Background In the context of the mostly generalized HIV epidemic in Côte d’Ivoire, key populations bear a higher burden of HIV than that borne by the general reproductive-aged population. Mathematical models have demonstrated the significant potential impact and cost-effectiveness of improving the coverage of HIV prevention and treatment services for key populations in Côte d’Ivoire. However, in 2019, coverage of these services remained limited by multiple intersecting stigmas affecting key populations, necessitating the study of innovative implementation strategies to better meet the needs of those most marginalized. Here, we leverage programmatic data to compare the effectiveness of the enhanced and traditional peer outreach approaches in reaching and providing community HIV testing to female sex workers not readily engaged in HIV prevention and treatment services in Côte d’Ivoire. Objective The aim of this study was to describe the characteristics of female sex workers reached by the LINKAGES project in Côte d’Ivoire with enhanced peer outreach and traditional peer outreach and to compare HIV-related outcomes between the women reached by both strategies. Methods Deidentified routine programmatic data collected as part of LINKAGES Côte d’Ivoire between October 2017 and April 2018 were used in these analyses. Demographic characteristics and HIV indicators including HIV testing history, HIV case-finding, linkage to HIV treatment, and treatment initiation were assessed using descriptive statistics. Differences in these indicators were compared by outreach strategy using Pearson chi-square tests. Results There were 9761 women reached with enhanced peer outreach and routine peer outreach included in these analyses. The overall case-finding rate in the sample was 7.8% (698/8851). Compared with women reached by routine outreach, those reached by enhanced peer outreach were more likely to have previously been tested for HIV (enhanced: 1695/2509, 67.6%; routine: 4302/7252, 60.0%; χ21=43.8; P=.001). The enhanced peer outreach approach was associated with a higher HIV case-finding rate (enhanced: 269/2507 10.7%; routine: 429/6344, 6.8%; χ21=32.3; P=.001), higher proportion of linkage to treatment (enhanced: 258/269, 95.9%; routine: 306/429, 71.3%; χ21=64.4; P=.001), and higher proportion of treatment initiation (enhanced: 212/269, 78.8%; routine: 315/429, 73.3%; χ21=2.6; P=.11). Women reached by both approaches were categorized as high risk for HIV-related behaviors such as condomless sex and number of sex acts in the previous week. Conclusions These analyses suggest that the novel peer-referral strategy, the enhanced peer outreach approach, was effective in reaching female sex workeres in Côte d’Ivoire with demonstrated acquisition risks for HIV and who had not been effectively engaged by routine outreach approaches. Scaling up novel strategies such as enhanced peer outreach in the context of differentiated service models may be needed to optimize HIV prevention and treatment outcomes for key populations in Côte d’Ivoire.

This paper reports on research that aimed to identify risk factors and preventive behaviours for HIV/STIs among men who have sex with men in Bulgaria, Kosovo, Macedonia and Romania. Twelve peer researchers conducted interviews on sexual behaviour, condom use and HIV/STI awareness. Data analysis revealed common themes across countries. Sexual activity takes place both in public spaces and private homes. Many men believe that careful partner selection and closing sexual networks to outsiders mitigate risk. Risk behaviours include unprotected sex within multiple partnerships, inconsistent condom use and the use of oil-based lubricants that compromise the integrity of condoms. Perceived susceptibility for infection is low and misconceptions exist about modes of transmission. Stigma and discrimination force men into clandestine settings and relationships where safer sexual behaviour is difficult. HIV prevention programmes should convey messages through the internet and peer networks, improve access to condoms and water-based lubricant, raise awareness about STIs, link men who have sex with men to appropriate services and reduce stigma to enable safer behaviour.

Objectives: To identify determinants of sexual behaviors among Ethiopian secondary school adolescents using Jessor's theoretical framework. Methods: A cross-sectional study design was used to examine determinants of sexual behaviors among 537 high school students aged 14-20. HIV risk and protective factors were identified based on a review of the literature. Focus group discussions and informal interviews were carried out to validate theoretical constructs and, together with the literature review, to guide questionnaire construction. Logistic regression analysis was used to examine associations between each risk and protective factor and each sexual behavior. Results: Most students (64 percent male and 89 percent female) were not sexually active. Only 56 percent of the sexually active youths reported ever using condoms. Family involvement, age of boy/girlfriend, expectations for aca-demic achievement, and substance abuse were associated with at least three of the six sexual behaviors or intentions examined. Risk and protective factors in the personality, perceived environment, and behavior domains were associated with at least one sexual behavior or intention. Conclusion: The findings are consistent with Jessor's theoretical framework and suggest that risk and protective factors from several domains contribute to Ethiopian adolescents' involvement in sexual behavior. Recommendation: The findings of this study may be used to design culturally sensitive school-based HIV/AIDS prevention programs in Ethiopia. Recommendations are made on how to design school-based HIV prevention programs and to carry out further research on gender differences in sexual behavior and HIV risk factors among students and out-of-school adolescents.

We discuss the value of these preliminary steps for securing external validity by identifying theoretical constructs that are relevant to the population at hand and the use of a survey instrument that adequately captures these constructs and provides reliable information.

BACKGROUND In the context of the mostly generalized HIV epidemic in Cote d’Ivoire, key populations (KPs), including female sex workers (FSWs) and men who have sex with men (MSM), bear a higher burden of HIV than other reproductive aged adults. Mathematical models have demonstrated the significant potential impact and cost-effectiveness of improving the coverage of HIV prevention and treatment services for key populations in Cote d’Ivoire. However, in 2019, coverage of these services remains limited by multiple intersecting stigmas affecting key populations, necessitating the study of innovative implementation strategies to better meet the needs of those most marginalized. Here, we leverage programmatic data to compare the effectiveness of the enhanced peer outreach approach (EPOA) and traditional peer outreach approaches in reaching and providing community HIV testing to FSWs not currently engaged in HIV prevention and treatment services in Cote d’Ivoire. OBJECTIVE The aim of this study was to describe the characteristics of FSWs reached by the LINKAGES project in Cote d’Ivoire with EPOA and traditional peer outreach and compare HIV-related outcomes between women reached by both strategies. METHODS De-identified routine programmatic data collected as part of LINKAGES Cote d’Ivoire between October 2017 and April 2018 were used in these analyses. Demographic characteristics and HIV indicators including HIV testing history, HIV case finding, linkage to HIV treatment and treatment initiation were assessed using descriptive statistics. Differences in these indicators by outreach strategy were then compared using Pearson’s Chi-squared tests. RESULTS The overall HIV prevalence of the 18,889 FSWs included in this study was 9.7%. Outcome comparison by outreach approach was carried out for 9,761 of 18,889 women reached and program participants reached by EPOA represented 26% of the analytical sample. Compared with women reached by the routine outreach approach, those reached by EPOA were more likely to have ever been previously tested for HIV (68% vs 60%; p < 0.001). EPOA was associated with a higher HIV case finding rate (11% vs 7%; p < 0.001) and women who were reached by EPOA were more likely to be linked to treatment (p <0.001) and initiated on treatment (p > 0.05). Women reached by both approaches were categorized as high risk for HIV-related behaviors such as condomless sex and number of sex acts in the previous week. CONCLUSIONS These analyses suggest that a novel peer-referral strategy, EPOA, was effective in reaching FSWs in Cote d’Ivoire who were at high risk for HIV and not reached by routine outreach approach. Scaling up novel outreach strategies like EPOA with differentiated service models may be needed to optimize HIV prevention and treatment outcomes for key populations in Cote d’Ivoire.