 Hi everyone. Today I will present the result of a retrospective analysis of HIV positive female sex worker in Myanmar. As Andrea said in Myanmar, HIV is concentrated in people who inject drugs, men who have sex with men and female sex workers. The prevalence of the general population is 0.5%, whereas it is 6.3% in female sex workers. In Myanmar, a condom use program was first piloted in 2001 and has recently been replaced by a more comprehensive program, which now includes commercial sex outside of brothels and also includes men who have sex with men. However, the prevalence of condom use in sex workers remains unclear. HIV in female sex worker in Southeast Asia context is understudied. There is a little published literature and the literature available mostly focused on prevention rather than clinical needs of infected female sex worker and their outcomes. One of the main important points is that analysis and HIV prevention and care effort are often biased due in part by the common misconception of sex worker. People assume that sex workers are only adult women in brothels and care okay parlor, although research is showing that street-based and informal sex work is also common and that men and children could also be engaged in sex work. A second point is that usually like it is in the current reporting system of the MOH in MSF, when cases of HIV are recorded, you can only select one category of high-risk behavior. You're either a sex worker or an injection drug user, but you cannot report both, although it is known that often there are overlapping risk factors. MSF OCA has been treating HIV in Myanmar since 2002 and now I was a court of about 32,000 HIV positive patient on ART. We have nine clinics in three states, Shan, Kachin and Yangon, and we were one of the first NGOs to focus on Irish group with specialized areas and counseling. We have now reduced our outreach and prevention activities and now that other actors are present in Myanmar. So since there's very few data available regarding HIV positive sex workers in Myanmar, our objectives are to describe clinical, virological and immunological characteristics and outcomes of the HIV positive female sex worker seen in MSF clinics. We did a retrospective court analysis using routinely collected medical data from FUSHA database. We looked at all HIV patients admitted between 2002 and 2015 in Shan, Kachin and Yangon projects and we used the sex work was self-reported and defined as ever having sold sex. We analyzed the court of adult female sex worker and compared their characteristic with adult female we did not report sex work. And before we look at the result I would like to show you where our court of adult female is taken from. So between 2002 and 2015 we had a cumulative court of 57,193 HIV positive patients of both genders and all age groups and of those about 1% reported having ever having sold sex of which 41 were males and 51 were under 18 years old. And in order to have more similar population to which compare the sex workers outcome we limited our analysis to female age over 18 years old and over which gives us a court of 22,296 HIV positive adult females of which 588 were sex workers. And if we look now and we compare female sex worker to non sex workers we can see that female sex worker are younger at diagnosis with a median age of 26 years old compared to 32 years old and non sex worker. They have a similar baseline CD4 and a similar immunosuppression status at first visit. However female sex worker had greater odds to be lost to follow up before ART initiation with 34% lost to follow up compared to 18% in non sex worker. If we now look at those initiated ART we can see that although female sex worker had lower odds to be retained in care after one year on ART the retention and care of sex worker was still very high with a proportion of 83%. And of those who are currently under care female sex worker had greater odds to be on second line ARV compared to non sex worker with 9% of female sex worker on second line compared to 5% in non sex workers. And overall female sex worker were more likely to be lost to follow up pre or post ART. But the majority of those lost to follow up were before ART initiation and with 70% of the lost to follow up that happened before ART initiation. Of course one of the main limitation in our study is that we think that sex work is most likely under reported. It can be under reported for various reasons such as stigma and the fact that self reported data but also due to staff bias. Like I briefly mentioned earlier there are more likely to ask about sex work if the patient fits their preconceived idea of who is a sex worker. And we think that however our main our biggest reason for under reporting is the way that the data was collected and recorded. So like I mentioned earlier only one high risk behavior can be recorded in the current system that we have. And this information was also only asked at registration. And this is something that we are changing now. In conclusion, we recommend that in order to increase uptake of HIV services and retention in care in female sex worker, we should first better identify sex worker patient by sensitizing L care providers and by improving the data collection and recording of high risk groups, which we are in the process of doing like I said. And we need also to study a little bit more our core to better understand adherence mobility reason for lost to follow up in outcomes in sex worker. And all this could help us adjust our service delivery model to their specific needs, which it could be privacy flexible opening hours and tailored counseling. Secondly, we should prioritize sex worker for test and treat since they are more likely to be lost to follow up before ART initiation. And we see that once on ART the retention in care is still very good. And finally, we recommend routine viral load testing to improve early diagnosis of viral logical failure. MSF has started this year and the MOH will start with the next global font round. Thank you very much and I want to thank everyone in Myanmar probably could not be with us tonight today because of the low bandwidth in Myanmar. Thank you.