PEPFARʼs Evolving HIV Prevention Approaches for Key Populations—People Who Inject Drugs, Men Who Have Sex With Men, and Sex Workers

2012 ◽  
Vol 60 ◽  
pp. S145-S151 ◽  
Author(s):  
Richard Needle ◽  
Joe Fu ◽  
Chris Beyrer ◽  
Virginia Loo ◽  
Abu S. Abdul-Quader ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sex Workers ◽  
People Who Inject Drugs ◽  
Key Populations ◽  
Sex With Men

'Getting to zero' in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 107 ◽  
Author(s):  
Michael M. Cassell ◽  
Timothy H. Holtz ◽  
Mitchell I. Wolfe ◽  
Michael Hahn ◽  
Dimitri Prybylski
Keyword(s):  
Hiv Prevention ◽  
Hiv Testing ◽  
Sex Workers ◽  
Population Level ◽  
Hiv Infections ◽  
Asia Pacific ◽  
Key Populations ◽  
Data Systems ◽  
Treatment Access ◽  
Sex With Men

Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of ‘zero new HIV infections’ without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. Low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved ‘cascade’ data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.

scholarly journals High levels of used syringe use and unsafe sex among people who inject drugs in Kumasi, Ghana: an urgent call for a comprehensive harm reduction approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Lisa J. Messersmith ◽  
Rose Adjei ◽  
Jennifer Beard ◽  
Angela R. Bazzi ◽  
Joel J. Earlywine ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Population Size ◽  
Sex Workers ◽  
People Who Inject Drugs ◽  
Syringe Sharing ◽  
Unsafe Sex ◽  
Lack Of Information ◽  
Sex With Men ◽  
Major Drug

Abstract Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

Understanding the Social Influences on Engaging Key Populations With HIV Prevention: A Qualitative Study With Men Who Have Sex With Men in Three Indonesian Cities

2019 ◽  
Vol 31 (3) ◽  
pp. 206-223 ◽  
Author(s):  
Elan Lazuardi ◽  
Christy E. Newman ◽  
Irma Anintya Tasya ◽  
Emily Rowe ◽  
D. N. Wirawan ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Service Access ◽  
Key Populations ◽  
Social Dimensions ◽  
Structured Interviews ◽  
Outreach Workers ◽  
Hiv Prevention Strategies ◽  
The Social ◽  
Sex With Men ◽  
The Many

The globally recognized test and treat approach underpins Indonesian national strategies to reduce and prevent HIV among key populations, including men who have sex with men. More comprehensive understanding of how engagement with HIV prevention is shaped by social and community practices will support these efforts. Between 2015 and 2016, focus groups and semi-structured interviews were conducted with 54 men who have sex with men in three urban settings in Indonesia to elicit their views on, and experiences of, HIV prevention and care. Focused on data relating to testing, findings documented the important influence of informal peer networks, community-based organizations and outreach workers. Some social dimensions of service access complicated this, particularly fear of stigma or lack of confidentiality in large service settings. The many differences between men challenges assumptions that a single set of HIV prevention strategies will work to engage all men who have sex with men living in Indonesia.

HIV non-occupational postexposure prophylaxis (nPEP) usage among five key populations in China

2021 ◽  
pp. sextrans-2020-054791
Author(s):  
Haochu Li ◽  
Ran Wei ◽  
Eduardo Piqueiras ◽  
Eric P F Chow ◽  
Kedi Jiao ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Prevention ◽  
Sex Workers ◽  
People Who Use Drugs ◽  
Key Populations ◽  
Multiple Use ◽  
Postexposure Prophylaxis ◽  
Cross Sectional ◽  
Prevention Services ◽  
Behavioural Factors

ObjectivesTo examine the feasibility of non-occupational postexposure prophylaxis (nPEP) as a national strategy for HIV prevention in China, we investigated nPEP usage and related sociodemographic and behavioural factors among five key populations at high risk of contracting HIV.MethodsWe conducted a cross-sectional study among five key populations from November 2018 to September 2019 in China using convenience sampling to recruit participants aged ≥18 years, self-reporting HIV status as either negative or unknown and providing written informed consent. Univariable and multivariable logistic regression models were fitted.ResultsOur analysis included data from 2022 participants with a mean age of 35 years (SD=11.62). Only 57 (2.82%) participants had ever used nPEP. Sociodemographic and behavioural factors related to nPEP usage included populations (p<0.0001), age (p<0.05), education (p<0.05), nPEP knowledge (p<0.01), receiving conventional HIV prevention services (p<0.05) and HIV testing (p<0.05). A significant percentage (26%) of nPEP users used nPEP medication more than once. Challenges and concerns, such as multiple use of nPEP and syndemic conditions, were emerging.ConclusionsKey populations in China had low nPEP usage rates. Female sex workers, people who use drugs, older and illiterate individuals with poor nPEP knowledge, not using HIV prevention services or never tested for HIV should be emphasised. Implementing nPEP services would be an important way to access high-risk individuals for intensive and tailored HIV prevention and intervention. Challenges of providing nPEP services and future study foci are highlighted.

scholarly journals Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study (Preprint)

2019 ◽  
Author(s):  
Priyanka Rani Garg ◽  
Leena Uppal ◽  
Sunil Mehra ◽  
Devika Mehra
Keyword(s):  
Cohort Study ◽  
Hiv Prevention ◽  
Mobile Health ◽  
Drug Users ◽  
Transgender Women ◽  
Asia Pacific ◽  
People Who Use Drugs ◽  
Key Populations ◽  
Sex With Men ◽  
Self Learning

BACKGROUND Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. OBJECTIVE The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. METHODS A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. RESULTS From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (<i>P</i>=.004), transgender women (<i>P</i>&lt;.001), and people who use drugs (<i>P</i>&lt;.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (<i>P</i>=.45), transgender women (<i>P</i>=.25), and people who use drugs (<i>P</i>&lt;.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; <i>P</i>=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. CONCLUSIONS This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV.

scholarly journals Peer Recruitment Strategies for Female Sex Workers Not Engaged in HIV Prevention and Treatment Services in Côte d’Ivoire: Program Data Analysis

10.2196/18000 ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. e18000
Author(s):  
Oluwasolape Olawore ◽  
Hibist Astatke ◽  
Tiffany Lillie ◽  
Navindra Persaud ◽  
Carrie Lyons ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Cote D'ivoire ◽  
Sex Workers ◽  
Côte D’Ivoire ◽  
Key Populations ◽  
Cote D’Ivoire ◽  
Female Sex ◽  
Côte D'ivoire ◽  
Prevention And Treatment ◽  
Peer Outreach

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.

Trends in HIV prevalence among people injecting drugs, men having sex with men, and female sex workers in Ukraine

2018 ◽  
Vol 29 (13) ◽  
pp. 1337-1344 ◽  
Author(s):  
Kostyantyn Dumchev ◽  
Yana Sazonova ◽  
Tetiana Salyuk ◽  
Olga Varetska
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
People Who Inject Drugs ◽  
Hiv Prevalence ◽  
New Wave ◽  
Female Sex ◽  
Hiv Epidemic ◽  
Nationally Representative ◽  
Sex With Men ◽  
Generation Surveillance

Once recognized as the most severe in Europe, the HIV epidemic in Ukraine is concentrated among people who inject drugs, men who have sex with men, and female sex workers. Integrated biobehavioral surveys, as a part of the second generation surveillance, are used to monitor HIV infection trends in key populations since 2002. The present paper is focused on the analysis of HIV prevalence trends in four nationally representative rounds of integrated biobehavioral surveys from 2008/9, 2011, 2013, and 2015 in people who inject drugs, men who have sex with men, and female sex workers. Between 2008/9 and 2015, the HIV prevalence has decreased significantly in people who inject drugs (24.2 to 22.0%) and female sex workers (13.6 to 6.3%), while the change in men who have sex with men was not significant (8.5 to 7.8%). There was a significant increase in people who inject drugs and men who have sex with men between 2013 and 2015. In subgroups younger than 25 years, prevalence increased more than twofold in men who have sex with men (1.9 to 4.3%), with no changes in people who inject drugs and female sex workers. The observed decline in prevalence, especially in young subgroups, may result from the effect of extensive prevention efforts on drug injection-related transmission. Recent increase in young men who have sex with men may be a sign of a new wave of the epidemic in this group.

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