Correlates of Disclosure of HIV Status for Female Sex Workers in Kigali, Rwanda Pubblico

Abstract

Background: The prevalence of HIV in Rwanda is 3% in the general population, but it is nearly 51% in female sex workers (FSW). Prior research suggests that disclosure of HIV status between partners is important for the prevention of incident HIV infections, yet there has been little investigation into disclosure between FSW and their clients. This study seeks to describe the behavioral, sociodemographic and clinical characteristics of HIV-negative FSW in Kigali, Rwanda, and to determine factors associated with disclosure of an HIV status by these FSW to their clients.

Methods: Cross-sectional data were gathered on n=444 FSW in Kigali, Rwanda who tested negative for HIV. Univariable analyses were conducted between all covariates and the dichotomized outcome of interest, discloses an HIV status to clients versus never discloses. Variables found significant in univariable analyses were considered for inclusion in a multivariable logistic model. Correlates of the outcome were reported with adjusted odds ratios and p-values.

Results: Fertility goals; literacy level; frequency of sex under the influence of alcohol; condom disuse due to client refusal; recruiting clients by referral from other FSW or from previous clients; and self-reported vaginal itching varied significantly with disclosure of HIV status in both univariable and multivariable analyses.

Conclusions: There are several factors associated with disclosure of an HIV status by FSW, including high literacy, the desire to have more children, and the ability to recruit clients via referral, which may imply stronger communication skills and social networks. However, disclosure may have different implications depending on true serostatus, the serostatus that is disclosed, and whether these are the same. Further investigation is recommended to determine whether the disclosure of false or variant serostatus is used as a condom use negotiation tactic and what health outcomes are associated with these variations in disclosure behaviors.

Table of Contents

Literature Review.........................................................................1

Introduction................................................................................6

Methods.....................................................................................7

Results......................................................................................10

Table 1......................................................................................14

Table 2......................................................................................20

Tables 3&4.................................................................................22

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

Citations....................................................................................30

Appendix....................................................................................33

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	HIV FSW disclosure serostatus
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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