Epidemiological trends in HIV infection among female sex workers in Cabo Verde, 2013-2023: evidence from three integrated bio-behavioural surveys.

INTRODUCTION: female sex workers (FSWs) remain disproportionately affected by human immunodeficiency virus (HIV) infection globally. In Cabo Verde, where the population HIV prevalence is below 1%, targeted surveillance among key populations is essential to sustain epidemic control. This study aimed to assess temporal trends in HIV infection prevalence, age-specific and geographic patterns, and behavioural and structural determinants of HIV infection among female sex workers in Cabo Verde between 2013 and 2023. METHODS: three cross-sectional integrated bio-behavioural surveys were in 2013 (n=452), 2017 (n=481), and 2023 (n=519) using respondent-driven sampling in six municipalities. Data were collected using structured interviewer-administered questionnaires and rapid HIV testing. Descriptive statistics, correlation analyses, and multivariable logistic regression were used to identify factors associated with HIV infection. RESULTS: HIV prevalence remained stable at 5.4% (2013), 5.3% (2017), and 4.9% (2023), far exceeding national levels (∼0.6%). Although HIV infection prevalence declined slightly over time (5.4% to 4.9%), this trend was not statistically significant (p for trend = 0.21). HIV infection prevalence was higher among older FSWs (30-44 years; 14.7%) and those with no formal education (23.1%). Age correlated positively with HIV (ρ=0.22, p<0.01), while education and condom use were inversely correlated. Older age (aOR=3.7, 95% CI: 1.9-6.9) and reported stigma (aOR=1.8, 95% CI: 1.1-3.0) independently predicted infection. CONCLUSION: HIV prevalence among FSWs in Cabo Verde has remained unchanged for a decade despite improved testing coverage (96% in 2023). Persistent structural inequities and stigma underscore the need for rights-based interventions, expanded PrEP, and strengthened prevention services for key populations.