pour le VIH, telles que les TS et leurs partenaires sexuels. Ainsi, les données issues des deux techniques peuvent être utilisées dans des procédures de contrôle des différents biais d’information inhérents aux données auto-rapportées par la technique FTFI. Pour un suivi et une évaluation efficaces des programmes de prévention de l’épidémie, la technique du PBS devrait être intégrée aux enquêtes comportementales.

Il serait intéressant qu’une évaluation globale des interventions préventives ciblées, à l’échelle nationale du Bénin, et intégrant la modélisation mathématique appliquée à l’ensemble des données observationnelles (comportementales et biologiques) provenant des différentes sous- populations concernées par l’épidémie dans les différentes zones d’interventions, et tenant compte de la dynamique de la transmission, complète la présente étude.

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