P1-S2.22 Changes in HIV knowledge & risk behaviours in female sex workers in Rwanda - HIV prevention implications of trend analyses in behavioural surveillance

Abstract

In Rwanda, existing empirical and analytical studies indicate that female commercial sex workers (FCSW) play an important role in the HIV epidemic. It is thus critical to track sexual risk behaviours in this group in order to develop effective prevention programs and services for sex workers. In this context, the Ministry of Health (MOH) of Rwanda and partners conducted two rounds of behavioural surveillance surveys (BSS) among FCSW in 2006 and 2010. We used time-location sampling based on geographic maps of sex work hotspots in Rwanda to recruit a nationally representative sample of 1040 FCSW in 2006 and 1338 FCSW in 2010. At the time of the interview, all FCSW present at the site were asked to participate in the study and administered a quantitative survey instrument after obtaining informed consent. Data were double-entered and analysed using EpiInfo, SPSS and STATA. χ 2 Tests of significance were performed on key variables. Logistic regression analysis was performed to control for key socio-demographics. Overall, an increase in comprehensive HIV knowledge from 18% in 2006 to 22% in 2010 was observed (p Value<0.0001). However, some misconceptions still persist, with a decline in FCSW who rejected that mosquito bites can transmit HIV from 74% in 2006 to 69% in 2010 (p value <0.0001). The median age of respondents' first paid sexual act remained the same, with a reported median age of 19 years in both surveys. The proportion of FCSW who reported having consistently used condoms in the month prior to the survey rose from 28% in 2006 to 35% in 2010 (p value<0.001). At the same time, the proportion of FCSW who reported having used a condom during their last sexual act with a paying client dropped from 84% in 2006 to 80% in 2010 (p value<0.001). Comparing key indicators from the 2006 and 2010 BSS provides important insights for HIV program planners. Although the comparison indicates that overall HIV knowledge has generally improved in the time between the two surveys, some misconceptions on HIV transmission still persist. Equally, regarding sexual behaviour and practices, although consistent condom use reportedly improved between the two BSS, the overall level of reported use is still relatively low and some important indicators—including condom use at last sex with a paying client—declined. These data further underscore the importance of reaching FCSW with prevention commodities and appropriate HIV education and behaviour change communication messages.