P13.02
Background: In Rwanda, an estimated 3% of the adult population is infected with HIV (3.6% of adult women and 2.3% of adult men). This prevalence is higher in urban setting 7.1% compared to rural setting 2.3%, and HIV risk is highest in urban FSW. Urgent access to ART for FSWs is vital to reduce new infections in clients. Rwanda national guidelines for ART for FSWs affirm that HIV+FSWs should initiate ART regardless of CD4 cell count.
Methods: FSWs were invited for services at Project San Francisco in Kigali Rwanda from September 2012-April 2014. Prior HIV testing, use of ARVs, and risk factors including average number of clients, and disclosure of HIV status to/from clients were assessed.
Results: In this period, 677 FSWs were invited and tested for HIV and 372 (55%) were HIV+. Of these, 265 (71%) knew their HIV status beforehand and 186 (70%) FSWs were using ARVs. On average, FSW had 16 clients/month, one fifth of whom were regular/repeat clients. 51% of HIV+FSWs disclosed their HIV status to their clients (73% willingly, 27% by client request). 25% of HIV+FSWs reported requesting the HIV status of their clients and 11% of HIV+FSWs were willing to get tested with their clients. FSW charged a median of $8 for services (range $2-$50) and reported a variety of successful strategies to minimize risk of violence from clients. Oral sex was reported by 10% and anal sex by 15% of FSW; 31% reported using condoms all the time and 44% most of the time. One in three were illiterate in the local language and one in eight could understand French or English.
Conclusions: HIV testing should be promoted among FSW and counseling should emphasize Rwanda guidelines regarding ART. Research is needed to better understand obstacles to testing and ART in HIV+FSW. It is encouraging that many HIV+FSW disclose their HIV status to clients and are willing to be jointly tested with regular/repeat clients; this may be an avenue for prevention research. Inconsistent condom use remains a concern.
