title: High burden of prevalent and recently acquired HIV among female sex workers and female HIV voluntary testing center clients in Kigali, Rwanda.
abstract: OBJECTIVE
  To estimate HIV prevalence and risk factors in population-based samples of female sex workers (FSW) and female voluntary counseling and testing (VCT) clients in Rwanda.
  
  
  METHODS
  We conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women.
  
  
  RESULTS
  Prevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0-27.0), 59.8% (56.4-63.2), and 7.6% (5.8-9.5) among FSW, and 12.8% (10.9-14.6), 43.2% (40.4-46.0), and 11.4% (9.7-13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible for ART based on CD4<350 cells/µl. Condom use at last sex was higher among FSW (74%) than VCT clients (12%). In age and district of residence-adjusted models, HIV-1 seropositivity was associated with HSV-2 co-infection; recent treatment for sexually transmitted infection (STI); genital symptoms; forced sex; imprisonment; widowhood; and alcohol consumption. Eleven percent of FSW and 12% of VCT clients had recently acquired HIV-1 per BED-CEIA and AI. HSV-2 infection and recent STI treatment were associated with recent HIV infection in both groups, and being married and vaginal cleansing were associated with recent infection before last sex among VCT clients.
  
  
  CONCLUSIONS
  This population-based survey reveals a high HIV prevalence and incidence among FSW and female VCT clients in Kigali, the scale of which is masked by the low general-population HIV prevalence in Rwanda. HIV/STI and family planning services should be strengthened.
authors.affiliation: Mailman School of Public Health, Columbia University, New York, New York, United States of America. braunstein.sarah@gmail.com
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Braunstein
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ingabire
authors.forename: Eveline
authors.initials: E
authors.lastname: Geubbels
authors.forename: Joseph
authors.initials: J
authors.lastname: Vyankandondera
authors.forename: Marie-Michèle
authors.initials: MM
authors.lastname: Umulisa
authors.forename: Elysée
authors.initials: E
authors.lastname: Gahiro
authors.forename: Mireille
authors.initials: M
authors.lastname: Uwineza
authors.forename: Coosje J
authors.initials: CJ
authors.lastname: Tuijn
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.forename: Janneke H H M
authors.initials: JH
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D015498:HIV-2 / Q000302:isolation & purification*; D006558:Herpes Genitalis / Q000453:epidemiology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D021841:Safe Sex / Q000706:statistics & numerical data; D060386:Sex Workers / Q000706:statistics & numerical data*; D055815:Young Adult