Men In Rwanda Research Articles

HIV and hepatitis B, C co-infection and correlates of HIV infection among men who have sex with men in Rwanda, 2021: a respondent-driven sampling, cross-sectional study

BackgroundMen who have sex with men (MSM) are a key population group disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. In Rwanda, the HIV epidemic remains a significant public health concern, and understanding the burden of HIV and hepatitis B and C coinfections among MSM is crucial for designing effective prevention and control strategies. This study aims to determine the prevalence of HIV, hepatitis B, and hepatitis C infections among MSM in Rwanda and identify correlates associated with HIV infection within this population.MethodsWe used respondent-driven sampling (RDS) to recruit participants between November and December 2021. A face-to-face, structured questionnaire was administered. Testing for HIV infection followed the national algorithm using two rapid tests: Alere Combo and STAT PAK as the first and second screening tests, respectively. Hepatitis B surface antigen (HBsAg) and anti-HCV tests were performed. All statistics were adjusted for RDS design, and a multivariable logistic regression model was constructed to identify factors associated with HIV infection.ResultsThe prevalence of HIV among MSM was 6·9% (95% CI: 5·5–8·6), and among HIV-positive MSM, 12·9% (95% CI: 5·5–27·3) were recently infected. The prevalence of hepatitis B and C was 4·2% (95% CI: 3·0–5·7) and 0·7% (95% CI: 0·4–1·2), respectively. HIV and hepatitis B virus coinfection was 0·5% (95% CI: 0·2–1·1), whereas HIV and hepatitis C coinfection was 0·1% (95% CI: 0·0–0·5), and no coinfection for all three viruses was observed. MSM groups with an increased risk of HIV infection included those who ever suffered violence or abuse because of having sex with other men (AOR: 3·42; 95% CI: 1·87–6·25), those who refused to answer the question asking about ‘ever been paid money, goods, or services for sex’ (AOR: 10·4; 95% CI: 3·30–32·84), and those not consistently using condoms (AOR: 3·15; 95% CI: 1·31–7·60).ConclusionThe findings suggest more targeted prevention and treatment approaches and underscore the importance of addressing structural and behavioral factors contributing to HIV vulnerability, setting interventions to reduce violence and abuse against MSM, promoting safe and consensual sexual practices, and expanding access to HIV prevention tools such as condoms and preexposure prophylaxis (PrEP).

Awareness and willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Rwanda: findings from a web-based survey.

Pre-exposure Prophylaxis (PrEP) is a daily pill aimed at reducing HIV transmission risk when taken as prescribed. It's highly recommended for high-risk Men who have sex with Men (MSM). This study aimed to assess PrEP awareness and willingness to use it among Rwandan MSM, a critical aspect given PrEP's proven effectiveness. The findings are expected to inform policy decisions and further advance the implementation of PrEP strategies. This is a cross-sectional study design that utilized a web-based survey conducted between April and June 2019 to assess awareness and willingness to use PrEP among sexually active MSM in Rwanda. A snowball sampling technique was used to recruit participants via social media such as WhatsApp and e-mail. Eligibility criteria included being sexually active, aged ≥18 years, self-identifying as MSM, residing in Rwanda, self-reported engagement in receptive or insertive anal sex in the last 12 months, and self-reported HIV-negative serostatus. We assessed two primary outcomes: PrEP awareness (having ever heard of PrEP) and willingness to use PrEP within one month of completing the survey. Multivariable logistic regression was performed to identify participant characteristics associated with PrEP awareness and willingness to use it. Out of 521 participants, the majority (73%) demonstrated awareness of PrEP. Factors linked to PrEP awareness included residing outside the capital, Kigali, being in the 18-29 age group, having higher education levels, perceiving a benefit from PrEP, and engaging in vaginal sex with a woman while using a condom in the last year. Additionally, 96% of participants expressed a strong willingness to use PrEP. Rwandan MSM exhibits a high level of PrEP awareness, notably associated with factors like location, age, education, perceived benefits, and condom use. The study also revealed a strong willingness to use PrEP, indicating promising prospects for its adoption among this group. These findings highlight the need for targeted awareness campaigns, personalized interventions, and comprehensive sexual health education to promote PrEP adoption and strengthen HIV prevention efforts among Rwandan MSM.

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90-90-90 targets among younger men in Rwanda.

In this study, we measured Rwandan men's engagement in HIV services based on the UNAIDS 90-90-90 targets and assessed factors associated with linkage to HIV services. We analyzed the Rwanda Population-based HIV Impact Assessment (RPHIA) data for 15- to 64-year-old males. We conducted bivariate analysis to assess the distribution and association of sociodemographic characteristics with UNAIDS 90-90-90 targets. We adjusted multivariable models to understand the effect measurement of associated factors and determine the factors that best predict the achievement of UNAIDS 90-90-90. Of 13 780 males aged 15-64 years who participated in the RPHIA and consented to the blood draw and HIV testing, 302 had a positive HIV result, while 301 had valid responses to all variables analyzed in this paper and were included in the analysis. We found that age group was an explanatory and predictive factor for achievement of UNAIDS 90-90-90. Younger men living with HIV (MLHIV) are less likely to have achieved UNAIDS 90-90-90 compared to MLHIV 50-64 years old: adjusted odds ratio (aOR) for MLHIV aged 15-34 years was 0.21 (0.08-0.53) and aOR for MLHIV aged 35-49 years was 0.77 (0.36-1.66). To close the UNAIDS 90-90-90 gap in Rwanda, innovative service delivery strategies are needed to support young MLHIV to reach 90-90-90.

Trends and correlates of intimate partner violence (IPV) victimization in Rwanda: results from the 2015 and 2020 Rwanda Demographic Health Survey (RDHS 2015 and 2020)

BackgroundIntimate partner violence (IPV) is reported to be a public health issue given its magnitude and long-lasting consequences. Men are generally thought to be perpetrators of IPV, but they can also be victims. In Rwanda, the experience of men as victims has not yet been described and characterized. The aim of this study is to examine the trends and correlates of IPV victimization for men and women in Rwanda.MethodsThe data for this study were extracted from the Rwanda Demographic and Health Survey (RDHS) in 2014/15 (female: n = 8292, male: n = 3470) and 2019/2020 (female = 8574, male: n = 3590). The survey had used a structured measure of IPV (i.e. physical, sexual, or emotional) and its related demographic characteristics to collect data in a nationally representative sample of ever-married women aged 15–49 years and men aged 15–59 years. Multiple logistic regression was applied to examine the association between demographic characteristics and IPV in both women and men.ResultThe prevalence of IPV among women increased from 40% in 2015 to 46% in 2020, while it decreased from 21 to 18% in men during the same time period. The associated factors for women IPV victimization in 2015 were: uneducated husband (Adjusted Odds Ratios (AOR) = 5.570, 95% CI 1.29–24.02), woman from the poorest household (AOR = 2.834, 95% CI 1.9–93.12), husband aged from 30 to 39 years (AOR = 2.797, 95% CI 1.517–5.158), husband consuming alcohol (AOR = 3.021, 95% CI 1.517–5.158); women involved in decisions about their own earnings (AOR = 0.576, 95% CI 0.37–0.88); and purchases (AOR = 0.472, 95% CI 0.27–0.82). However, the factors such as uneducated husbands (AOR = 3.032, 95% CI 1.117–8.24); husbands consuming alcohol (AOR = 1.712, 95% CI 2.408–4.486); a woman's involvement in decisions on her personal health (AOR = 0.443, 95% CI 0.30–0.63) and visits from her family or relatives (AOR = 0.405, 95% = 0.41–0.22) were factors of IPV in 2020. On the other hand, the associated factors for men IPV victimization in 2015 were being from richer wealth index (AOR = 0.21, 95% CI 0.04–1.04), frequency of being hit in last 12 months by other than partner (AOR = 5.49, 95% CI 1.65–18.25), woman often consuming alcohol (AOR = 13.30, 95% CI 1.9–93.12); whereas its associated factor in 2020 were women consuming alcohol (3.91, 95% CI 0.55–9.87).ConclusionThe present study revealed a significant increase in IPV against women, and slight decrease of IPV against men in Rwanda from 2015 to 2020, as well as its associated risks and protective factors over time. This increase needs further exploration given that government and partners have invested in policies and strategies to mitigate the IPV with limited impact. Since there is a relationship between IPV prevalence and education, the existing laws on domestic violence need to be known by the citizens. Findings from this study evidenced also visits from extended families to be a protective factor and therefore suggesting the necessity of a family and community-based approach in managing IPV in Rwanda. Future studies to assess the effectiveness of community-based approach in preventing IPV.

Evaluation of a health education program for improving uptake of HIV self-testing by men in Rwanda: a pilot pragmatic randomized control trial

BackgroundHealth education interventions tailored to suit men have the potential to improve health outcomes for this underserved population. HIV self-testing (HIVST) is a promising approach to overcoming challenges associated with low HIV testing rates among men. The primary objective of this study is to assess the feasibility of conducting a definitive trial to determine the effectiveness of a locally adapted and optimized health education program (HEP) on the uptake of HIVST among men in Kigali, Rwanda.MethodsThis study employs a pilot pragmatic randomized controlled trial to evaluate an HIVST HEP for men. Participants were randomized to the intervention (HEP) arm or to the control arm. In the intervention group, the adapted HEP was administered in addition to routine health education. In the non-intervention group, only routine health education was offered. Participant data was collected first upon recruitment and then after 3 months’ follow-up using interviewer-administered questionnaires.ResultsThere was a 100% response rate at enrollment and no loss to follow-up at exit. There was significant association between the study arm and knowledge of HIVST. Participants in the control arm had a mean knowledge score of 67% compared to 92% among participants in the intervention arm. There was an association between the study arm and HIVST uptake: 67% of the study participants in the intervention arm self-reported HIVST uptake compared to 23% of the participants in the control arm.DiscussionThis pilot study demonstrates the feasibility of a larger trial to assess the effectiveness of an HEP intervention on uptake of HIVST among men. We found preliminary evidence of increased uptake of HIVST in the intervention group.Trial registrationPan African Clinical Trial Registry PACTR201908758321490. Registered on 8 August 2019.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Co-creation of a health education program for improving the uptake of HIV self-testing among men in Rwanda: nominal group technique

ObjectiveThis study sought to collaborate with key stakeholders to reach a consensus regarding the predominant barriers preventing the uptake of HIV testing services (HTS) by men and co-create an acceptable educational program to improve the knowledge of HIV self-testing (HIVST) among men in Rwanda. MethodsWe employed the nominal group technique to identify a consensus regarding the predominant barriers currently impeding the male uptake of HTS. The health education program content was guided by the ranked barriers. We applied Mezirow's Transformational Learning Theory for curriculum development. ResultsEleven key barriers currently impeding the male uptake of HTS were identified in the nominal group process. The stakeholders co-created an interactive, structured curriculum containing information on the health locus of control; HIV etiology, transmission, diagnosis, status disclosure benefits, care and treatment services; and an overview of the HIVST background and test procedure to address multiple barriers. ConclusionKey stakeholders co-created a comprehensive health education program tailored to men, which integrates education about health beliefs, HIV/AIDS and HIVST. Further studies to assess the effectiveness of the program are needed. It is anticipated that the intervention will improve the uptake of HIVST among men in Kigali, Rwanda.

Adaptation of a Health Education Program for Improving the Uptake of HIV Self-Testing by Men in Rwanda: A Study Protocol.

Background and objectives: Available evidence shows a low uptake of HIV services among men in Rwanda. HIV self-testing (HIVST), a new intervention, may have the potential to improve the uptake of HIV testing services among men. The current study aims to adapt a health education program (HEP) for improving the uptake of HIVST among men in Rwanda. Materials and Methods: We propose a mixed method study, which will be conducted in four phases. In Phase 1, we will conduct a scoping review to map the available evidence on health education programs for men in low- and middle-income countries (LMICs). In Phase 2, we will conduct interviews with stakeholders in the Rwanda HIV response and healthcare providers to determine their perspectives on implementation of HIVST in Rwanda. In Phase 3, a cross-sectional survey will be used to assess HIVST awareness and acceptability among men in Rwanda. Guided by findings from Phases 1, 2, and 3, we will employ the nominal group technique to develop and optimize the HEP for improving the uptake of HIVST among men in Rwanda. In Phase 4, we will use a pragmatic pilot randomized controlled trial to assess the preliminary impact of the HEP for men in Rwanda and assess the feasibility of a later, larger study. We will employ the Stata version 16 statistical package and NVivo version 12 for the analysis of quantitative and qualitative data, respectively. We anticipate that the findings of this study will inform implementers and policy makers to guide strategies on the implementation of HIVST in Rwanda and ultimately accomplish goals set forth in the Rwanda 2019–2024 Fourth Health Sector Strategic Plan on scaling up the number of men who know their HIV status. Conclusion: It is anticipated that this study will proffer solutions and strategies that are applicable not only in Rwanda but also in similar settings of LMICs.

HIV self-testing in Rwanda: awareness and acceptability among male clinic attendees in Kigali, Rwanda: A cross-sectional survey

BackgroundThe Rwandan Ministry of Health recently (in February 2017) recommended the use of HIV self-testing (HIVST) as an additional strategy for hard-to-reach populations such as men. However, the level of awareness and acceptability of this testing strategy among this population in Rwanda is not known. The main objective of this study is to assess the level of awareness and acceptability of HIVST among male clinic attendees in Kigali, Rwanda. MethodsA cross-sectional survey was employed to systematically sample and interview 579 male health-facility attendees over a seven-week period. We employed a pretested interviewer questionnaire to collect data. The chi-square test was used to determine associations between explanatory variables. Univariate binary logistic regression analysis was carried out to obtain preliminary insight into the unconditional association of each independent variable and dependent variables (awareness and acceptability). Multiple logistic regression was employed to determine explanatory variables associated with awareness or acceptability status while adjusting for other study variables. All statistical analyses were performed using Stata version 11.2. ResultsOf the 579 men interviewed, only 21% were aware of HIVST, while 74% found it acceptable. Logistic regression analysis identified the following as factors significantly (p < 0.05) associated with HIVST awareness: having paid or received money for sex in the past month, health-seeking behavior, HIVST knowledge, HIVST attitude, and HIV risk perception. Factors associated with HIVST acceptability include the following: health-seeking behavior, HIVST knowledge, HIVST attitude, and condom use after taking drugs and alcohol. ConclusionThe findings reveal low awareness and high acceptability of HIVST among men in Rwanda. Our findings accentuate the need to promote awareness of HIVST as an important intervention for improving the uptake of HIV testing among men, a traditionally hard-to-reach population in Rwanda.

A qualitative study on oral-fluid-based HIV self-testing experiences among men in Kigali, Rwanda.

Introductionthere has been a global call to engage men in the fight against the HIV epidemic. Poor uptake of HIV testing services among men has been reported in most of sub-Saharan Africa where the HIV epidemic continues to be a major public health problem. HIV self-testing (HIVST) has potential to bridge the gap; however, there is a paucity of research evidence on oral-fluid-based HIVST experiences among men in Rwanda. The aim of this study was to assess oral-fluid-based HIVST experiences among men.Methodsa qualitative study based on individual interviews was employed on 21 men who voluntarily obtained oral-fluid-based HIV self-test kits and consented for follow-up post-test interviews. Interview guides explored men´s perspectives on the oral-fluid-based HIV self-screening experience. A conventional content analysis qualitative approach was adopted, entailing inductive thematic analysis.Resultsthe majority of participants expressed satisfaction with the experience of self-testing, citing privacy and turn-around time. Participants presented contradicting views on usability of test kits and post-test status disclosure to sexual partners. One participant reported post-test distress resulting from unexpected results.ConclusionHIVST is attractive to men and may have potential for improving uptake of HIV testing services in this group without compromising the testing experience. Concerns on missing linkage to care and potential social harms and adverse events should not be ignored.

'When you talk to someone in a bad way or always put her under pressure, it is actually worse than beating her': Conceptions and experiences of emotional intimate partner violence in Rwanda and South Africa.

Emotional intimate partner violence (IPV) is extremely common and has significant health and social consequences, yet typically receives much less attention in research and programming than physical and sexual IPV. This limits our understanding of how women experience and understand emotional IPV in different settings, which is required to inform effective prevention and response. This paper draws on qualitative data collected in mixed-methods impact evaluations of two IPV prevention programmes conducted as part of the What Works to Prevent Violence Against Women and Girls Global Programme. In doing so, we seek to develop a more nuanced understanding of the forms, causes and consequences of emotional IPV in heterosexual relationships in two distinct African settings. We draw on two rounds of in-depth interviews conducted with 15 women in South Africa and three rounds of interviews conducted with 57 women and men in Rwanda, all of whom were participants in the programmes, around their experiences of and conceptualizations of emotional IPV. Thematic analysis around emotional IPV was conducted and compared across both data sets, informed by a cross comparative analysis approach. The analysis found that the categories or types of acts perceived as emotional IPV by women experienced were similar across settings. Women in both contexts described public humiliation, control of mobility, access to housing and silencing as important categories of actions experienced emotional IPV. These types of emotional IPV were underpinned by similar patterns of gender inequalities, with the intention for men to assert control and power over women. The specific acts through which these categories of emotional IPV manifested in the two settings arose from contextual differences related to the social structure of relationships and dominant social norms. This analysis highlights commonalities in the underlying categorial understanding of IPV in two distinct African settings, and well as the differences in specific manifestations which stem from the social context of relationships. In doing so, we highlight both broad categorical areas of IPV that may be important to address in future research and prevention programming, as well as affirming the need for information on context-specific manifestations of emotional IPV to inform local intervention programmes.

Is HIV Self-Testing a Potential Answer to the Low Uptake of HIV Testing Services Among Men in Rwanda? Perspectives of Men Attending Tertiary Institutions and Kimisagara Youth Centre in Kigali, Rwanda

BACKGROUND &amp;amp; OBJECTIVE: Rwanda has generally experienced low uptake of HIV testing services among men. However, the reasons behind this have not been researched. The main aim of this study was to explore whether HIV self-testing (HIVST) would have the capacity to improve uptake of HIV testing services among men in Rwanda. &#x0D; &#x0D; METHODS: We conducted a qualitative study of 22 men attending tertiary institutions and the Kimisagara Youth Centre in Kigali, Rwanda. Data collection was conducted through open interviews. Data analysis was conducted through thematic content analysis.&#x0D; &#x0D; RESULTS: Our findings revealed that most men had poor knowledge of HIVST, but the majority were willing to adopt it. Four main themes emerged during data analysis. Theme one indicated that men experienced a lack of sufficient information on HIVST. From theme two, it was uncovered that some men were indifferent to HIVST. From theme three, it emerged that most men perceived the cost as the main barrier to HIVST; however, if it was offered free of charge, they were willing to adopt it. Finally, theme four revealed that most men willing to adopt HIVST were concerned about the potential social harm and possible adverse events associated with HIVST.

The Role of Women in Production and Management of RTB Crops in Rwanda and Burundi: Do Men Decide, and Women Work?

This paper evaluates the determinants of decision-making in relation to the production of four crops (banana, cassava, potato, and sweet potato). Understanding the division of labor and decision-making in crop management may lead to designing better interventions targeted at improving efficiency in smallholder agriculture. In 2014, the research team conducted a quantitative household survey with heads of households involving 261 women and 144 men in Burundi and 184 women and 222 men in Rwanda. Most of the decisions and labor provision during the production of both cash crops (potato and banana) and food crops (sweet potato and cassava) were done jointly by men and women in male-headed households. Higher values for ‘credit access’, ‘land size’, and ‘farming as the main occupation of the household head’ increased the frequency of joint decision-making in male-headed households. A decline in the amount of farm income reduced the participation of men as decision-makers. A reduction in total household income and proximity to the market was correlated with joint decision-making. Gender norms also contributed to the lower participation of women in both decision-making and labor provision in banana and potato cultivation. Although a large proportion of decisions were made jointly, women perceived that men participate more in decision-making processes within the household during the production of cash crops. Increased participation by women in decision-making will require an active and practical strategy which can encourage adjustments to existing traditional gender norms that recognize men as the main decision-makers at both the household and community levels.

‘Winning Life’ and the Discipline of Death at Iwawa Island

ABSTRACTThis article analyses Iwawa, a rehabilitation centre for ‘delinquent’ young men in Rwanda. Like prisons, detention centres and refugee camps elsewhere, Iwawa is both a place of nurture and abandonment; of improving life and disallowing it. We argue that in order to grasp these tensions, we might pay attention to the role of death in disciplining those who are confined. A common way for these young men to address their experience was to say that they had to ‘win life’, and that those who did not win life would often die. Death as a possibility animates life in the camp and explains how the camp is at once a place of abandonment and improvement. The possibility of death also creates hierarchies in the camp between those who win and those who loose; those who become ideal developmental subjects of the Rwandan state and those who do not.

The role of community health workers and local leaders in reducing attrition among participant in the AIDS indicator survey and HIV incidence in a national cohort study in Rwanda

BackgroundRetention of participants in longitudinal prospective surveys can challenging for population health researchers. Community health workers (CHWs) may help reduce attrition.MethodsWe used data came from a longitudinal prospective household-based survey targeting women and men in Rwanda, collected between June 2013 and December 2014. The sample was drawn from a population that included all residents of all 30 districts, 416 sectors, and 14,837 villages in Rwanda. The outcome measure was time to loss-to-follow-up. Follow up visits occurred at three, six and nine, and 12 months. A Cox proportional hazards model was constructed to identify factors independently associated with time to loss-to-follow-up.ResultsOverall, 14,222 respondents consented to be interviewed at baseline. At the end of 12 months of follow up, 13,728 were revisited and consented to participate at 12 months of follow up. The overall attrition rate was 8.0%. A majority of those lost (54.3%) were less than 25 years of age, male (55.1%), not living in union (67.3%), had no education level or had primary education level (71.4%), or were in the highest wealth index (54.2%). Compared to illiterate, secondary education was negatively associated with attrition.ConclusionThe Rwanda AIDS indicator and HIV incidence survey recorded a very high retention of participants after 12 months. CHWs and local leaders played a major role to reduce attrition rate and identifying factors associated with loss-to-follow-up can help CHWs strengthen the quality of longitudinal survey data.

Love matters: exploring conceptions of love in Rwanda and Swaziland and relationship to HIV and intimate partner violence

Health risks such as intimate partner violence (IPV) and HIV infection often occur within intimate sexual relationships, yet the study of love and intimacy is largely absent from health research on African populations. This study explores how women and men in Rwanda and Swaziland understand and represent love in their intimate sexual partnerships. In Rwanda, 58 in-depth interviews with 15 couples, 12 interviews with activists, and 24 focus group discussions were carried out during formative and evaluative research of the Indashyikirwa programme, which aims to reduce IPV and support healthy couple relationships. In Swaziland, 117 in-depth, life-course interviews with 14 women and 14 men focused on understanding intimate sexual partnerships. We analysed these qualitative data thematically using a Grounded Theory approach. Participants described love as being foundational to their intimate sexual partnerships. Women and men emphasised that love is seen and expressed through actions and tangible evidence such as gifts and material support, acts of service, showing intentions for marriage, sexual faithfulness, and spending time together. Some participants expressed ambivalent narratives regarding love, gifts, and money, acknowledging that they desired partners who demonstrated love through material support while implying that true love should be untainted by desires for wealth. IPV characterised many relationships and was perceived as a threat to love, even as love was seen as a potential antidote to IPV. Careful scholarship of love is critical to better understand protective and risk factors for HIV and IPV and for interventions that seek to ameliorate these risks.

Gender digital divide in Rwanda: A qualitative analysis of socioeconomic factors

This study aims at exploring how information and communications technology (ICT) is accessed and used by women and men in Rwanda. Specifically, we analyze the factors that contribute to the gender digital divide in Rwanda. In addition, we assess the importance of equal access to ICTs between genders. Rwanda is a particulary interesting case study, since previous studies on gender differences in the usage and accessibility of ICTs have focused on Western countries, while Africa, and Rwanda in particular, have been less covered. The qualitative method of in-depth interviews was used to collect the data. Interviews were analyzed using a thematic analysis technique. The findings of this study reveal that a gender digital divide still exists in Rwanda, even though the government puts forth much effort to eradicate this phenomenon. Reasons for barriers for women’s access to ICTs were found in social, economic and cultural factors, such as feelings of lack of self-worth, self-confidence, and proper educations; heavy domestic responsibilities; and computer anxiety. The findings also indicated that equal access to ICTs would be a shortcut to economic growth in Rwanda. This study concludes that Rwandan women need to be better educated in the use of computer technologies. Certain gender-sensitive strategies that guide the use of ICTs in this way also need to be established.

Circumcision Status and Time to Sexual Debut Among Youth in Sub-Saharan Africa: Evidence from Six Demographic and Health Surveys.

This paper examines the relationship between circumcision status and timing of sexual debut among unmarried youth in Sub-Saharan Africa using Demographic and Health Surveys. Results from survival analysis indicate that the association between circumcision and timing of first sex is place and context specific. Compared to uncircumcised, circumcised men in Rwanda, Uganda and Namibia hasten sexual initiation, whilst circumcised youth in Ethiopia and Mali delayed sex initiation. In Togo however, we found parity in timing to sexual debut. Our multivariate results reveal that, knowledge of HIV/AIDS risk and educational level also feed into the association between circumcision and timing of sex initiation- implying that efforts to prevent new HIV infection through circumcision could benefit from a proper understanding of how diverse set of factors interact in specific contexts to shape youth's decisions to initiate early sex.

008.6 The gendered influence of stigma on hiv testing behaviour: results from a population-based survey of women and men in rwanda

Objective Stigmatisation is a multifaceted process, and distinct domains of stigma may impact HIV testing behaviour differently. We examined the relationship between two stigma domains and HIV testing behaviour among Rwandan men and women who participated in a population-based survey in 2011. Methods We conducted multivariable logistic regression with data from 4,669 Rwandan women (N = 2613) and men (N = 2,056) aged 15 years and older to predict ‘ever tested for HIV’. Independent variables included sociodemographics, knowledge of and proximity to HIV, and two stigma domains, ‘drivers’ (fear of HIV infection through casual contact with PLHIV) and ‘manifestations’ (anticipated and perceived stigma, shame and discriminatory attitudes). All analyses were disaggregated by gender. Results Three quarters of women and men reported ever testing for HIV. Sociodemographic variables significantly associated with HIV testing behaviour included: age, secondary (women only) and post-secondary education (both genders), complete knowledge of HIV [women only, OR: 1.52, 95% CI: 1.20–1.96], frequent trips outside the community (men only), and proximity (personally knowing a PLHIV) [women, OR: 1.66, 95% CI: 1.22–2.25; men, OR: 1.89, 95% CI: 1.36 – 2.60]. Fear of becoming infected with HIV via contact with saliva was the only stigma variable significantly associated with testing behaviour for women [OR: 0.68, 95% CI: 0.49 – 0.94]. For men, holding a discriminatory attitude was the only stigma variable significantly associated with testing behaviour [OR: 0.63, 95% CI: 0.41–0.98]. Socioeconomic status and residence were not significantly associated with HIV testing behaviour for either gender. Conclusion These findings demonstrate that drivers and manifestations of stigma influence HIV testing behaviour differently for women and men, suggesting the need for tailored interventions, including stigma-reduction components, to increase HIV testing among both genders in Rwanda. Targeted interventions are also needed to increase testing among adolescents (15–24) and older (50+) men and women. Disclosure of interest statement Nothing to declare.

HIV knowledge and risky sexual behavior among men in Rwanda.

IntroductionNew infections of Human Immunodeficiency Virus (HIV) remain a big problem in many countries. Different interventions have been implemented to improve the general knowledge of HIV, with the hypothesis that increasing HIV knowledge will reduce risky sexual behavior (RSB). However, HIV knowledge may not necessarily reduce RSB. This study explores HIV knowledge and its effect on RSB.MethodsThe study used data from the 2005 and 2010 Rwanda Demographic and Health Surveys to analyze the association between HIV risk factors and two types of RSB (having two or more partners in the past 12 months; and among those with two or more partners, not using a condom at last sex) and the association between HIV knowledge and those RSB. Multivariate logistic regression was used to determine predictors of RSB.ResultsAmong 2,773 men in 2005 and 3,772 men in 2010, 5% and 7% respectively reported having two or more sexual partners. Among them, 93% in 2005 and 74% in 2010 did not use a condom at the last sex. Between 2005 and 2010, knowledge of the protective effect of having just one uninfected faithful partner, and basic knowledge of HIV decreased. Knowledge of the protective effect of using condoms increased from 90% to 94%. However, HIV knowledge was not associated with either type of RSB.ConclusionIn setting up policies and strategies related to HIV prevention, policymakers should consider that focusing on HIV knowledge is not sufficient in itself.