Discreet Diagnostics

by Aubrey Weber, Technical Officer, FHI360 @awebermph

Mylène Nibizi* is a female sex worker (FSW) living in Ngozi province, Burundi. She’s always known that she might have HIV, but FSWs like Mylène face substantial barriers to accessing existing testing services, including fear of stigma and discrimination from healthcare providers.

“I never had an HIV test before,” explains Mylène. “I was afraid that my neighbors or clients could know my status if I tested in a nearby health center.”

Burundi’s HIV prevalence among key populations—including FSWs like Mylène, men who have sex with men and transgender people—is very high. For female sex workers, the prevalence rate is estimated to be extremely high at 21.3 percent. So the USAID- and PEPFAR-supported LINKAGES project, implemented by FHI360, has been working in Burundi since 2016 to reach key populations to link them to HIV self-testing (HIVST) services.

In 2018, LINKAGES Burundi used funding from the Office of the U.S. Global AIDS Coordinator and Health Diplomacy to introduce peer-mediated HIVST using OraQuick HIVST devices in three provinces, including Ngozi. Peer-mediated HIVST is when a peer educator explains to someone in their key population how to use the kit, provides post-test counseling and refers or accompanies the peer to other needed services.

Mylène describes her experience with a peer educator. “One day, I was approached by a peer educator providing HIV self-test kits in our area,” she recalls. “[The peer educator] found me at home and told me about a new test that I could use myself. I agreed to use the test and she showed me how to do it.”

HIVST has many advantages, especially for marginalized key populations. Not only is it confidential and easy to use, but results can also be read directly by the individual taking the test.

Mylène remembers when she read her self-test results. “The result of the test was positive. In the beginning, I felt afraid, even if it was not a big surprise to me. But my friend comforted me, and I accepted it.”

“The following day I went to [the] clinic, accompanied by [my peer educator], to have a confirmatory test.” With a friend by her side, Mylène felt confident walking into the clinic to confirm her test and get connected to care she needed.

“Since then, I am regularly taking my medicine and my health is well. Nobody in my neighborhood knows anything about my HIV status, apart from my peer educator. I now make sure to use condoms with my clients.”

*Name changed to protect the client’s identity.


This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: © PSI/Benjamin Schilling

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