A call to action for concentrated HIV epidemics

Beyrer, Chris; Baral, Stefan; Weir, Brian W.; Curran, James W.; Chaisson, Richard E.; Sullivan, Patrick S.

doi:10.1097/coh.0000000000000043

Cited by 24 publications

(21 citation statements)

References 51 publications

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“…6–8 However, when studied separately, there has been sustained HIV incidence and high HIV prevalence among key populations. 9 …”

Section: Introductionmentioning

confidence: 99%

“…9–11 Consistent data suggest that the mechanism by which structural determinants increase HIV risks is by limiting the provision and uptake of effective HIV prevention, treatment, and care services. 11–14 Enacted stigma, including verbal, physical, and sexual harassment, as well as discrimination within health care settings have been documented as barriers to services for key populations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

Lyons

Ketende

Diouf

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the 3-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal.Methods:Baseline assessment includes a questionnaire and biological testing for HIV. A proportion of participants enrolled into a 24-month longitudinal cohort with questionnaires and biological testing every 3 months. In these preliminary analyses, ISMIs are evaluated from participants in the cohort through uptake of HIV services and implementation outcomes.Results:Overall, 724 MSM and 758 FSW participated in the baseline assessment. HIV prevalence is 30.2% (n = 219/724) among MSM and 5.3% (n = 40/758) among FSW. Fear of seeking health services among MSM is 17.7% (n = 128/724) at baseline, 10.5% (n = 18/172) at month 3, and 9.8% (n = 10/102) at month 6 (P < 0.004); and among FSW is 21.9% (n = 166/758) at baseline, 8.1% (n = 15/185) at month 3, and 10.7% (n = 18/168) at month 6 (P < 0.001). Overall, 63.9% (n = 62/97) of MSM and 82.5% (n = 118/143) of FSW agreed that the intervention is effective in addressing stigma; however, loss to follow-up was 41.1% among MSM and 10% among FSW.Conclusion:Baseline data reinforce the need for stigma mitigation interventions, combined with enhanced linkage and retention to optimize HIV treatment. Preliminary results show high levels of HIV-related risk determinants and suggest the potential utility of the ISMI to decrease perceived stigma relating to engagement in HIV prevention, treatment, and care services among key populations in Senegal.

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“…6–8 However, when studied separately, there has been sustained HIV incidence and high HIV prevalence among key populations. 9 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

Lyons

Ketende

Diouf

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

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“…High incidence HIV epidemics among MSM are ongoing in the U.S., with marked severity among young and racial and ethnic minority MSM, and in countries as diverse as France, the UK, Thailand, China, Kenya, and Russia (2). Data from HIV bio-behavioral surveillance surveys and prospective studies that have measured incident infections among MSM confirm that these HIV epidemics cannot be understood at the individual level alone—even when personal risk is modest, lifetime acquisition probabilities can reach over 50% among men in high transmission settings (3).…”

Section: Introductionmentioning

confidence: 99%

Enhanced use of phylogenetic data to inform public health approaches to HIV among men who have sex with men

2017

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The multi-dimensional nature and continued evolution of HIV epidemics among men who have sex with men (MSM) requires innovative intervention approaches. Strategies are needed that recognize the individual, social, and structural factors driving HIV transmission; that can pinpoint networks with heightened transmission risk; and that can help target intervention in real-time. HIV phylogenetics is a rapidly evolving field with strong promise for informing innovative responses to the HIV epidemic among MSM. Currently, HIV phylogenetic insights are providing new understandings of characteristics of HIV epidemics involving MSM, social networks influencing transmission, characteristics of HIV transmission clusters involving MSM, targets for antiretroviral and other prevention strategies, and dynamics of emergent epidemics. Maximizing the potential of HIV phylogenetics for HIV responses among MSM will require attention to key methodological challenges and ethical considerations, as well as resolving key implementation and scientific questions. Enhanced and integrated use of HIV surveillance, socio-behavioral, and phylogenetic data resources are becoming increasingly critical for informing public health approaches to HIV among MSM.

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“…In fact, in some areas, the incidence of new HIV infections has increased in this group [4,9]. Young, high-risk women in southern Africa thus represent a ‘key population’ [99], with levels of HIV infection comparable to the highly vulnerable populations globally that are targeted for increased resources and intervention, such as male and female commercial sex workers, and men who have sex with men [10]. Sustained high HIV incidence in young women represents an enormous health disparity that requires appropriate interventions and resources, poses a threat to the well-being of the next generation, and is a critical factor driving the ongoing HIV epidemic in southern Africa [11].…”

Section: Introductionmentioning

confidence: 99%

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

et al. 2015

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Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 percent in South Africa, 23 percent in Botswana, 23 percent in Lesotho and 26.5 percent in Swaziland. Existing research has illuminated some of the key social, behavioral and structural factors associated with young women's disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships, and age disparities in relationships between younger women and older male partners. Important structural factors include the region's history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.

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A call to action for concentrated HIV epidemics

Cited by 24 publications

References 51 publications

Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

Enhanced use of phylogenetic data to inform public health approaches to HIV among men who have sex with men

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches

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