Sex workers, marginalization and health
Research approaches to achieving health equity in Benin's sex trade environment


  • University of Abomey-Calavi (Bénin)
  • Laval University, Canada

Nominated Principal Investigator

  • Michel Alary, Laval University, Quebec City, Canada
  • Program team

    Principal Investigator

    • Adolphe Kpatchavi, University of Abomey-Calavi
      Abomey-Calavi, Benin


    • Emmanuelle Bédard, University of Quebec at Rimouski
      Lévis, Canada
    • Marie-Pierre Gagnon, Laval University
      Quebec City, Canada
    • Lisa Avery, University of Manitoba
      Winnipeg, Canada
    • Marcel Zannou, University of Abomey-Calavi
      Cotonou, Benin

    Knowledge users

    • Jérôme Charles Sossa, National AIDS Program of Benin
      Cotonou, Benin
    • Joséphat Avocè, OSV/Jordan
      Cotonou, Benin

    Program staff in Benin

    • Fernand Guédou
    • Luc Béhanzin
    • Victorin Sossoukpè
    • Hubert Anani
    • Jeannette DaSilveira
    • Hervé Thossou

    Program staff in Canada

    • Christian Lafrance
    • Johanne Leroux
    • Marylène Dugas

    Students and interns in Canada

    • Georges Batona
    • Fatoumata Korika

    Students and interns in Benin

    • Timothée Togbé
    • Mawoussi Aisségbé
    • Mistourath Sacca-Sidi
    • Mariette Aikpé
    • Egnonam Hadonou

Back row, left to right: Fernand Guédou, Adolphe Kpatchavi, Joséphat Avocè, Michel Alary, Hervé Thossou
Front row: Hubert Anani, Christian Lafrance, Georges Batona, Victorin Sossoukpè, Jeannette DaSilveira, Mariette Aikpé, Luc Béhanzin, Mistourath Sacca-Sidi

Program team, Benin

Research objectives

The research team is undertaking a research program whose general objective is to obtain a better understanding of the overall sexual and reproductive health (SRH) of female sex workers in Benin in order to develop, implement and evaluate interventions to prevent HIV and promote SRH among these women. The specific objectives of the program are divided into two components: Understanding and Action.


The research team is applying the conceptual frameworks of program science to the entire program, using intervention mapping to develop the interventions from the data collected in the Understanding component and Habicht and Victora's approach to conduct the evaluations. To achieve the objectives of the Understanding component, the team conducted a health services survey, a qualitative survey and a second-generation surveillance survey in Year 1 and a quantitative socio-behavioural survey of female sex workers in Year 2. Over the course of the rest of the grant, the team has been working on pre-testing, implementing and evaluating the interventions.

Project update: How can female sex trade workers in Cotonou, Benin, be mobilized to address health and violence?

In addition to their high risk of contracting HIV/AIDs, female sex workers in Cotonou (Republic of Benin, West Africa) suffer a high level of physical, sexual and psychological violence. These issues are generally underestimated and neglected by authorities and the community. Violence, in particular, is often considered to be "part of the job" and goes under-reported by those involved in the trade.

To address these issues and empower the community of approximately 1110 female sex workers living in Cotonou, Dr. Michel Alary and his colleagues working in Africa launched an initiative called Ensemble nous sommes plus fortes. To kick off the program, they hosted a workshop involving 30 sex workers and representatives from organizations working with them to identify their priorities, which included improving the living conditions of sex workers and their families, reducing violence and increasing the use of condoms. Once these priorities were identified, a group of 100 sex worker leaders and peer educators was established to support and advocate for this community. Since then, and thanks to a meeting of 225 female sex workers held in Cotonou in 2014, a self-governing organization of sex workers was created, called Association Solidarité.

To date, the Ensemble nous sommes plus fortes program has led to a number of improvements for this community, such as:

  • Brothel owners and bartenders have offered safe spaces for Association Solidarité's meetings;
  • Leaders and peer educators organize regular information sessions with female sex workers in their workplaces, including awareness sessions on HIV prevention, family planning and cervical cancer screening. The health information sessions, in particular, have led to increased demand for condoms (from workers) and voluntary visits to health service providers;
  • Workers have had the courage to call the vice squad for assistance when faced with aggression from customers, which is a positive new development for this community;
  • Meetings are providing women with the opportunity to share their stories about aggression, illness and death with their peers, which ultimately leads to better peer support; and
  • Health authorities are increasingly recognizing the need to involve female sex workers in health-related community activities. In addition, Association Solidarité is now involved in the various committees defining HIV/AIDS control strategies in Benin.

The female sex workers of Cotonou now actively negotiate with the owners of their workplaces and with law enforcement forces. They have united against customers who do not want to use condoms and those who use force to have unprotected sex. This research program is successfully empowering these women to identify and manage their social and health problems and is documenting the evolution of Association Solidarité.

Associated links

Selected publications

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