An Urgent Need for Integration of Family Planning Services Into HIV Care

Schwartz, Sheree; Papworth, Erin; Thiam-Niangoin, Marguerite; Kouamé, Abo; Dramé, Fatou Maria; Diouf, Daouda; Bamba, Amara; Ezouatchi, Rebecca; Tety, Josiane; Grover, Elise; Baral, Stefan

doi:10.1097/qai.0000000000000448

Cited by 83 publications

(49 citation statements)

References 28 publications

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“…Globally, MSM are disproportionately affected by HIV. In sub-Saharan Africa, MSM have an HIV prevalence four times that of heterosexual men 14. Stigma and discrimination against LGBTI individuals are common in Southern Africa,15 and same-sex practicing Africans living with HIV are known to be marginalised by HIV programmes, increasing the probability of premature death 16.…”

Section: Introductionmentioning

confidence: 99%

‘They will be afraid to touch you’: LGBTI people and sex workers' experiences of accessing healthcare in Zimbabwe—an in-depth qualitative study

et al. 2017

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ObjectivesTo examine experiences of key populations (lesbian, gay, bisexual, trans and intersex (LGBTI) people, men who have sex with men (MSM) and sex workers) in Zimbabwe regarding access to, and experiences of, healthcare.DesignQualitative study using in-depth interviews and focus groups, with thematic analysis.ParticipantsSixty individuals from key populations in Zimbabwe.SettingParticipants were recruited from four locations (Harare, Bulawayo, Mutare, Beitbridge/Masvingo).ResultsParticipants described considerable unmet needs and barriers to accessing basic healthcare due to discrimination regarding key population status, exacerbated by the sociopolitical/legal environment. Three main themes emerged: (1) key populations' illnesses were caused by their behaviour; (2) equal access to healthcare is conditional on key populations conforming to ‘sexual norms’ and (3) perceptions that healthcare workers were ill-informed about key populations, and that professionals' personal attitudes affected care delivery. Participants felt unable to discuss their key population status with healthcare workers. Their healthcare needs were expected to be met almost entirely by their own communities.ConclusionsThis is one of very few studies of healthcare access beyond HIV for key populations in Africa. Discrimination towards key populations discourages early diagnosis, limits access to healthcare/treatment and increases risk of transmission of infectious diseases. Key populations experience unnecessary suffering from untreated conditions, exclusion from healthcare and extreme psychological distress. Education is needed to reduce stigma and enhance sensitive clinical interviewing skills. Clinical and public health implications of discrimination in healthcare must be addressed through evidence-based interventions for professionals, particularly in contexts with sociopolitical/legal barriers to equality.

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Section: Introductionmentioning

confidence: 99%

‘They will be afraid to touch you’: LGBTI people and sex workers' experiences of accessing healthcare in Zimbabwe—an in-depth qualitative study

et al. 2017

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“…15,18 Many FSW become aware of their HIV infection as a result of opt out testing during pregnancy. 14,20,21 FSW commonly undergo voluntary HIV testing for frequent illness or deterioration of health. 14 To improve uptake of HIV care and treatment and prevent ongoing transmission, the barriers to HIV testing for FSW in sub-Saharan Africa must be delineated.…”

Section: Introductionmentioning

confidence: 99%

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

Lancaster

Lungu

et al. 2016

International Journal of Drug Policy

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Background HIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and marijuana use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. Methods From July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and marijuana use and lack of HIV infection awareness. Results Of the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose-response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current marijuana use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). Conclusion Increased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.

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“…IMIS’s initial sampling stage consisted of Latin hypercube sampling of 5 million parameter sets. Sets producing model predictions within prespecified constraints for the following outcomes were accepted: national HIV prevalence by sex and age groups [8,14,22], HIV prevalence among FSW [9,23–26], HIV prevalence among MSM by age [10], HIV prevalence among CFSW [27], and overall ART coverage from 2002 to 2014 [28–34]. Binomial likelihoods for HIV prevalence data were calculated by age group for both men and women in the general population and for FSW, CFSW, and MSM (by age group for the latter).…”

Section: Methodsmentioning

confidence: 99%

“…HIV prevalence in Côte d’Ivoire declined to 3.7% in 2011–2012 [8] but remains substantially higher among MSM and FSW [9,10], who are identified as key populations in the country’s most recent national strategic plan [11]. Yet, Côte d’Ivoire’s emphasis on ART scale-up has recently resulted in funding declines for condoms and prevention activities for key populations [3].…”

Section: Introductionmentioning

confidence: 99%

Population-level impact of an accelerated HIV response plan to reach the UNAIDS 90-90-90 target in Côte d’Ivoire: Insights from mathematical modeling

et al. 2017

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BackgroundNational responses will need to be markedly accelerated to achieve the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This target aims for 90% of HIV-positive individuals to be aware of their status, for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of those on treatment to have a suppressed viral load by 2020, with each individual target reaching 95% by 2030. We aimed to estimate the impact of various treatment-as-prevention scenarios in Côte d’Ivoire, one of the countries with the highest HIV incidence in West Africa, with unmet HIV prevention and treatment needs, and where key populations are important to the broader HIV epidemic.Methods and findingsAn age-stratified dynamic model was developed and calibrated to epidemiological and programmatic data using a Bayesian framework. The model represents sexual and vertical HIV transmission in the general population, female sex workers (FSW), and men who have sex with men (MSM). We estimated the impact of scaling up interventions to reach the UNAIDS targets, as well as the impact of 8 other scenarios, on HIV transmission in adults and children, compared to our baseline scenario that maintains 2015 rates of testing, ART initiation, ART discontinuation, treatment failure, and levels of condom use. In 2015, we estimated that 52% (95% credible intervals: 46%–58%) of HIV-positive individuals were aware of their status, 72% (57%–82%) of those aware were on ART, and 77% (74%–79%) of those on ART were virologically suppressed. Reaching the UNAIDS targets on time would avert 50% (42%–60%) of new HIV infections over 2015–2030 compared to 30% (25%–36%) if the 90-90-90 target is reached in 2025. Attaining the UNAIDS targets in FSW, their clients, and MSM (but not in the rest of the population) would avert a similar fraction of new infections (30%; 21%–39%). A 25-percentage-point drop in condom use from the 2015 levels among FSW and MSM would reduce the impact of reaching the UNAIDS targets, with 38% (26%–51%) of infections averted. The study’s main limitation is that homogenous spatial coverage of interventions was assumed, and future lines of inquiry should examine how geographical prioritization could affect HIV transmission.ConclusionsMaximizing the impact of the UNAIDS targets will require rapid scale-up of interventions, particularly testing, ART initiation, and limiting ART discontinuation. Reaching clients of FSW, as well as key populations, can efficiently reduce transmission. Sustaining the high condom-use levels among key populations should remain an important prevention pillar.

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An Urgent Need for Integration of Family Planning Services Into HIV Care

Cited by 83 publications

References 28 publications

‘They will be afraid to touch you’: LGBTI people and sex workers' experiences of accessing healthcare in Zimbabwe—an in-depth qualitative study

‘They will be afraid to touch you’: LGBTI people and sex workers' experiences of accessing healthcare in Zimbabwe—an in-depth qualitative study

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

Population-level impact of an accelerated HIV response plan to reach the UNAIDS 90-90-90 target in Côte d’Ivoire: Insights from mathematical modeling

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