Similar, but different: drivers of the disproportionate <scp>HIV</scp> and sexually transmitted infection burden of key populations

Mayer, Kenneth R.; Allan‐Blitz, Lao‐Tzu

doi:10.1002/jia2.25344

Cited by 19 publications

(11 citation statements)

References 58 publications

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“…Socio-behavioral risk factors for STIs in this group include low levels of education, not being married, multiple sex partners, alcohol and drug use, and early sexual debut [8][9][10][11]. Additionally, key populations such as men who have sex with men, transgender women, and commercial sex workers are at increased risk of STI acquisition [12,13].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study

et al. 2021

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Objectives Sexually transmitted infections (STIs) are a major cause of morbidity. Understanding drivers of transmission can inform effective prevention programs. We describe STI prevalence and identify factors associated with STIs in four African countries. Methods The African Cohort Study is an ongoing, prospective cohort in Kenya, Nigeria, Tanzania and Uganda. At enrollment, a physical exam was conducted and STI diagnosis made by a clinician using a syndromic management approach. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for factors associated with an STI diagnosis. Results As of June 2020, 3544 participants were enrolled. STI prevalence was 7.7% and did not differ by HIV status (p = 0.30). Prevalence differed by syndrome (3.5% vaginal discharge, 1.5% genital ulcer, 2.1% lower abdominal pain, 0.2% inguinal bubo). The odds of having an STI were higher at all sites compared to Kisumu West, Kenya, and among those with a primary level education or below compared to those with secondary or higher (aOR: 1.77; 95% CI: 1.32–2.38). The odds of an STI diagnosis was higher among participants 18–29 years (aOR: 2.29; 95% CI: 1.35–3.87), females (aOR: 2.64; 95% CI: 1.94–3.59), and those with depression (aOR: 1.78; 95% CI: 1.32–2.38). Among PLWH, similar factors were independently associated with an STI diagnosis. Viral suppression was protective against STIs (aOR: 2.05; 95% CI: 1.32–3.20). Conclusions Prevalence of STIs varied by site with young people and females most at risk for STIs. Mental health is a potential target area for intervention.

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Section: Introductionmentioning

confidence: 99%

Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study

et al. 2021

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“…KP programmes – particularly in Africa – have long struggled to meet and maintain the same ARV treatment, retention and viral suppression rates, and countries with high adult HIV prevalence are experiencing a concentration of HIV infections among KPs [2,3]. Significant barriers such as stigma, discrimination, criminalization, violence, unfriendly healthcare workers, lack of specialized services and state‐sanctioned policies undermine access to healthcare services for KPs [4,5]. Deconstructing these barriers is critical to provide quality HIV services for all and close the inequity gap between health services delivered to KPs and those delivered to other populations.…”

Section: Introductionmentioning

confidence: 99%

Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy

et al. 2021

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Introduction The United States President’s Emergency Plan for AIDS Relief (PEPFAR) is a large bilateral funder of the global HIV response whose policy decisions on key populations (KPs) programming determine the shape of the key populations’ response in many countries. Understanding the size and relative share of PEPFAR funds going to KPs and the connection between PEPFAR’s targets and resulting programming is crucial for successfully serving key populations. Methods Publicly available PEPFAR budgets for key populations’ services were assessed by country and geographical region for all 52 countries with budget data in fiscal year (FY) 2020. For the 23 countries which completed a full planning process in FY 2018 and 2019, PEPFAR targets for HIV testing and treatment initiation for key populations were assessed. Expenditures for KP programming were calculated to determine whether shifts in targets translated into programming. Implementing partners were characterized by the level of specialization using the share of assigned targets made up by KPs. The average target per year and implementing partner was calculated for each KP group and indicator. Results PEPFAR country KP budgets ranged from US$35,000 to $15.2 million, and the proportion of funding to key populations varied by region, with Eastern and Southern African countries having the lowest proportion. Between FY 2018 and 2019, the KP targets for HIV testing and treatment among KPs increased, whereas expenditures on key populations decreased from US$115.4 to $111.0 million. Of the 11 countries with an increase in HIV testing targets, seven had a decrease in KP expenditures. Of the nine countries with an increase in treatment initiation targets, five had a decrease in KP expenditures. The proportion of targets assigned to partners which do not specialize in key populations increased from FY 2018 to 2019. Conclusions Current key population policies have not resulted in a tight connection between targets and expenditures. This includes assigning a large proportion of key populations programming to partners who do not specialize in key populations, which may weaken the performance management role of the targets. These results signal that a new approach to key populations programming is needed.

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“…Insofar, it is noteworthy that in recent years, many comments have called for these OPH rules to be implemented in order to curb the ongoing spread of HIV and other STIs, which means a return to established rules.Most of the issues listed below have been selected from the references listedunder References, but are not cited here again.Preliminary remarks: We would like to note that only the combination of various measures related to specific situations may be helpful to reach the curb-ing of the HIV epidemic[111] [112][113]. There is also a complex need to adapt and implement current prevention campaigns to address the overlapping vulnerabilities of various at-risk key populations in modern societies[114] [115].Without a preventive vaccination, the vision "End of AIDS" remains questionable.1) HIV testing: People living unaware with their HIV infection present an unmanageable potential to keep upright, at least regional HIV epidemics; a multitude of benefits may result when reaching these people for testing for HIV and other STIs; this approach can help to reduce those who currently present with a late HIV diagnosis, late presenters[116]. The goal is to help them get treatment and link them to the respective healthcare services in the context of the TASP concept and medical service for acute and persistent health problems[117].…”

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confidence: 99%

HIV Prevention Concepts—Counter Movements Challenging Societies

Dennin¹,

Sinn²

2020

WJA

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This article focuses on emerging trends conflicting current HIV prevention concepts. We address developments in Europe where similar HIV prevention strategies are applied. With epidemiological, time-staggered records from a European institution, we show how ineffective HIV prevention measures have turned out. The decision-makers responsible for these prevention concepts have ignored a multitude of individual motivations from people responsible for the spread of HIV. Both the legal classification of the messages of the prevention campaigns and the obligations of those affected by HIV concerning their social responsibility are analyzed. There are published requirements for updated, multisectoral prevention campaigns. They focus on the intensification of HIV testing concepts to reduce the proportion of late presenters and to link key populations of various kinds to medical and social care services. Four categories present relevant issues with the potential to combine them into suitable arrangements for new prevention concepts.

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Similar, but different: drivers of the disproportionate HIV and sexually transmitted infection burden of key populations

Cited by 19 publications

References 58 publications

Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study

Factors associated with sexually transmitted infections among care-seeking adults in the African Cohort Study

Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy

HIV Prevention Concepts—Counter Movements Challenging Societies

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