title: HIV diagnosis, linkage to HIV care, and HIV risk behaviors among newly diagnosed HIV-positive female sex workers in Kigali, Rwanda.
abstract: OBJECTIVE
  To evaluate linkage-to-care, sexual behavior change, and psychosocial experiences among newly HIV-diagnosed female sex workers (FSWs) in Rwanda.
  
  
  METHODS
  FSWs (n = 800) with unknown serostatus were screened for HIV during 2007/2008. Women testing HIV positive (n = 192) were referred to care and asked to return for interviews and laboratory testing 12-36 months postdiagnosis. One hundred fourty-one women (73%) returned for the postdiagnosis visit.
  
  
  RESULTS
  Median CD4 count at diagnosis was 460 cells per microliter [interquartile range (IQR): 308-628], with 32% eligible for antiretroviral therapy (ART) per national CD4 criteria (median CD4: 235, IQR: 152-303). Postdiagnosis, 92% of women reported having disclosed their HIV status to a friend or relative, 85% reported having enrolled in HIV care (median 30 days after diagnosis, IQR: 7-360), including 89% among ART-eligible women. Among ART-eligible women in care, 87% had initiated ART, with a median follow-up CD4 count of 354 cells per microliter (IQR: 213-456). Women who did not initiate ART experienced a 6-month CD4 count change of -14 cells per microliter (IQR: -41 to 13). Three-quarters of women reported reduced sexual risk behavior postdiagnosis, with only 64% continuing to identify as FSWs. However, 53% reported past month condom use only "sometimes."
  
  
  CONCLUSIONS
  Timely linkage to care and ART uptake were high in this group of Rwandan FSWs. However, risky sexual behaviors remained common after enrollment in care. HIV-positive FSWs are an important and receptive group for targeted efforts to increase HIV diagnosis and linkage to care/treatment. Once in care, intensified and sustained HIV prevention education is necessary.
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA. braunstein.sarah@gmail.com
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Braunstein
authors.forename: Marie-Michèle
authors.initials: MM
authors.lastname: Umulisa
authors.forename: Nienke J
authors.initials: NJ
authors.lastname: Veldhuijzen
authors.forename: Evelyne
authors.initials: E
authors.lastname: Kestelyn
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ingabire
authors.forename: Jeanine
authors.initials: J
authors.lastname: Nyinawabega
authors.forename: Janneke H H M
authors.initials: JH
authors.lastname: van de Wijgert
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D010349:Patient Compliance; D011584:Psychology; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D011477:Sex Work / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents