Factors associated with prevalent HIV infection among female sex workers in Rwanda and Zambia Public

Abstract

Female sex workers (FSW) generally have an increased risk of acquiring HIV infection. In Rwanda and Zambia, FSW have an HIV prevalence that is about 17 times and 4 times greater than the HIV prevalence among the adult population (ages 15 to 49) in those countries, respectively. In this paper, we analyze cross-sectional data collected on 1,204 HIV-negative (N=191) and HIV-positive (N=1,013) women recruited from a sample of FSW seeking HIV, STI, and family planning services between September 2012 and March 2015 in Kigali, Rwanda and Lusaka and Ndola, Zambia, to assess factors associated with prevalent HIV infection. Eligible women were between the age of 18 and 45, completed a face-to-face interview, underwent a gynecological exam and HIV and STI testing. We assessed all variables for potential associations with prevalent HIV in the overall sample and stratified by city, and estimated prevalence odds ratios (pORs) using logistic regression. All variables that were statistically significant in the bivariate analysis were considered for the multivariate logistic regression model. A final model was determined based on backwards elimination and adjusted ORs (aORs) calculated. The final model of correlates of HIV infection included condom use by city (condomless sex in the past month was reported more frequently by HIV-positive women in Kigali, but less frequently in Lusaka and Ndola), no previous HIV test, older age, being widowed, treatment for ulcers in the past year, lower abdominal pain, treatment for urinary tract infection, treatment for syphilis, and treatment for pelvic inflammatory disease. HIV-positive women were less likely to report a previous HIV test (aOR=2.3, 95% confidence interval (CI): 1.4, 3.6) and more likely to report a reproductive health disturbance (e.g. treatment for ulcers in the past year (aOR=5.4, 95% CI: 2.4, 12.1)). Nonetheless, there was a high burden of STIs among all women in the study. STI screening and treatment may be a useful intervention for FSW in Rwanda and Zambia regardless of serostatus. Similarly, creating programs that target HIV-positive women for HIV testing would be beneficial to identify unknown positive infections and link women to care.

Table of Contents

Chapter I Background

HIV/AIDS Globally.............................................1

Sex Work and HIV/AIDS.....................................2

HIV/AIDS in Rwanda..........................................3

Sex workers in Rwanda......................................4

HIV/AIDS in Zambia..........................................9

Sex workers in Zambia.....................................10

Rwanda Zambia HIV Research Group (RZHRG)....12

Chapter II Manuscript

Introduction....................................................14

Methods.........................................................16

Study Population and Data Collection.................16

Screening and Enrollment Visit..........................17

Laboratory Testing...........................................17

Demographic and Behavioral Survey..................18

IRB Approval..................................................18

Data Analysis..................................................19

Results...........................................................20

Demographics.................................................20

Reproductive Health Disturbances

and Contraception............................................21

Gynecological Exam.........................................22

Treatment for Reproductive

Health Disturbances.........................................22

Multivariate Model...........................................22

Discussion......................................................23

References.....................................................30

Tables............................................................37

Table 1..........................................................37

Table 2..........................................................39

Table 3..........................................................42

Chapter III Public Health Implications...............44

Appendix ......................................................46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	HIV Female sex workers Epidemiology
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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