Despite high STI vulnerability among sex workers in Kigali, Rwanda, stigma remains a barrier to service use

Prevalence of sexually transmitted infections, genital symptoms and health-care seeking behaviour among HIV-negative female sex workers in Kigali, Rwanda

N J Veldhuijzen MDPhD, M van Steijn BSc, J Nyinawabega BSc, E Kestelyn MSc, M Uwineza BSc, J Vyankandondera MD and J H H M van de Wijgert PhD. Int J STD AIDS. 2013 Mar 20. [Epub ahead of print]

Timely diagnosis and treatment of sexually transmitted infections (STIs) is often hampered by the lack of symptoms, inadequate diagnostics and/or poor availability, accessibility and quality of treatment in resource-limited settings. Female sex workers (FSW) are highly vulnerable for HIV and key transmitters of STIs. Among FSW (n = 400) participating in a prospective HIV incidence study in Kigali, Rwanda, only 15% (17/116) of women with laboratory-diagnosed non-ulcerative STIs at baseline reported symptoms. Only 27% (20/74) of women self-reporting genital symptoms sought care at enrolment, and 39% (46/117) of women with self-reported genital symptoms during follow-up. During focus group discussions, FSW considered treatment-seeking and partner notification important. Shame and feeling disrespected by doctors or other health-care workers were identified as barriers to seeking health care. A comprehensive STI control programme targeting both symptomatic and asymptomatic FSW should be considered in this setting.

Abstract access [1]

Editor’s notes: STI control is an important component of HIV prevention programmes and includes syndromic STI management, health education, condom promotion, and partner notification and treatment. Timely diagnosis and treatment of STIs is often hampered by the lack of symptoms, inadequate diagnostics and/or poor availability, accessibility and quality of treatment. Many women (and to a lesser extent men) are asymptomatic and not all symptomatic patients will seek care. Some may not recognize the symptoms, be unaware of the risks involved, delay seeking care or consult unqualified sources. Sex workers are vulnerable to STI and HIV infection. Women commonly are not aware of infection, making service access difficult. This cohort study shows that most sex workers in Rwanda with laboratory diagnosed STI infections do not have symptoms. Even women with symptoms were unlikely to seek treatment upon enrolment in the trial. Shame and anticipated stigma remained a barrier to women using services. This paper highlights the need to eliminate stigma and discrimination, alongside the ongoing importance of the provision of effective STI treatment services.  

Africa [6]
Rwanda [7]
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