High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda
High Burden of Prevalent and Recently Acquired HIV among Female Sex Workers and Female HIV Voluntary Testing Center Clients in Kigali, Rwanda
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DOI：
10.1371/journal.pone.0024321
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发表时间：
2011-09-19
期刊：
影响因子：
3.7
通讯作者：
van de Wijgert, Janneke H. H. M.
中科院分区：
文献类型：
--
作者：
Braunstein, Sarah L.;Ingabire, Chantal M.;van de Wijgert, Janneke H. H. M.
目的：估计卢旺达女性性工作者（FSW）和女性自愿咨询和检测（VCT）客户人群样本中的艾滋病毒患病率和危险因素。方法：我们对卢旺达800名FSW和1250名女性VCT客户进行了横断面调查，包括对HIV-1/2、HSV-2和妊娠进行访谈和检测，以及BED-CEIA和患病率指数（AI），以确定hiv感染妇女中的近期感染情况。结果：FSW中HIV-1、HSV-2和妊娠的患病率分别为24% （95% CI: 21.0 ~ 27.0）、59.8%（56.4 ~ 63.2）和7.6% (5.8 ~ 9.5)，VCT中HIV-1、HSV-2和妊娠的患病率分别为12.8%（10.9 ~ 14.6）、43.2%（40.4 ~ 46.0）和11.4%（9.7 ~ 13.3）。35%的FSW和25%的VCT客户从未接受过艾滋病毒检测。根据国家指南，33%的新诊断为hiv的FSW和36%的VCT客户已经符合基于cd4350细胞/ml的ART的条件。最后性行为中避孕套的使用率在性工作者中（74%）高于在性行为中（12%）。在年龄和地区居住调整模型中，HIV-1血清阳性与HSV-2合并感染相关；最近对性传播感染的治疗；生殖器症状;被迫性;徒刑;寡妇;还有饮酒。根据BED-CEIA和AI， 11%的FSW和12%的VCT客户最近感染了HIV-1。在两组中，2型单纯疱疹病毒感染和近期性传播感染治疗与近期HIV感染相关，已婚和阴道清洁与VCT客户最后一次性行为前近期感染相关。结论：这项基于人群的调查显示，基加利的性工作者和女性VCT客户中存在较高的艾滋病毒流行率和发病率，其规模被卢旺达一般人群中较低的艾滋病毒流行率所掩盖。应加强艾滋病毒/性传播感染和计划生育服务。
Objectives: 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/ml. 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.